Eastwood, Sophie Victoria; (2024) Ethnic differences in prescribing and effectiveness of medication for hypertension, lipid-lowering and type 2 diabetes. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

People of UK South Asian and African/ African Caribbean ethnicity experience excess stroke, type 2 diabetes complications and coronary heart disease (for South Asian groups), compared to people of European ethnicity. Pharmacological lowering of blood pressure, blood glucose and cholesterol are the three cornerstones of CVD primary prevention. Treatments lower cardiovascular disease risk effectively, are well-established and among the most used medications in UK primary care. Yet to date, evidence on ethnic differences in prescribing of cardiovascular preventative medication or risk factor control, which may contribute to inequities in downstream disease, has been limited and conflicting. Using a nationally-representative database of UK primary care records, three observational retrospective cohort studies aimed to investigate ethnic differences in: a) hypertension management and their contribution to blood pressure (BP) control in 731,506 people with hypertension, b) glycaemic trajectories in the five years after glucose-lowering therapy initiation for 61,981 people with type 2 diabetes and c) guideline-indicated statin initiation for 27,511 people with type 2 diabetes. Statistical methods included time-to-event analysis, linear/ logistic/ negative binomial/ Cox regression techniques and mixed effects modelling for repeated measures. Whilst antihypertensive initiation was earlier in people of South Asian and African/ African Caribbean ethnicity with hypertension than those of European ethnicity, blood pressure control at one year after antihypertensive initiation was 20% less likely in people of African/ African Caribbean than South Asian or European ethnicity (chapter 3). More unfavourable glycaemic trajectories in the first five years of glucose-lowering therapy were present for people of African/ African Caribbean ethnicity than those of European or South Asian ethnicity, partly explained by their higher baseline HbA1c (chapter 4). People of South Asian and African/ African Caribbean ethnicity with type 2 diabetes were 25% and 10% respectively less likely to be prescribed a guideline-indicated statin than people of European ethnicity (chapter 5). In summary, important ethnicity-related inequalities in prescribing cardiovascular preventative therapy and risk factor control were identified, particularly for the African/ African Caribbean groups. The work from this thesis will enable improved targeting of future interventions tackling ethnic inequity in cardiometabolic disease management. Policy initiatives tackling these are imperative to address the downstream excess of cardiovascular disease and diabetes complications in this group.

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