Sustained socio-economic inequalities in hospital admissions for cardiovascular events among people with diabetes in England

Objective This study aimed to determine changes in absolute and relative socio-economic inequalities in hospital admissions for major cardiovascular events and procedures among people with diabetes in England. Methods We identified all patients with diagnosed diabetes aged ≥45 years admitted to hospital in England between 2004-2005 and 2014-2015 for acute myocardial infarction, stroke, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Socio-economic status was measured using Index of Multiple Deprivation. Diabetes-specific admission rates were calculated for each year by deprivation quintile. We assessed temporal changes using negative binomial regression models. Results Most admissions for cardiovascular causes occurred among people aged ≥65 years (71%) and men (63.3%), and the number of admissions increased steadily from the least to the most deprived quintile. People with diabetes in the most deprived quintile had 1.94-fold increased risk of acute myocardial infarction (95% CI 1.79-2.10), 1.92-fold risk of stroke (95% CI 1.78-2.07), 1.66-fold risk of CABG (95% CI 1.50-1.74), and 1.76-fold risk of PCI (95% CI 1.64-1.89) compared with the least deprived group. Absolute differences in rates between the least and most deprived quintiles did not significantly change for acute myocardial infarction (P=0.29) and were reduced for stroke, CABG and PCI (by 17.5, 15 and 11.8 per 100,000 people with diabetes, respectively, P≤0.01 for all). Conclusions Socio-economic inequalities persist in diabetes-related hospital admissions for major cardiovascular events in England. Besides improved risk stratification strategies considering socio-economically defined needs, wide-reaching population-based policy interventions are required to reduce inequalities in diabetes outcomes

Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD).

BACKGROUND: Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects. AIM: The aim of this study was to determine whether the relative proportions of self-reported ingestions of GHB or its precursors GBL and 1,4BD were similar to those seen in analysis of seized drugs. DESIGN AND METHODS: Retrospective review of our clinical toxicology database to identify all cases of self-reported recreational GHB, GBL and 1,4BD use associated with ED presentation in 2006. Additionally all seized substances on people attending local club venues were analysed by a Home Office approved laboratory to identify any illicit substances present. RESULTS: In 2006, there were a total of 158 ED presentations, of which 150 (94.9%) and 8 (5.1%) were GHB and GBL self-reported ingestions respectively; 96.8% (153) were recreational use. Of the 418 samples seized, 225 (53.8%) were in liquid form; 85 (37.8%) contained GHB and 140 (62.2%) contained GBL. None of the seized samples contained 1,4BD and there were no self-reported 1,4BD ingestions. CONCLUSION: Self-reported GHB ingestion was much more common than GBL ingestion, whereas GBL was more commonly found in the seized samples. These differences suggest that GBL use may be more common than previously thought and we suggest that there should be further debate about the legal status of the precursors of GHB