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. 2019 Dec 31:11:1081-1088.
doi: 10.2147/CLEP.S227621. eCollection 2019.

Ethnic Differences in the Prevalence of Type 2 Diabetes Diagnoses in the UK: Cross-Sectional Analysis of the Health Improvement Network Primary Care Database

Tra My Pham  1   2 , James R Carpenter  1   3 , Tim P Morris  1 , Manuj Sharma  2 , Irene Petersen  2   4
Affiliations

Ethnic Differences in the Prevalence of Type 2 Diabetes Diagnoses in the UK: Cross-Sectional Analysis of the Health Improvement Network Primary Care Database

Tra My Pham et al. Clin Epidemiol. .

Abstract

Aims/hypothesis: Type 2 diabetes mellitus is associated with high levels of disease burden, including increased mortality risk and significant long-term morbidity. The prevalence of diabetes differs substantially among ethnic groups. We examined the prevalence of type 2 diabetes diagnoses in the UK primary care setting.

Methods: We analysed data from 404,318 individuals in The Health Improvement Network database, aged 0-99 years and permanently registered with general practices in London. The association between ethnicity and the prevalence of type 2 diabetes diagnoses in 2013 was estimated using a logistic regression model, adjusting for effect of age group, sex, and social deprivation. A multiple imputation approach utilising population-level information about ethnicity from the UK census was used for imputing missing data.

Results: Compared with those of White ethnicity (5.04%, 95% CI 4.95 to 5.13), the crude percentage prevalence of type 2 diabetes was higher in the Asian (7.69%, 95% CI 7.46 to 7.92) and Black (5.58%, 95% CI 5.35 to 5.81) ethnic groups, while lower in the Mixed/Other group (3.42%, 95% CI 3.19 to 3.66). After adjusting for differences in age group, sex, and social deprivation, all minority ethnic groups were more likely to have a diagnosis of type 2 diabetes compared with the White group (OR Asian versus White 2.36, 95% CI 2.26 to 2.47; OR Black versus White 1.65, 95% CI 1.56 to 1.73; OR Mixed/Other versus White 1.17, 95% CI 1.08 to 1.27).

Conclusion: The prevalence of type 2 diabetes was higher in the Asian and Black ethnic groups, compared with the White group. Accurate estimates of ethnic prevalence of type 2 diabetes based on large datasets are important for facilitating appropriate allocation of public health resources, and for allowing population-level research to be undertaken examining disease trajectories among minority ethnic groups, that might help reduce inequalities.

Keywords: electronic health records; ethnicity; missing not at random; multiple imputation; primary care database; type 2 diabetes.

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Conflict of interest statement

TMP was supported by the National Institute for Health Research (NIHR) School for Primary Care Research (project number 379), and awards to establish the Farr Institute of Health Informatics Research, London, from the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, NIHR, National Institute for Social Care and Health Research, and Wellcome Trust (grant MR/K006584/1). TMP, JRC, and TPM were supported by the Medical Research Council (grant numbers MC_UU_12023/21 and MC_UU_12023/29). Not in relation to this project, JRC received personal fees from Pfizer, GSK, and grants from AstraZeneca, and IP and MS received funding from Novo Nordisk A/S. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Figures

Figure 1
Figure 1
Flowchart of the inclusion criteria for study sample. Note: Adapted from Pham TM, Carpenter JR, Morris TP, Wood AM, Petersen I. Population-calibrated multiple imputation for a binary/categorical covariate in categorical regression models. Stat Med. 2019;38(5):792–808. doi:10.1002/sim.8004. Creative Commons license and disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode. Abbreviation: THIN, The Health Improvement Network.
Figure 2
Figure 2
Association between type 2 diabetes diagnosis and ethnic group, both crude (grey circles) and adjusted for sex, age group, and deprivation status (black circles) under calibrated-δ adjustment multiple imputation, n=404,318, m=30 imputations. Hollow circles: the White ethnic group was set as the reference category for ethnicity. Abbreviation: CI, confidence interval.
See this image and copyright information in PMC

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