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Yu D, Jordan KP, Wilkie R, Bailey J, Fitzpatrick J, Ali N, Niblett P, Peat G. Persistent inequalities in consultation incidence and prevalence of low back pain and osteoarthritis in England between 2004 and 2019. Rheumatol Adv Pract 2022; 7:rkac106. [PMID: 36601519 PMCID: PMC9800855 DOI: 10.1093/rap/rkac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
Objective We wanted to determine whether socioeconomic inequalities in primary care consultation rates for two major, disabling musculoskeletal conditions in England narrowed or widened between 2004 and 2019. Methods We analysed data from Clinical Practice Research Datalink Aurum, a national general practice electronic health records database, linked to national deprivation ranking of each patient's registered residential postcode. For each year, we estimated the age- and sex-standardized consultation incidence and prevalence for low back pain and OA for the most deprived 10% of neighbourhoods through to the least deprived 10%. We then calculated the slope index of inequality and relative index of inequality overall and by sex, age group and geographical region. Results Inequalities in low back pain incidence and prevalence over socioeconomic status widened between 2004 and 2013 and stabilized between 2014 and 2019. Inequalities in OA incidence remained stable over socioeconomic status within the study period, whereas inequalities in OA prevalence widened markedly over socioeconomic status between 2004 and 2019. The widest gap in low back pain incidence and prevalence over socioeconomic status was observed in populations resident in northern English regions and London and in those of working age, peaking at 45-54 years. Conclusion We found persistent, and generally increasing, socioeconomic inequalities in the rate of adults presenting to primary care in England with low back pain and OA between 2004 and 2019.
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Affiliation(s)
- Dahai Yu
- Correspondence: Dahai Yu, Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire ST5 5BG, UK. E-mail:
| | - Kelvin P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Ross Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - James Bailey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Justine Fitzpatrick
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Nuzhat Ali
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Paul Niblett
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK,Department of Allied Health Professions, College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, UK
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Yu D, Missen M, Jordan KP, Edwards JJ, Bailey J, Wilkie R, Fitzpatrick J, Ali N, Niblett P, Peat G. Trends in the Annual Consultation Incidence and Prevalence of Low Back Pain and Osteoarthritis in England from 2000 to 2019: Comparative Estimates from Two Clinical Practice Databases. Clin Epidemiol 2022; 14:179-189. [PMID: 35210865 PMCID: PMC8860349 DOI: 10.2147/clep.s337323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare estimates of annual person-consulting incidence and prevalence of low back pain (LBP) and osteoarthritis for two national English electronic health record databases (Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD). Patients and Methods Retrospective, population-based, longitudinal cohort study. LBP and osteoarthritis cases were defined using established codelists in people aged ≥15 and ≥45 years, respectively. Incident cases were new recorded cases in a given calendar year with no relevant consultation in the previous 3 years (denominator = exact person-time in the same calendar year for the at-risk population). Prevalent cases were individuals with ≥1 consultation for the condition of interest recorded in a given calendar year, irrespective of prior consultations for the same condition (denominator = all patients with complete registration history in the previous 3 years). We estimated age-sex standardised incidence and annual (12-month period) prevalence for both conditions in 2000–2019, overall, and by sex, age group, and region. Results Standardised incidence and prevalence of LBP from Aurum were lower than those from GOLD until 2014, after which estimates were similar. Both databases showed recent declines in incidence and prevalence of LBP: declines began earlier in GOLD (after 2012–2014) than Aurum (after 2014–2015). Standardised incidence (after 2011) and prevalence of osteoarthritis (after 2003) were higher in Aurum than GOLD and showed different trends: incidence and prevalence were stable or increasing in Aurum, decreasing in GOLD. Stratified estimates in CPRD Aurum suggested consistently higher occurrence among women, older age groups, and those living in the north of England. Conclusion Comparative analyses of two English databases produced conflicting estimates and trends for two common musculoskeletal conditions. Aurum estimates appeared more consistent with external sources and may be useful for monitoring population musculoskeletal health and healthcare demand, but they remain sensitive to analytic decisions and data quality.
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Affiliation(s)
- Dahai Yu
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
- Correspondence: Dahai Yu, Email
| | - Matthew Missen
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Kelvin P Jordan
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - John J Edwards
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - James Bailey
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Ross Wilkie
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Justine Fitzpatrick
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Nuzhat Ali
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Paul Niblett
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - George Peat
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
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Michaels JA, Campbell WB, Rigby KA, Chan P, Beard J, Wood R, Lonsdale R, Sheriff S, Palfreyman S, Thompson J, Allington K, Brazier J, Shackley P, Niblett P, Peters A, Bickerton D. A New Pragmatic Classification System for Varicose Veins. Phlebology 2016. [DOI: 10.1177/026835550101600108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: An anatomical classification system for varicose veins which has a direct and pragmatic bearing on treatment. Methods: A group of trial participants from the two vascular units involved met to design a system. A consensus on the form and content of the system was reached. This process included forming a set of ideal classification criteria, a literature review of existing classification systems and a pilot study of the proposed system. Results: The identified classification systems were felt to be unsatisfactory for a number of reasons including being difficult to understand and use, requiring special investigations and not linking through to clinical management options. The pilot study demonstrated consensus between clinicians when using our system. Conclusion: A system has been developed that is easy to learn, use and understand. It can be employed in a busy outpatient setting and produces an acceptable degree of agreement regarding the anatomical nature of varicose veins.
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Affiliation(s)
- J. A. Michaels
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | | | - K. A. Rigby
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | - P. Chan
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | - J. Beard
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | - R. Wood
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | - R.J. Lonsdale
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | - S. Sheriff
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | - S. Palfreyman
- Sheffield Vascular Institute, Northern General Hospital, Sheffield
| | | | | | - J. Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P. Shackley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - A. Peters
- Royal Devon and Exeter Hospital, Exeter
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