• Ailsa J McKay, Laura H Gunn, Eszter P Vamos, Jonathan Valabhji, German Molina, Mariam Molokhia, and Azeem Majeed.
• Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: ailsa.mckay08@imperial.ac.uk.
• Diabetes Res. Clin. Pract. 2021 Apr 1; 174: 108746.

AimsTo describe associations between incentivised primary care clinical and process indicators and mortality, among patients with type 2 diabetes in England.MethodsA historical 2010-2017 cohort (n = 84,441 adults) was derived from the UK CPRD. Exposures included English Quality and Outcomes Framework glycated haemoglobin (HbA1c; 7.5%, 59 mmol/mol), blood pressure (140/80 mmHg), and cholesterol (5 mmol/L) indicator attainment; and number of National Diabetes Audit care processes completed, in 2010-11. The primary outcome was all-cause mortality.ResultsOver median 3.9 (SD 2.0) years follow-up, 10,711 deaths occurred. Adjusted hazard ratios (aHR) indicated 12% (95% CI 8-16%; p < 0.0001) and 16% (11-20%; p < 0.0001) lower mortality rates among those who attained the HbA1c and cholesterol indicators, respectively. Rates were also lower among those who completed 7-9 vs. 0-3 or 4-6 care processes (aHRs 0.76 (0.71-0.82), p < 0.0001 and 0.61 (0.53-0.71), p < 0.0001, respectively), but did not obviously vary by blood pressure indicator attainment (aHR 1.04, 1.00-1.08; p = 0.0811).ConclusionsCholesterol, HbA1c and comprehensive process indicator attainment, was associated with enhanced survival. Review of community-based care provision could help reduce the gap between indicator standards and current outcomes, and in turn enhance life expectancy.Copyright © 2021 Elsevier B.V. All rights reserved.

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