Health Inequality and its link to HbA1c Test Recovery in a Developed Health Economy: In a 'Nearly Post COVID-19' World

Heald, Adrian; Holland, David; Duff, Christopher J; Scargill, Jonathan; Hanna, Fahmy; Fryer, Anthony

Abstract

Background: We previously showed that in first 6 months of the UK Covid-19(C19) pandemic >6.6million HbA1c tests were missed, including 1.4million in people with diabetes(DM). Furthermore, C19 more significantly impacts people with DM / socioeconomically disadvantaged individuals.

Aim: To examine variability in recovery rate of HbA1c testing, and links to demographics, including deprivation status.

Methods: We examined HbA1c tests across 7 UK sites (570 general practices; 4.57m population) between Oct-2017 and Dec-2021. We compared monthly tests during 4 periods: Apr-Jun2020 (C19 Impact Period; CIP1), Jul-Dec2020 (Inter-Lockdown Recovery; ILR), Jan-Feb2021 (CIP2) and Mar-Dec2021 (Post-Lockdown Recovery; PLR), with the equivalent period in 2019. We then examined effect of practice size/diabetes prevalence/proportion aged>65 years and deprivation score.

Results: For all 7 centres, monthly requests dropped by 85.2-89.4% of the mean monthly 2019 request numbers in Apr-2020. During the following 3 periods, degree of recovery showed greater variability between centres (ILR: 74.0-93.2%, CIP2: 78.6-94.2%, PLR: 89.0-105.7%). No link between age/practice size/diabetes prevalence and post-pandemic recovery was seen. Return to pre-pandemic levels during the two recovery periods was associated with deprivation status. Compared with equivalent pre-pandemic periods, HbA1c testing during the PLR period was lower in higher deprivation areas (deciles 6-10: 91.3-93.5% of 2019 levels) than those with lower deprivation (deciles 1-5:96.2-99.7% of 2019 levels; P<0.001). Similar findings were noted for the ILR period: deprivation deciles 6-10 were 79.2-82.6% of 2019 levels compared with 83.8-88.9% for deciles 1-5 (P<0.001). This trend was not evident during CIP1/CIP2. UK-wide, these account for ~582,000 and ~358,000 additional missed tests during the ILR and PLR periods in areas at greatest social disadvantage.

Conclusions: C19 continues to have a major impact on diabetes management/HbA1c testing with some centres yet to return to pre-pandemic testing levels. This appears most significant in areas of greatest socio-economic deprivation.

• Presentation Conference Type: Poster
• Conference Name: Society for Endocrinology BES 2022
• Conference Location: Harrogate, United Kingdom
• Start Date: Nov 14, 2022
• End Date: Nov 16, 2022
• Deposit Date: Oct 5, 2023
• DOI: https://doi.org/10.1530/endoabs.86.p75
• Keywords: General Medicine
• Publisher URL: https://www.endocrine-abstracts.org/ea/0086/ea0086p75