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Meffen A, Houghton JSM, Nickinson ATO, Pepper CJ, Sayers RD, Gray LJ. Understanding variations in reported epidemiology of major lower extremity amputation in the UK: a systematic review. BMJ Open 2021; 11:e053599. [PMID: 34615685 PMCID: PMC8496376 DOI: 10.1136/bmjopen-2021-053599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Estimate the prevalence/incidence/number of major lower extremity amputations (MLEAs) in the UK; identify sources of routinely collected electronic health data used; assess time trends and regional variation; and identify reasons for variation in reported incidence/prevalence of MLEA. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, EMcare, CINAHL, The Cochrane Library, AMED, Scopus and grey literature sources searched from 1 January 2009 to 1 August 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Reports that provided population-based statistics, used routinely collected electronic health data, gave a measure of MLEA in adults in the general population or those with diabetes in the UK or constituent countries were included. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Instruments were performed by two reviewers independently. Due to considerable differences in study populations and methodology, data pooling was not possible; data were tabulated and narratively synthesised, and study differences were discussed. RESULTS Twenty-seven reports were included. Incidence proportion for the general population ranged from 8.2 to 51.1 per 100 000 and from 70 to 291 per 100 000 for the population with diabetes. Evidence for trends over time was mixed, but there was no evidence of increasing incidence. Reports consistently found regional variation in England with incidence higher in the north. No studies reported prevalence. Differences in database use, MLEA definition, calculation methods and multiple procedure inclusion which, together with identified inaccuracies, may account for the variation in incidence. CONCLUSIONS UK incidence and trends in MLEA remain unclear; estimates vary widely due to differences in methodology and inaccuracies. Reasons for regional variation also remain unexplained and prevalence uninvestigated. International consensus on the definition of MLEA and medical code list is needed. Future research should recommend standards for the reporting of such outcomes and investigate further the potential to use primary care data in MLEA epidemiology. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020165592.
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Affiliation(s)
- Anna Meffen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - John S M Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Coral J Pepper
- Department of Library and Information Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Robert D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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Barbosa GCG, Ali MS, Araujo B, Reis S, Sena S, Ichihara MYT, Pescarini J, Fiaccone RL, Amorim LD, Pita R, Barreto ME, Smeeth L, Barreto ML. CIDACS-RL: a novel indexing search and scoring-based record linkage system for huge datasets with high accuracy and scalability. BMC Med Inform Decis Mak 2020; 20:289. [PMID: 33167998 PMCID: PMC7654019 DOI: 10.1186/s12911-020-01285-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Record linkage is the process of identifying and combining records about the same individual from two or more different datasets. While there are many open source and commercial data linkage tools, the volume and complexity of currently available datasets for linkage pose a huge challenge; hence, designing an efficient linkage tool with reasonable accuracy and scalability is required. Methods We developed CIDACS-RL (Centre for Data and Knowledge Integration for Health – Record Linkage), a novel iterative deterministic record linkage algorithm based on a combination of indexing search and scoring algorithms (provided by Apache Lucene). We described how the algorithm works and compared its performance with four open source linkage tools (AtyImo, Febrl, FRIL and RecLink) in terms of sensitivity and positive predictive value using gold standard dataset. We also evaluated its accuracy and scalability using a case-study and its scalability and execution time using a simulated cohort in serial (single core) and multi-core (eight core) computation settings. Results Overall, CIDACS-RL algorithm had a superior performance: positive predictive value (99.93% versus AtyImo 99.30%, RecLink 99.5%, Febrl 98.86%, and FRIL 96.17%) and sensitivity (99.87% versus AtyImo 98.91%, RecLink 73.75%, Febrl 90.58%, and FRIL 74.66%). In the case study, using a ROC curve to choose the most appropriate cut-off value (0.896), the obtained metrics were: sensitivity = 92.5% (95% CI 92.07–92.99), specificity = 93.5% (95% CI 93.08–93.8) and area under the curve (AUC) = 97% (95% CI 96.97–97.35). The multi-core computation was about four times faster (150 seconds) than the serial setting (550 seconds) when using a dataset of 20 million records. Conclusion CIDACS-RL algorithm is an innovative linkage tool for huge datasets, with higher accuracy, improved scalability, and substantially shorter execution time compared to other existing linkage tools. In addition, CIDACS-RL can be deployed on standard computers without the need for high-speed processors and distributed infrastructures.
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Affiliation(s)
- George C G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.
| | - M Sanni Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,NDORMS, Center for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Bruno Araujo
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Sandra Reis
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Samila Sena
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Maria Y T Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Julia Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Rosemeire L Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Leila D Amorim
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Robespierre Pita
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Marcos E Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Computer Science Department, Federal University of Bahia (UFBA), Salvador, Brazil.,Department of Statistics, London School of Economics and Political Science (LSE), London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Institute of Public Health, Federal University of Bahia (UFBA), Salvador, Brazil
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Henderson D, Burton JK, Lynch E, Clark D, Rintoul J, Bailey N. Data Resource Profile: the Scottish Social Care Survey (SCS) and the Scottish Care Home Census (SCHC). Int J Popul Data Sci 2019; 4:1108. [PMID: 34095535 PMCID: PMC8142955 DOI: 10.23889/ijpds.v4i1.1108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Linked health care datasets have been used effectively in Scotland for some time. Use of social care data has been much more limited, partly because responsibility for these services is distributed across multiple local authorities. However, there are substantial interactions between health and social care (also known internationally as long-term care) services, and keen policy interest in better understanding these. We introduce two social care resources that can now be linked to health datasets at a population level across Scotland to study these interdependencies. These data emerge from the Scottish Government’s centralised collation of data from mandatory returns provided by local authorities and care homes. Methods Deterministic and Probabilistic methods were used to match the Social Care Survey (SCS) and Scottish Care Home Census (SCHC) to the Community Health Index (CHI) number via the National Records of Scotland (NRS) Research Indexing Spine. Results For the years 2010/11 to 2015/16, an overall match rate of 91.2% was achieved for the SCS to CHI from 31 of Scotland’s 32 local authority areas. This rate varied from 76.7% to 98.5% for local authority areas. A match rate of 89.8% to CHI was achieved for the SCHC in years 2012/13 to 2015/16 but only 52.5% for the years 2010/11 to 2011/12. Conclusion Indexing of the SCS and SCHC to CHI offers a new and rich resource of data for health and social care research.
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Affiliation(s)
- D Henderson
- Urban Big Data Centre, University of Glasgow, Glasgow, G12 8RZ
| | - J K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA
| | - E Lynch
- Health and Social Care Analysis Division, Scottish Government, Edinburgh, EH1 3DG
| | - D Clark
- Indexing Team, National Records of Scotland, Edinburgh, EH12 7UT
| | - J Rintoul
- Health and Social Care Analysis Division, Scottish Government, Edinburgh, EH1 3DG
| | - N Bailey
- Urban Big Data Centre, University of Glasgow, Glasgow, G12 8RZ
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Burton JK, Marwick CA, Galloway J, Hall C, Nind T, Reynish EL, Guthrie B. Identifying care-home residents in routine healthcare datasets: a diagnostic test accuracy study of five methods. Age Ageing 2019; 48:114-121. [PMID: 30124764 PMCID: PMC6322499 DOI: 10.1093/ageing/afy137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/26/2018] [Indexed: 11/12/2022] Open
Abstract
Background there is no established method to identify care-home residents in routine healthcare datasets. Methods matching patient's addresses to known care-home addresses have been proposed in the UK, but few have been formally evaluated. Study design prospective diagnostic test accuracy study. Methods four independent samples of 5,000 addresses from Community Health Index (CHI) population registers were sampled for two NHS Scotland Health Boards on 1 April 2017, with one sample of adults aged ≥65 years and one of all residents. To derive the reference standard, all 20,000 addresses were manually adjudicated as 'care-home address' or not. The performance of five methods (NHS Scotland assigned CHI Institution Flag, exact address matching, postcode matching, Phonics and Markov) was evaluated compared to the reference standard. Results the CHI Institution Flag had a high PPV 97-99% in all four test sets, but poorer sensitivity 55-89%. Exact address matching failed in every case. Postcode matching had higher sensitivity than the CHI flag 78-90%, but worse PPV 77-85%. Area under the receiver operating curve values for Phonics and Markov scores were 0.86-0.95 and 0.93-0.98, respectively. Phonics score with cut-off ≥13 had PPV 92-97% with sensitivity 72-87%. Markov PPVs were 90-95% with sensitivity 69-90% with cut-off ≥29.6. Conclusions more complex address matching methods greatly improve identification compared to the existing NHS Scotland flag or postcode matching, although no method achieved both sensitivity and positive predictive value > 95%. Choice of method and cut-offs will be determined by the specific needs of researchers and practitioners.
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Affiliation(s)
- Jennifer K Burton
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Charis A Marwick
- Population Health Sciences Division, School of Medicine, University of Dundee, Dundee, UK
| | - James Galloway
- Health Informatics Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Christopher Hall
- Health Informatics Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Thomas Nind
- Health Informatics Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Emma L Reynish
- Dementia and Ageing Research Group, Faculty of Social Science, University of Stirling, Stirling, UK
| | - Bruce Guthrie
- Population Health Sciences Division, School of Medicine, University of Dundee, Dundee, UK
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