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Ethnic differences in prescribing and effectiveness of medication for hypertension, lipid-lowering and type 2 diabetes

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). Green open access

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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.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Ethnic differences in prescribing and effectiveness of medication for hypertension, lipid-lowering and type 2 diabetes
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine > MRC Unit for Lifelong Hlth and Ageing
URI: https://discovery.ucl.ac.uk/id/eprint/10185738
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