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Research

Variation in laboratory testing for patients with long-term conditions: a longitudinal cohort study in UK primary care

Timothy Jones, Rita Patel, Martha M C Elwenspoek, Jessica C Watson, Ed Mann, Katharine Alsop and Penny F Whiting
BJGP Open 2023; 7 (1): BJGPO.2022.0139. DOI: https://doi.org/10.3399/BJGPO.2022.0139
Timothy Jones
1 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
3 Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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  • ORCID record for Timothy Jones
  • For correspondence: Timothy.Jones{at}bristol.ac.uk
Rita Patel
1 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
3 Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Martha M C Elwenspoek
1 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Jessica C Watson
1 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Ed Mann
4 Tyntesfield Medical Group, Bristol, UK
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Katharine Alsop
5 Nightingale Valley Practice, Bristol, UK
6 Brisdoc Healthcare Services, Bristol, UK
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Penny F Whiting
1 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Article Figures & Data

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    Figure 1. Inclusion and exclusion of people to the cohort with long-term conditions. CKD = chronic kidney disease. UTS = up to standard (GP practice data quality).
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    Figure 2. Venn diagram for numbers with each of the three long-term conditions and the overlap between them (933 907 individuals). CKD = chronic kidney disease
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    Figure 3. Tests ordered per person per year for people with only hypertension (left), only type 2 diabetes (middle), or only chronic kidney disease (right). Note: Box plot shows median, interquartile range (25th and 75th percentiles), and whiskers are 10th and 90th percentiles.

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    Table 1. Patient demographics by long-term condition (n = 933 907)
    CohortAll hypertensionHypertension onlyAll diabetesDiabetes onlyAll CKDCKD only
    n (% of cohort)810 412 (86.8%)514 757 (55.1%)266 169 (28.5%)76 707 (8.2%)211 937 (22.7%)37 585 (4.0%)
    Average follow-up, years (SD)3.39 (1.42)3.33 (1.42)3.39 (1.43)3.11 (1.41)3.40 (1.42)3.12 (1.4)
    Women (%)417 137 (51.5%)263 882 (51.3%)116 323 (43.7%)30 423 (39.7%)125 737 (59.3%)22 970 (61.1%)
    Age, years
     0–4969 253 (8.5%)56 515 (11.0%)30 688 (11.5%)19 652 (25.6%)5214 (2.5%)2305 (6.1%)
     50–59132 564 (16.4%)100 697 (19.6%)47 622 (17.9%)20 006 (26.1%)11 909 (5.6%)4131 (11.0%)
     60–69198 668 (24.5%)138 543 (26.9%)66 105 (24.8%)18 593 (24.2%)30 110 (14.2%)6929 (18.4%)
     70–79210 480 (26.0%)126 887 (24.6%)67 268 (25.3%)12 465 (16.3%)61 187 (28.9%)9966 (26.5%)
     80–89150 878 (18.6%)71 719 (13.9%)44 291 (16.6%)5049 (6.6%)73 170 (34.5%)9646 (25.7%)
     ≥9048 569 (6.0%)20 396 (4%)10 195 (3.8%)942 (1.2%)30 347 (14.3%)4608 (12.3%)
    Region
     North East5423 (0.7%)3380 (0.7%)1756 (0.7%)524 (0.7%)1439 (0.7%)238 (0.6%)
     North West79 662 (9.8%)50 351 (9.8%)27 423 (10.3%)7857 (10.2%)20 998 (9.9%)3679 (9.8%)
     Yorkshire and the Humber7216 (0.9%)4511 (0.9%)2560 (1.0%)767 (1.0%)1872 (0.9%)317 (0.8%)
     East Midlands1353 (0.2%)873 (0.2%)504 (0.2%)157 (0.2%)267 (0.1%)25 (0.1%)
     West Midlands70 046 (8.6%)42 454 (8.2%)23 134 (8.7%)6383 (8.3%)21 165 (10.0%)3605 (9.6%)
     East of England44 093 (5.4%)29 540 (5.7%)12 911 (4.9%)3466 (4.5%)9424 (4.4%)1406 (3.7%)
     South West56 990 (7.0%)34 583 (6.7%)18 891 (7.1%)5250 (6.8%)18 018 (8.5%)3629 (9.7%)
     South Central86 190 (10.6%)57 568 (11.2%)25 465 (9.6%)7845 (10.2%)20 362 (9.6%)3372 (9.0%)
     London82 620 (10.2%)53 350 (10.4%)30 412 (11.4%)9389 (12.2%)16 867 (8.0%)2821 (7.5%)
     South East Coast90 307 (11.1%)55 868 (10.9%)28 052 (10.5%)7886 (10.3%)27 992 (13.2%)5640 (15.0%)
     Northern Ireland34 257 (4.2%)21 322 (4.1%)11 146 (4.2%)3361 (4.4%)10 883 (5.1%)2418 (6.4%)
     Scotland116 790 (14.4%)74 728 (14.5%)38 497 (14.5%)11 904 (15.5%)30 185 (14.2%)5054 (13.4%)
     Wales135,465 (16.7%)86,229 (16.8%)45,418 (17.1%)11,918 (15.5%)32,465 (15.3%)5381 (14.3%)
    Deprivation quintile
     1 — Least98 840 (24%)66 295 (25.4%)26 489 (19.7%)7474 (19.3%)25 006 (23.3%)4697 (24.7%)
     291 231 (22.2%)58 934 (22.6%)27 388 (20.4%)7560 (19.5%)23 815 (22.2%)4280 (22.5%)
     388 676 (21.6%)56 040 (21.5%)28 559 (21.2%)7896 (20.4%)23 384 (21.8%)4100 (21.6%)
     474 759 (18.2%)45 819 (17.5%)27 634 (20.5%)8222 (21.2%)19 801 (18.4%)3398 (17.9%)
     5 — Most57 819 (14.1%)34 001 (13.0%)24 430 (18.2%)7585 (19.6%)15 499 (14.4%)2532 (13.3%)
     Missing399 087 (49.2%)253 668 (49.3%)131 669 (49.5%)37 970 (49.5%)104 432 (49.3%)18 578 (49.4%)
    Ethnic group
     White313 676 (92.5%)192 426 (93.2%)99 936 (87.1%)26 297 (84.2%)93 235 (95%)16 392 (96.5%)
     Black8371 (2.5%)5068 (2.5%)3694 (3.2%)1039 (3.3%)1597 (1.6%)176 (1%)
     Asian10 706 (3.2%)5007 (2.4%)7946 (6.9%)2842 (9.1%)2164 (2.2%)244 (1.4%)
     Other6453 (1.9%)3958 (1.9%)3102 (2.7%)1068 (3.4%)1136 (1.2%)167 (1%)
     Missing471 206 (58.1%)308 298 (59.9%)151 491 (56.9%)45 461 (59.3%)113 805 (53.7%)20 606 (54.8%)
    • CKD = chronic kidney disease.

Supplementary Data

  • Jones_BJGPO.2022.0139_Supp.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.

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Variation in laboratory testing for patients with long-term conditions: a longitudinal cohort study in UK primary care
Timothy Jones, Rita Patel, Martha M C Elwenspoek, Jessica C Watson, Ed Mann, Katharine Alsop, Penny F Whiting
BJGP Open 2023; 7 (1): BJGPO.2022.0139. DOI: 10.3399/BJGPO.2022.0139

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Variation in laboratory testing for patients with long-term conditions: a longitudinal cohort study in UK primary care
Timothy Jones, Rita Patel, Martha M C Elwenspoek, Jessica C Watson, Ed Mann, Katharine Alsop, Penny F Whiting
BJGP Open 2023; 7 (1): BJGPO.2022.0139. DOI: 10.3399/BJGPO.2022.0139
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Keywords

  • general practice
  • primary health care
  • hypertension
  • diabetes mellitus
  • renal insufficiency, chronic
  • healthcare disparities

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