Ethnic disparities in quality of diabetes care in Scotland: A national cohort study

Aims The aim of this study is to compare quality of diabetes care in people with type 2 diabetes by ethnicity, in Scotland. Methods Using a linked national diabetes registry, we included 162,122 people newly diagnosed with type 2 diabetes between 2009 and 2018. We compared receipt of nine guideline indicated processes of care in the first‐year post‐diabetes diagnosis using logistic regression, comparing eight ethnicity groups to the White group. We compared annual receipt of HbA1c and eye screening during the entire follow‐up using generalised linear mixed effects. All analyses adjusted for confounders. Results Receipt of diabetes care was lower in other ethnic groups compared to White people in the first‐year post‐diagnosis. Differences were most pronounced for people in the: African, Caribbean or Black; Indian; and other ethnicity groups for almost all processes of care. For example, compared to White people, odds of HbA1c monitoring were: 44% lower in African, Caribbean or Black people (OR 0.56 [95% CI 0.48, 0.66]); 47% lower in Indian people (OR 0.53 [95% CI 0.47, 0.61]); and 50% lower in people in the other ethnicity group (OR 0.50 [95% CI 0.46, 0.58]). Odds of receipt of eye screening were 30%–40% lower in most ethnic groups compared to the White group. During median 5 year follow‐up, differences in HbA1c monitoring and eye screening largely persisted, but attenuated slightly for the former. Conclusions There are marked ethnic disparities in routine diabetes care in Scotland in the short‐ and medium‐term following diabetes diagnosis. Further investigation is needed to establish and effectively address the underlying reasons.