Abstract
Background
The NHS Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing Type-2 Diabetes Mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH). How this programme affects inequalities by age, sex, limiting illnesses or disability, ethnicity, or deprivation is not known.
Methods
We used multinomial and binary logistic regression models to compare whether the population with NDH at different stages of the programme are representative of the population with NDH: stages include (i) prevalence of NDH [using survey data from UK Household Longitudinal Study (N=794) and Health Survey for England (N=1,383)]; (ii) identification in primary care and offer of programme [using administrative data from the National Diabetes Audit (N=1,267,350)]; and (iii) programme participation [using programme provider records (N=98,024)]).
Results
Predicted probabilities drawn from the regressions with demographics as each outcome and dataset identifier as predictors showed that younger adults (aged under 40) [4% of the NDH population (95% CIs 2.4%-6.5%)] and older adults (aged 80 and above) [12% (95%CIs 9.5%-14.2%)] were slightly underrepresented amongst programme participants [2% (95%CIs 1.8%-2.2%) and 8% (95%CIs 7.8%-8.2%) of programme participants, respectively]. People living in deprived areas were under-represented in 8 sessions [14% (95% CIs 13.7%-14.4%) vs 20% (95%CIs 16.4%-23.6%) in the general population]. Ethnic minorities were overrepresented among offers [35% (95%CIs 35.1%-35.6%) vs 13% (95%CIs 9.1%-16.4%) in general population], though the proportion dropped at the programme completion stage [19% (95%CI 18.5%-19.5%)].
Conclusion
The DPP has the potential to reduce ethnic inequalities, but may widen socioeconomic, age, and limiting illness or disability related inequalities in T2DM. Whilst ethnic minority groups are over-represented at the identification and offer stages, efforts are required to support completion of the programme. Programme providers should target underrepresented groups to ensure equitable access and narrow inequalities in T2DM.
The NHS Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing Type-2 Diabetes Mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH). How this programme affects inequalities by age, sex, limiting illnesses or disability, ethnicity, or deprivation is not known.
Methods
We used multinomial and binary logistic regression models to compare whether the population with NDH at different stages of the programme are representative of the population with NDH: stages include (i) prevalence of NDH [using survey data from UK Household Longitudinal Study (N=794) and Health Survey for England (N=1,383)]; (ii) identification in primary care and offer of programme [using administrative data from the National Diabetes Audit (N=1,267,350)]; and (iii) programme participation [using programme provider records (N=98,024)]).
Results
Predicted probabilities drawn from the regressions with demographics as each outcome and dataset identifier as predictors showed that younger adults (aged under 40) [4% of the NDH population (95% CIs 2.4%-6.5%)] and older adults (aged 80 and above) [12% (95%CIs 9.5%-14.2%)] were slightly underrepresented amongst programme participants [2% (95%CIs 1.8%-2.2%) and 8% (95%CIs 7.8%-8.2%) of programme participants, respectively]. People living in deprived areas were under-represented in 8 sessions [14% (95% CIs 13.7%-14.4%) vs 20% (95%CIs 16.4%-23.6%) in the general population]. Ethnic minorities were overrepresented among offers [35% (95%CIs 35.1%-35.6%) vs 13% (95%CIs 9.1%-16.4%) in general population], though the proportion dropped at the programme completion stage [19% (95%CI 18.5%-19.5%)].
Conclusion
The DPP has the potential to reduce ethnic inequalities, but may widen socioeconomic, age, and limiting illness or disability related inequalities in T2DM. Whilst ethnic minority groups are over-represented at the identification and offer stages, efforts are required to support completion of the programme. Programme providers should target underrepresented groups to ensure equitable access and narrow inequalities in T2DM.
| Original language | English |
|---|---|
| Journal | Journal of Epidemiology & Community Health |
| DOIs | |
| Publication status | Published - 23 Jun 2023 |
Keywords
- Type 2 Diabetes Mellitus
- Non-diabetic hyperglycaemia
- health inequalities
- behavioural interventions
