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Research

Health Inequalities Programme

The CEG team has a number of related themes within this programme.  The research work builds on the high level of ethnicity recording in east London general practice, which allows us to examine differences in chronic disease prevalence and management in the socially diverse environment of east London.

Projects include:

1. Tower Hamlets Health Equity Project 2007-11

This project builds on current work in CEG which aims to improve the delivery of chronic disease management (CDM) in primary care.  We focus on ischaemic heart disease (IHD), chronic obstructive pulmonary disorder (COPD) and diabetes, as these are the major chronic diseases in Tower Hamlets.  The project is funded by the Health Foundation.  http://www.health.org.uk/ 

The project had two work streams:

1. Provision of two annual health equity audits for each of the 36 practices in Tower Hamlets, with practice based facilitation to implement the audit findings.

2. Linking GP practices with self-management programmes for chronic disease management.  http://www.shaw-theatre.com/

These interventions aim to improve practitioner recognition and understanding of health inequalities, and encourage greater self management skills among people with chronic disease.  The project reports and the project conference presentations can be accessed below: 

• PCT Health Equity Summary report - Final - December 2010 
• Health Equity final report 2010 v6 long report 
• PCT Health Equity final full report 2010 Appendix

Conference Presentations - July 2010

• Health Inequalities in East London: Dr.Somen Banerjee 
• Intro and Project Overview Reducing Health Inequalities in Chronic Disease: Dr.Sally Hull 
• The success of ethnicity recording in primary care: Dr.Kambiz Boomla
• Health Equity Project main results: Dr.Sally Hull and Ellena Badrick 
• Reducing inequalities Self Management Course evaluation: Dr.Sharmin Shajahan and Ellena Badrick
• Investigating cardiovascular multimorbidity in east London: Rohini Mathur
• The effect of ethnicity on diabetes, hypertension and chronic kidney disease: Dr. Gavin Dreyer

Further work on this project includes:

• A 'health equity dashboard' across east London to be developed with the new commissioning organisations
• A report to examine health inequalities among disadvantaged groups (serious mental illness and learning disabilities) with diabetes and CVD.

Related Publications:
Hull SA, Mathur R, Badrick E, Robson J, Boomla K.  Recording ethnicity in primary care: assessing the methods and impact.  British Journal of General Practice 2011; 61:290-294

Mathur R, Hull SA, Badrick E, Robson J. Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management. British Journal of General  Practice 2011; 61:262-270

Mathur R, Hunter S, Badrick E, Hull SA, Boomla K, Bremner S, Robson J. Prescribing in general practice for people with coronary heart disease; equity by age, sex, and ethnic group.  Ethnicity and Health 2011; 16:107-123

Hull SA. Health inequalities: affects the health of all. British Journal of General Practice (editorial)  2010, 579: 797-8

Hull SA, Rivas C, Bobby J, Boomla K, Robson J. Hospital data may be more accurate than census data in estimating the ethnic composition of general practice populations.  Primary Care Informatics, 2009, Vol 17(2) 67-78

2010 Hull SA. Dreyer G, Yaqoob.
Collection of data on race and ethnic group in physician practices. New Engl.J. Med 363:1 July 1, 2010 (letter)
Robson J, Hull SA, Mathur R.  Cardiovascular  Risk in vulnerable Groups.  Health Equity Report - Cardiovascular Risk in Vulnerable Groups

2. Chronic Kidney Disease in east London populations

Working with partners in the renal department at BLT to identify differences by ethnicity in prevalence, progression and management of CKD in hypertensive and diabetic populations in east London.

Related Publications:
Dreyer G, Hull SA,  Aitken Z, Chessor A, Yaqoob M
How does ethnicity affect the prevalence and management of CKD among diabetics in east London. Quarterly Journal of Medicine, 2009; 102(4):261-9

Hull SA, Dreyer G, Badrick E, Chessor A, Yaqoob MM. The relationship of ethnicity to the prevalence and management of hypertension and associated chronic kidney disease.  (in press)

Cardiovascular Disease and Diabetes Programme

Projects which provide evidence and support to improve chronic disease management in primary care:

1. HILO

Working with partners in the cardiac department at BLT, this is a trial to compare different methods of improving primary care management of hypertension.

Collier DJ, Robson J, Scott R, Will CM, Eldridge SE, Griffiths CJ, Badrick E, Saxena M, Richards S, Caulfield MJ. HiLo: a health services intervention study: methods and interim results on the first 2000 patients at 1 year. J Hum Hypertens 2010; 24::708-709

2. QRISK

We have worked with Prof J Hippisley-Cox, University of Nottingham to develop a risk score identifying the risk of cardiovascular events. This uses a national dataset, QResearch, based on primary care data. The score is the first to take account of ethnic and socioeconomic diversity in England. It is used throughout England and Wales as part of the NHS Health Checks programme aiming to cover 20 million people and has attracted international interest.

Related publications:
Hippisley-Cox J, Coupland C, Robson J, Sheikh A, Brindle P. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore.
BMJ. 2009;338:b880. doi: 10.1136/bmj.b880.

Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation
of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ  335:136.

Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Brindle P. The performance of the QRISK cardiovascular risk prediction algorithm in an external UK sample of patients from general  practice: a validation study. Heart. 2008; 94: 34-9.

3. Identifying atrial fibrillation, managing the risk of stroke

In people with atrial fibrillation the CHADSVASC scoring system identifies their risk of a stroke and HAS-BLED identifies their risk of bleeding. These scores assist the clinical decision to prescribe anticoagulant drugs. We are developing a computer tool to help all east London practices identify patients who may benefit from anticoagulation.
In addition we are working with colleagues in South London to examine the effect of ethnicity and social deprivation on the prevalence and management of atrial fibrillation.

4. Diabetes

East London has one of the highest rates of type 2 diabetes in the UK, closely associated with density of local South Asian and Black African/Caribbean populations.

We have been involved in the development of the QDScore, a new diabetes risk score which predicts the risk of developing diabetes in the next 5-10 years.

With QMUL colleagues we have conducted a systematic review of diabetes risk scoring systems.
Using the QD score we are geographically mapping the risk of diabetes across east London. Descriptive statistics will identify the distribution of diabetes risk in different population subgroups, with the future aim of implementing preventive strategies and targeting intervention.

Other projects will explore the effect of ethnicity and social deprivation on the effectiveness of medications on diabetes outcomes.

Related publications:
Noble D,  Mathur R,  Meads C,  Dent T,   Greenhalgh P. “A statistical feast but an impact famine: Systematic review of risk scores for type 2 diabetes”, British Medical Journal, under review

Ethnic disparity in glycaemic control in type 2 diabetes 2004-9: The effect of social deprivation G. James, E. Badrick, R. Mathur, P. Baker, S. Hull, J. Robson. Submitted Aug 2011

Treatment and ethnic group influences on control of glycated haemoglobin in type 2 diabetes. G. James,  E. Badrick, R. Mathur, P. Baker, S. Hull, J. Robson. Submitted Aug 2011

Hippisley-Cox J, Coupland C, Robson J, Sheikh A, Brindle P Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. BMJ. 2009 Mar 17;338:b880. doi: 10.1136/bmj.b880.