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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

Authors

Adrian Heald

David Holland

Christopher J Duff

Jonathan Scargill

Fahmy Hanna



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.

Citation

Heald, A., Holland, D., Duff, C. J., Scargill, J., Hanna, F., & Fryer, A. (2022, November). Health Inequality and its link to HbA1c Test Recovery in a Developed Health Economy: In a 'Nearly Post COVID-19' World. Poster presented at Society for Endocrinology BES 2022, Harrogate, United Kingdom

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