Socioeconomic inequalities in the quality of care for long-term conditions in England: retrospective, observational study of electronic primary care records from the Clinical Practice Research Datalink.

BACKGROUND

Variation in primary care quality across social groups contributes to health inequalities. We examined achievement rates for quality-of-care indicators among patients attending primary care practices in England, comparing rates for patients living in the most and least deprived areas.

METHODS

We analysed electronic health records from 2.2 million patients in 2019/2020, registered with 300 practices contributing to the Clinical Practice Research Datalink (CPRD) Aurum database. Patients were grouped by neighbourhood deprivation using the 2019 Index of Multiple Deprivation. We assessed inequality in 35 quality-of-care indicators from the Quality and Outcomes Framework pay-for-performance scheme for 607 126 patients with a relevant long-term condition, calculating differences in (a) age-sex adjusted achievement rates (overall inequality) and (b) rates further adjusted for common practice fixed effects (within-practice inequality) obtained by logistic regression. Rates were calculated for all patients with relevant conditions (population achievement) and the subset not excluded from the scheme by practices (reported achievement).

RESULTS

There was no consistent socioeconomic pattern in reported achievement of individual indicators overall (across all practices), but within-practice reported achievement was significantly lower for patients in more deprived areas for eight indicators. Population achievement was significantly lower for patients in more deprived areas for 13 indicators, reflecting higher exclusion rates. Population achievement was higher in more deprived areas for one indicator. The largest inequalities were for influenza vaccination (chronic obstructive pulmonary disease and stroke) and haemoglobin A1c (HbA1c) control (diabetes).

CONCLUSION

Within the same practice, patients from more deprived areas are less likely to receive recommended care for key quality of care indicators.