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Rawle MJ, Lau WCY, Gonzalez-Izquierdo A, Patalay P, Richards M, Davis D. Associations Between Midlife Anticholinergic Medication Use and Subsequent Cognitive Decline: A British Birth Cohort Study. Drugs Aging 2024:10.1007/s40266-024-01116-x. [PMID: 38740716 DOI: 10.1007/s40266-024-01116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Anticholinergic medication use is associated with cognitive decline and incident dementia. Our study, a prospective birth cohort analysis, aimed to determine if repeated exposure to anticholinergic medications was associated with greater decline, and whether decline was reversed with medication reduction. METHODS From the Medical Research Council (MRC) National Survey of Health and Development, a British birth cohort with all participants born in a single week of March 1946, we quantified anticholinergic exposure between ages 53 and 69 years using the Anticholinergic Cognitive Burden Scale (ACBS). We used multinomial regression to estimate associations with global cognition, quantified by the Addenbrooke's Cognitive Examination, 3rd Edition (ACE-III). Longitudinal associations between ACBS and cognitive test results (Verbal memory quantified by the Word Learning Test [WLT], and processing speed quantified by the Timed Letter Search Task [TLST]) at three time points (age 53, 60-64 and 69) were assessed using mixed and fixed effects linear regression models. Analyses were adjusted for sex, childhood cognition, education, chronic disease count and severity, and mental health symptoms. RESULTS Anticholinergic exposure was associated cross-sectionally with lower ACE-III scores at age 69, with the greatest effects in those with high exposure at ages 60-64 (mean difference - 2.34, 95% confidence interval [CI] - 3.51 to - 1.17). Longitudinally, both mild-moderate and high ACBS scores were linked to lower WLT scores, again with high exposure showing larger effects (mean difference with contemporaneous exposure - 0.90, 95% CI - 1.63 to - 0.17; mean difference with lagged exposure - 1.53, 95% CI - 2.43 to - 0.64). Associations remained in fixed effects models (mean difference with contemporaneous exposure -1.78, 95% CI -2.85 to - 0.71; mean difference with lagged exposure - 2.23, 95% CI - 3.33 to - 1.13). Associations with TLST were noted only in isolated contemporaneous exposure (mean difference - 13.14, 95% CI - 19.04 to - 7.23; p < 0.01). CONCLUSIONS Anticholinergic exposure throughout mid and later life was associated with lower cognitive function. Reduced processing speed was associated only with contemporaneous anticholinergic medication use, and not historical use. Associations with lower verbal recall were evident with both historical and contemporaneous use of anticholinergic medication, and associations with historical use persisted in individuals even when their anticholinergic medication use decreased over the course of the study.
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Affiliation(s)
- Mark J Rawle
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
- Academic Centre for Healthy Ageing (ACHA) @ Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, London, E11 1NR, UK.
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, UCL, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics and Health Data Research UK, UCL, London, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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Brooks K, Yoshimura H, Gonzalez-Izquierdo A, Zakkak N, Kukendra-Rajah K, Lip GYH, Providencia R. The association between atrial fibrillation and dementia: A UK linked electronic health records cohort study. Eur J Clin Invest 2024; 54:e14154. [PMID: 38217524 DOI: 10.1111/eci.14154] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/27/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND We investigated the association between atrial fibrillation (AF) and dementia, and its subtypes (vascular-VaD, Alzheimer, mixed and rare dementia), and identified predictors for dementia in AF patients. METHODS The analysis was based on 183,610 patients with new-onset AF and 367,220 non-AF controls in the United Kingdom between 1998 and 2016, identified in three prospectively collected, linked electronic health records sources. Time-to-event (dementia or subtypes) analyses were performed using Cox proportional hazards and weighted Cox. Sub-analyses performed: including & censoring stroke and age (median used as cut-off). RESULTS Over a median follow-up of 2.67 years (IQR .65-6.02) for AF patients and 5.84 years for non-AF patients (IQR 2.26-11.80), incidence of dementia in the AF cohort was 2.65 per 100 person-years, compared to 2.02 in the non-AF cohort. After adjustment, a significant association was observed between AF and all-cause dementia (HR = 1.38, 95% CI: 1.31-1.45), driven by a strong association with VaD (HR = 1.55, 95% CI: 1.41-1.70). AF was also associated with mixed dementia (HR = 1.26, 95% CI: 1.01-1.56), but we could not confirm an association with Alzheimer (HR = 1.05, 95% CI: .94-1.16) and rare dementia forms (HR = 1.19, 95% CI: .90-1.56). Ischemic stroke (HR = 1.40, 95% CI: 1.26-1.56), subarachnoid haemorrhage (HR = 2.08, 95% CI: 1.47-2.96), intracerebral haemorrhage (HR = 1.95, 95% CI: 1.54-2.48) and diabetes (HR = 1.32, 95% CI: 1.24-1.41) were identified as the strongest predictors of dementia in AF patients. CONCLUSIONS AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia.
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Affiliation(s)
- Kieran Brooks
- Institute of Health Informatics Research, University College London, London, UK
| | - Hiroyuki Yoshimura
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Nadine Zakkak
- Institute of Health Informatics Research, University College London, London, UK
| | - Kishore Kukendra-Rajah
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Rui Providencia
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
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Pathak N, Zhang CX, Boukari Y, Burns R, Menezes D, Hugenholtz G, French RS, Gonzalez-Izquierdo A, Mathur R, Denaxas S, Hayward A, Sonnenberg P, Aldridge RW. Sexual and reproductive health and rights of migrant women attending primary care in England: A population-based cohort study of 1.2 million individuals of reproductive age (2009-2018). J Migr Health 2024; 9:100214. [PMID: 38327760 PMCID: PMC10847991 DOI: 10.1016/j.jmh.2024.100214] [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: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
Background Evidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009-2018). Methods This population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated. Findings There were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9-0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7-0.7) and cervical screening (RR 0.96;95 %CI 0.95-0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1-1.2) and management of fertility problems (RR 1.39;95 %CI 1.08-1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45-1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60-0.66), subdermal implant (RR 0.72;95 %CI 0.69-0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34-0.36). Interpretation Healthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.
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Affiliation(s)
- Neha Pathak
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute for Global Health, University College London, London, WC1E 6JB, UK
- Guy's & St Thomas's NHS Foundation Trust, London, SE1 9RT, UK
| | - Claire X. Zhang
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Gregory Hugenholtz
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Rebecca S French
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- BHF Data Science Center, Health Data Research UK, London, NW1 2DA, UK
| | - Andrew Hayward
- Inclusion Health, UK Health Security Agency, London, UK
- Institute of Epidemiology and Healthcare, University College London, London, WC1E 7HB, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, WC1E 6JB, UK
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Prugger C, Perier MC, Gonzalez-Izquierdo A, Hemingway H, Denaxas S, Empana JP. Incidence of 12 common cardiovascular diseases and subsequent mortality risk in the general population. Eur J Prev Cardiol 2023; 30:1715-1722. [PMID: 37294923 DOI: 10.1093/eurjpc/zwad192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Incident events of cardiovascular diseases (CVDs) are heterogenous and may result in different mortality risks. Such evidence may help inform patient and physician decisions in CVD prevention and risk factor management. AIMS This study aimed to determine the extent to which incident events of common CVD show heterogeneous associations with subsequent mortality risk in the general population. METHODS AND RESULTS Based on England-wide linked electronic health records, we established a cohort of 1 310 518 people ≥30 years of age initially free of CVD and followed up for non-fatal events of 12 common CVD and cause-specific mortality. The 12 CVDs were considered as time-varying exposures in Cox's proportional hazards models to estimate hazard rate ratios (HRRs) with 95% confidence intervals (CIs). Over the median follow-up of 4.2 years (2010-16), 81 516 non-fatal CVD, 10 906 cardiovascular deaths, and 40 843 non-cardiovascular deaths occurred. All 12 CVDs were associated with increased risk of cardiovascular mortality, with HRR (95% CI) ranging from 1.67 (1.47-1.89) for stable angina to 7.85 (6.62-9.31) for haemorrhagic stroke. All 12 CVDs were also associated with increased non-cardiovascular and all-cause mortality risk but to a lesser extent: HRR (95% CI) ranged from 1.10 (1.00-1.22) to 4.55 (4.03-5.13) and from 1.24 (1.13-1.35) to 4.92 (4.44-5.46) for transient ischaemic attack and sudden cardiac arrest, respectively. CONCLUSION Incident events of 12 common CVD show significant adverse and markedly differential associations with subsequent cardiovascular, non-cardiovascular, and all-cause mortality risk in the general population.
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Affiliation(s)
- Christof Prugger
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marie-Cécile Perier
- INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Diseases, Université Paris Cité, 56 rue Leblanc, 75015 Paris, France
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Road, NW1 2DA London, UK
- Health Data Research UK, 215 Euston Road, NW1 2DA London, UK
- UCL Hospitals Biomedical Research Centers (BRC), 270 Tottenham Court Road, 215 Euston Road, NW1 2BE London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, NW1 2DA London, UK
- Health Data Research UK, 215 Euston Road, NW1 2DA London, UK
- UCL Hospitals Biomedical Research Centers (BRC), 270 Tottenham Court Road, 215 Euston Road, NW1 2BE London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, NW1 2DA London, UK
- Health Data Research UK, 215 Euston Road, NW1 2DA London, UK
- UCL Hospitals Biomedical Research Centers (BRC), 270 Tottenham Court Road, 215 Euston Road, NW1 2BE London, UK
- British Heart Foundation Data Science Center, 215 Euston Road, NW1 2BE London, UK
| | - Jean-Philippe Empana
- INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Diseases, Université Paris Cité, 56 rue Leblanc, 75015 Paris, France
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Josephson CB, Gonzalez-Izquierdo A, Engbers JDT, Denaxas S, Delgado-Garcia G, Sajobi TT, Wang M, Keezer MR, Wiebe S. Association of comorbid-socioeconomic clusters with mortality in late onset epilepsy derived through unsupervised machine learning. Seizure 2023; 111:58-67. [PMID: 37536152 DOI: 10.1016/j.seizure.2023.07.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Late-onset epilepsy is a heterogenous entity associated with specific aetiologies and an elevated risk of premature mortality. Specific multimorbid-socioeconomic profiles and their unique prognostic trajectories have not been described. We sought to determine if specific clusters of late onset epilepsy exist, and whether they have unique hazards of premature mortality. METHODS We performed a retrospective observational cohort study linking primary and hospital-based UK electronic health records with vital statistics data (covering years 1998-2019) to identify all cases of incident late onset epilepsy (from people aged ≥65) and 1:10 age, sex, and GP practice-matched controls. We applied hierarchical agglomerative clustering using common aetiologies identified at baseline to define multimorbid-socioeconomic profiles, compare hazards of early mortality, and tabulating causes of death stratified by cluster. RESULTS From 1,032,129 people aged ≥65, we identified 1048 cases of late onset epilepsy who were matched to 10,259 controls. Median age at epilepsy diagnosis was 68 (interquartile range: 66-72) and 474 (45%) were female. The hazard of premature mortality related to late-onset epilepsy was higher than matched controls (hazard ratio [HR] 1.73; 95% confidence interval [95%CI] 1.51-1.99). Ten unique phenotypic clusters were identified, defined by 'healthy' males and females, ischaemic stroke, intracerebral haemorrhage (ICH), ICH and alcohol misuse, dementia and anxiety, anxiety, depression in males and females, and brain tumours. Cluster-specific hazards were often similar to that derived for late-onset epilepsy as a whole. Clusters that differed significantly from the base late-onset epilepsy hazard were 'dementia and anxiety' (HR 5.36; 95%CI 3.31-8.68), 'brain tumour' (HR 4.97; 95%CI 2.89-8.56), 'ICH and alcohol misuse' (HR 2.91; 95%CI 1.76-4.81), and 'ischaemic stroke' (HR 2.83; 95%CI 1.83-4.04). These cluster-specific risks were also elevated compared to those derived for tumours, dementia, ischaemic stroke, and ICH in the whole population. Seizure-related cause of death was uncommon and restricted to the ICH, ICH and alcohol misuse, and healthy female clusters. SIGNIFICANCE Late-onset epilepsy is an amalgam of unique phenotypic clusters that can be quantitatively defined. Late-onset epilepsy and cluster-specific comorbid profiles have complex effects on premature mortality above and beyond the base rates attributed to epilepsy and cluster-defining comorbidities alone.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Centre for Health Informatics, University of Calgary, Calgary, AB, Canada
| | | | | | - Spiros Denaxas
- UCL Institute of Health Informatics, London, UK; Health Data Research (HDR) UK, London, UK; Alan Turing Institute, London, UK
| | - Guillermo Delgado-Garcia
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Mark R Keezer
- Department of Neurosciences, Université de Montreal, Montreal, Quebec, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Josephson CB, Gonzalez-Izquierdo A, Denaxas S, Sajobi TT, Klein KM, Wiebe S. Independent Associations of Incident Epilepsy and Enzyme-Inducing and Non-Enzyme-Inducing Antiseizure Medications With the Development of Osteoporosis. JAMA Neurol 2023; 80:843-850. [PMID: 37306981 PMCID: PMC10262059 DOI: 10.1001/jamaneurol.2023.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/03/2023] [Indexed: 06/13/2023]
Abstract
Importance Both epilepsy and enzyme-inducing antiseizure medications (eiASMs) having varying reports of an association with increased risks for osteoporosis. Objective To quantify and model the independent hazards for osteoporosis associated with incident epilepsy and eiASMS and non-eiASMs. Design, Setting, and Participants This open cohort study covered the years 1998 to 2019, with a median (IQR) follow-up of 5 (1.7-11.1) years. Data were collected for 6275 patients enrolled in the Clinical Practice Research Datalink and from hospital electronic health records. No patients who met inclusion criteria (Clinical Practice Research Datalink-acceptable data, aged 18 years or older, follow-up after the Hospital Episode Statistics patient care linkage date of 1998, and free of osteoporosis at baseline) were excluded or declined. Exposure Incident adult-onset epilepsy using a 5-year washout and receipt of 4 consecutive ASMs. Main Outcomes and Measures The outcome was incident osteoporosis as determined through Cox proportional hazards or accelerated failure time models where appropriate. Incident epilepsy was treated as a time-varying covariate. Analyses controlled for age, sex, socioeconomic status, cancer, 1 or more years of corticosteroid use, body mass index, bariatric surgery, eating disorders, hyperthyroidism, inflammatory bowel disease, rheumatoid arthritis, smoking status, falls, fragility fractures, and osteoporosis screening tests. Subsequent analyses (1) excluded body mass index, which was missing in 30% of patients; (2) applied propensity score matching for receipt of an eiASM; (3) restricted analyses to only those with incident onset epilepsy; and (4) restricted analyses to patients who developed epilepsy at age 65 years or older. Analyses were performed between July 1 and October 31, 2022, and in February 2023 for revisions. Results Of 8 095 441 adults identified, 6275 had incident adult-onset epilepsy (3220 female [51%] and 3055 male [49%]; incidence rate, 62 per 100 000 person-years) with a median (IQR) age of 56 (38-73) years. When controlling for osteoporosis risk factors, incident epilepsy was independently associated with a 41% faster time to incident osteoporosis (time ratio [TR], 0.59; 95% CI, 0.52-0.67; P < .001). Both eiASMs (TR, 0.91; 95% CI, 0.87-0.95; P < .001) and non-eiASMs (TR, 0.77; 95% CI, 0.76-0.78; P < .001) were also associated with significant increased risks independent of epilepsy, accounting for 9% and 23% faster times to development of osteoporosis, respectively. The independent associations among epilepsy, eiASMs, and non-eiASMs remained consistent in propensity score-matched analyses, cohorts restricted to adult-onset epilepsy, and cohorts restricted to late-onset epilepsy. Conclusions and Relevance These findings suggest that epilepsy is independently associated with a clinically meaningful increase in the risk for osteoporosis, as are both eiASMs and non-eiASMs. Routine screening and prophylaxis should be considered in all people with epilepsy.
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Affiliation(s)
- Colin B. Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary, Alberta, Canada
| | - Arturo Gonzalez-Izquierdo
- UCL Institute of Health Informatics, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Spiros Denaxas
- UCL Institute of Health Informatics, London, United Kingdom
- Health Data Research UK, London, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Tolulope T. Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Alberta, Canada
| | - Karl Martin Klein
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Alberta, Canada
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Alberta, Canada
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7
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Wilde H, Tomlinson C, Mateen BA, Selby D, Kanthimathinathan HK, Ramnarayan P, Du Pre P, Johnson M, Pathan N, Gonzalez-Izquierdo A, Lai AG, Gurdasani D, Pagel C, Denaxas S, Vollmer S, Brown K. Hospital admissions linked to SARS-CoV-2 infection in children and adolescents: cohort study of 3.2 million first ascertained infections in England. BMJ 2023; 382:e073639. [PMID: 37407076 PMCID: PMC10318942 DOI: 10.1136/bmj-2022-073639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To describe hospital admissions associated with SARS-CoV-2 infection in children and adolescents. DESIGN Cohort study of 3.2 million first ascertained SARS-CoV-2 infections using electronic health care record data. SETTING England, July 2020 to February 2022. PARTICIPANTS About 12 million children and adolescents (age <18 years) who were resident in England. MAIN OUTCOME MEASURES Ascertainment of a first SARS-CoV-2 associated hospital admissions: due to SARS-CoV-2, with SARS-CoV-2 as a contributory factor, incidental to SARS-CoV-2 infection, and hospital acquired SARS-CoV-2. RESULTS 3 226 535 children and adolescents had a recorded first SARS-CoV-2 infection during the observation period, and 29 230 (0.9%) infections involved a SARS-CoV-2 associated hospital admission. The median length of stay was 2 (interquartile range 1-4) days) and 1710 of 29 230 (5.9%) SARS-CoV-2 associated admissions involved paediatric critical care. 70 deaths occurred in which covid-19 or paediatric inflammatory multisystem syndrome was listed as a cause, of which 55 (78.6%) were in participants with a SARS-CoV-2 associated hospital admission. SARS-CoV-2 was the cause or a contributory factor in 21 000 of 29 230 (71.8%) participants who were admitted to hospital and only 380 (1.3%) participants acquired infection as an inpatient and 7855 (26.9%) participants were admitted with incidental SARS-CoV-2 infection. Boys, younger children (<5 years), and those from ethnic minority groups or areas of high deprivation were more likely to be admitted to hospital (all P<0.001). The covid-19 vaccination programme in England has identified certain conditions as representing a higher risk of admission to hospital with SARS-CoV-2: 11 085 (37.9%) of participants admitted to hospital had evidence of such a condition, and a further 4765 (16.3%) of participants admitted to hospital had a medical or developmental health condition not included in the vaccination programme's list. CONCLUSIONS Most SARS-CoV-2 associated hospital admissions in children and adolescents in England were due to SARS-CoV-2 or SARS-CoV-2 was a contributory factor. These results should inform future public health initiatives and research.
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Affiliation(s)
- Harrison Wilde
- Department of Statistics, University of Warwick, Warwick, UK
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Christopher Tomlinson
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- UCL UK Research and Innovation Centre for Doctoral Training in AI-enabled Healthcare Systems, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Bilal A Mateen
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
- Wellcome Trust, London, UK
| | - David Selby
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | | | - Padmanabhan Ramnarayan
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London UK Imperial College London, London, UK
| | - Pascale Du Pre
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Mae Johnson
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
| | - Nazima Pathan
- University Department of Paediatrics, Cambridge University, Cambridge, UK
| | | | - Alvina G Lai
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
| | - Deepti Gurdasani
- William Harvey Institute, Queen Mary University of London, London, UK
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Spiros Denaxas
- University College London (UCL) Institute of Health Informatics, UCL, London, UK
- University College London Hospitals Biomedical Research Centre, UCL, London, UK
| | - Sebastian Vollmer
- Department for Data Science and its Applications, German Research Centre for Artificial Intelligence (DFKI), Kaiserslautern, Germany
- Department of Computer Science, TU Kaiserslautern, Kaiserslautern, Germany
| | - Katherine Brown
- Institute of Cardiovascular Science, UCL, London, UK
- Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK
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8
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Elkheder M, Gonzalez-Izquierdo A, Qummer Ul Arfeen M, Kuan V, Lumbers RT, Denaxas S, Shah AD. Translating and evaluating historic phenotyping algorithms using SNOMED CT. J Am Med Inform Assoc 2023; 30:222-232. [PMID: 36083213 PMCID: PMC9846670 DOI: 10.1093/jamia/ocac158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/29/2022] [Revised: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Patient phenotype definitions based on terminologies are required for the computational use of electronic health records. Within UK primary care research databases, such definitions have typically been represented as flat lists of Read terms, but Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) (a widely employed international reference terminology) enables the use of relationships between concepts, which could facilitate the phenotyping process. We implemented SNOMED CT-based phenotyping approaches and investigated their performance in the CPRD Aurum primary care database. MATERIALS AND METHODS We developed SNOMED CT phenotype definitions for 3 exemplar diseases: diabetes mellitus, asthma, and heart failure, using 3 methods: "primary" (primary concept and its descendants), "extended" (primary concept, descendants, and additional relations), and "value set" (based on text searches of term descriptions). We also derived SNOMED CT codelists in a semiautomated manner for 276 disease phenotypes used in a study of health across the lifecourse. Cohorts selected using each codelist were compared to "gold standard" manually curated Read codelists in a sample of 500 000 patients from CPRD Aurum. RESULTS SNOMED CT codelists selected a similar set of patients to Read, with F1 scores exceeding 0.93, and age and sex distributions were similar. The "value set" and "extended" codelists had slightly greater recall but lower precision than "primary" codelists. We were able to represent 257 of the 276 phenotypes by a single concept hierarchy, and for 135 phenotypes, the F1 score was greater than 0.9. CONCLUSIONS SNOMED CT provides an efficient way to define disease phenotypes, resulting in similar patient populations to manually curated codelists.
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Affiliation(s)
- Musaab Elkheder
- Institute of Health Informatics, University College London, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK, London, UK
| | | | - Valerie Kuan
- Institute of Health Informatics, University College London, London, UK
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK.,Barts Health NHS Trust, London, UK.,University College London Hospitals NHS Trust, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK, London, UK.,British Heart Foundation Data Science Centre, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK.,University College London Hospitals NHS Trust, London, UK
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9
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Kuan V, Denaxas S, Patalay P, Nitsch D, Mathur R, Gonzalez-Izquierdo A, Sofat R, Partridge L, Roberts A, Wong ICK, Hingorani M, Chaturvedi N, Hemingway H, Hingorani AD. Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health 2023; 5:e16-e27. [PMID: 36460578 DOI: 10.1016/s2589-7500(22)00187-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Globally, there is a paucity of multimorbidity and comorbidity data, especially for minority ethnic groups and younger people. We estimated the frequency of common disease combinations and identified non-random disease associations for all ages in a multiethnic population. METHODS In this population-based study, we examined multimorbidity and comorbidity patterns stratified by ethnicity or race, sex, and age for 308 health conditions using electronic health records from individuals included on the Clinical Practice Research Datalink linked with the Hospital Episode Statistics admitted patient care dataset in England. We included individuals who were older than 1 year and who had been registered for at least 1 year in a participating general practice during the study period (between April 1, 2010, and March 31, 2015). We identified the most common combinations of conditions and comorbidities for index conditions. We defined comorbidity as the accumulation of additional conditions to an index condition over an individual's lifetime. We used network analysis to identify conditions that co-occurred more often than expected by chance. We developed online interactive tools to explore multimorbidity and comorbidity patterns overall and by subgroup based on ethnicity, sex, and age. FINDINGS We collected data for 3 872 451 eligible patients, of whom 1 955 700 (50·5%) were women and girls, 1 916 751 (49·5%) were men and boys, 2 666 234 (68·9%) were White, 155 435 (4·0%) were south Asian, and 98 815 (2·6%) were Black. We found that a higher proportion of boys aged 1-9 years (132 506 [47·8%] of 277 158) had two or more diagnosed conditions than did girls in the same age group (106 982 [40·3%] of 265 179), but more women and girls were diagnosed with multimorbidity than were boys aged 10 years and older and men (1 361 232 [80·5%] of 1 690 521 vs 1 161 308 [70·8%] of 1 639 593). White individuals (2 097 536 [78·7%] of 2 666 234) were more likely to be diagnosed with two or more conditions than were Black (59 339 [60·1%] of 98 815) or south Asian individuals (93 617 [60·2%] of 155 435). Depression commonly co-occurred with anxiety, migraine, obesity, atopic conditions, deafness, soft-tissue disorders, and gastrointestinal disorders across all subgroups. Heart failure often co-occurred with hypertension, atrial fibrillation, osteoarthritis, stable angina, myocardial infarction, chronic kidney disease, type 2 diabetes, and chronic obstructive pulmonary disease. Spinal fractures were most strongly non-randomly associated with malignancy in Black individuals, but with osteoporosis in White individuals. Hypertension was most strongly associated with kidney disorders in those aged 20-29 years, but with dyslipidaemia, obesity, and type 2 diabetes in individuals aged 40 years and older. Breast cancer was associated with different comorbidities in individuals from different ethnic groups. Asthma was associated with different comorbidities between males and females. Bipolar disorder was associated with different comorbidities in younger age groups compared with older age groups. INTERPRETATION Our findings and interactive online tools are a resource for: patients and their clinicians, to prevent and detect comorbid conditions; research funders and policy makers, to redesign service provision, training priorities, and guideline development; and biomedical researchers and manufacturers of medicines, to provide leads for research into common or sequential pathways of disease and inform the design of clinical trials. FUNDING UK Research and Innovation, Medical Research Council, National Institute for Health and Care Research, Department of Health and Social Care, Wellcome Trust, British Heart Foundation, and The Alan Turing Institute.
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Affiliation(s)
- Valerie Kuan
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK.
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; UCL BHF Research Accelerator, University College London, London, UK; Alan Turing Institute, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK; British Heart Foundation Data Science Centre, HDR UK, London, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, University College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Primary Care, Wolfson Institute of Primary Care, Queen Mary University of London, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK; British Heart Foundation Data Science Centre, HDR UK, London, UK
| | - Linda Partridge
- Institute of Healthy Ageing, Department of Genetics, Evolution and Environment, University College London, London, UK; Max Planck Institute for Biology of Ageing, Cologne, Germany
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Ian C K Wong
- School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | | | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK
| | - Aroon D Hingorani
- UCL BHF Research Accelerator, University College London, London, UK; Institute of Cardiovascular Science, University College London, London, UK; University College London Hospitals NIHR Biomedical Research Centre, London, UK
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10
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Syed S, Gonzalez-Izquierdo A, Allister J, Feder G, Li L, Gilbert R. Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study. Lancet Digit Health 2022; 4:e482-e496. [PMID: 35595677 DOI: 10.1016/s2589-7500(22)00061-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/14/2022] [Accepted: 03/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Electronic health records (EHRs) of mothers and children provide an opportunity to identify adverse childhood experiences (ACEs) during crucial periods of childhood development, yet well developed indicators of ACEs remain scarce. We aimed to develop clinically relevant indicators of ACEs for linked EHRs of mothers and children using a multistage prediction model of child maltreatment and maternal intimate partner violence (IPV). METHODS In this multistage development and validation study, we developed a representative population-based birth cohort of mothers and children in England, followed from up to 2 years before birth to up to 5 years after birth across the Clinical Practice Research Datalink (CPRD) GOLD (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics mortality register. We included livebirths in England between July 1, 2004, and June 30, 2016, to mothers aged 16-55 years, who had registered with a general practitioner (GP) that met CPRD quality standards before 21 weeks of gestation. The primary outcome (reference standard) was any child maltreatment or maternal IPV in either the mother's or child's record from 2 years before birth (maternal IPV only) to 5 years after birth. We used seven prediction models, combined with expert ratings, to systematically develop indicators. We validated the final indicators by integrating results from machine learning models, survival analyses, and clustering analyses in the validation cohort. FINDINGS We included data collected between July 1, 2002, and June 27, 2018. Of 376 006 eligible births, we included 211 393 mother-child pairs (422 786 patients) from 400 practices, of whom 126 837 mother-child pairs (60·0%; 240 practices) were randomly assigned to a derivation cohort and 84 556 pairs (40·0%; 160 practices) to a validation cohort. We included 63 indicators in six ACE domains: maternal mental health problems, maternal substance misuse, adverse family environments, child maltreatment, maternal IPV, and high-risk presentations of child maltreatment. Excluding the seven indicators in the reference standard, 56 indicators showed high discriminative validity for the reference standard of any child maltreatment or maternal IPV between 2 years before and 5 years after birth (validation cohort, area under the receiver operating characteristic curve 0·85 [95% CI 0·84-0·86]). During the 2 years before birth and 5 years after birth, the overall period prevalence of maternal IPV and child maltreatment (reference standard) was 2·3% (2876 of 126 837 pairs) in the derivation cohort and 2·3% (1916 of 84 556 pairs) in the validation cohort. During the 2 years before and after birth, the period prevalence was 39·1% (95% CI 38·7-39·5; 34 773 pairs) for any of the 63 ACE indicators, 22·2% (21·8-22·5%; 20 122 pairs) for maternal mental health problems, 15·7% (15·4-16·0%; 14 549 pairs) for adverse family environments, 8·1% (7·8-8·3%; 6808 pairs) for high-risk presentations of child maltreatment, 6·9% (6·7-7·2%; 7856 pairs) for maternal substance misuse, and 3·0% (2·9-3·2%; 2540 pairs) for any child maltreatment (2·4% [2·3-5·6%; 2051 pairs]) and maternal IPV (1·0% [0·8-1·0%; 875 pairs]). 62·6% (21 785 of 34 773 pairs) of ACEs were recorded in primary care only, and 72·3% (25 140 cases) were recorded in the maternal record only. INTERPRETATION We developed clinically relevant indicators for identifying ACEs using the EHRs of mothers and children presenting to general practices and hospital admissions. Over 70% of ACEs were identified via maternal records and were recorded in primary care by GPs within 2 years of birth, reinforcing the importance of reviewing parental and carer records to inform clinical responses to children. ACE indicators can contribute to longitudinal surveillance informing public health policy and resource allocation. Further evaluation is required to determine how ACE indicators can be used in clinical practice. FUNDING None.
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Affiliation(s)
- Shabeer Syed
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK; Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, UK.
| | | | | | - Gene Feder
- Centre for Academic Primary, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
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11
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White B, Rafiq M, Gonzalez-Izquierdo A, Hamilton W, Price S, Lyratzopoulos G. Risk of cancer following primary care presentation with fatigue: a population-based cohort study of a quarter of a million patients. Br J Cancer 2022; 126:1627-1636. [PMID: 35181753 PMCID: PMC9130200 DOI: 10.1038/s41416-022-01733-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The management of adults presenting with fatigue presents a diagnostic challenge, particularly regarding possible underlying cancer. METHODS Using electronic health records, we examined cancer risk in patients presenting to primary care with new-onset fatigue in England during 2007-2013, compared to general population estimates. We examined variation by age, sex, deprivation, and time following presentation. FINDINGS Of 250,606 patients presenting with fatigue, 12-month cancer risk exceeded 3% in men aged 65 and over and women aged 80 and over, and 6% in men aged 80 and over. Nearly half (47%) of cancers were diagnosed within 3 months from first fatigue presentation. Site-specific cancer risk was higher than the general population for most cancers studied, with greatest relative increases for leukaemia, pancreatic and brain cancers. CONCLUSIONS In older patients, new-onset fatigue is associated with cancer risk exceeding current thresholds for urgent specialist referral. Future research should consider how risk is modified by the presence or absence of other signs and symptoms. Excess cancer risk wanes rapidly after 3 months, which could inform the duration of a 'safety-netting' period. Fatigue presentation is not strongly predictive of any single cancer, although certain cancers are over-represented; this knowledge can help prioritise diagnostic strategies.
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Affiliation(s)
- Becky White
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, UK.
| | - Meena Rafiq
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Willie Hamilton
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Sarah Price
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, UK
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12
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Espuny Pujol F, Pagel C, Brown KL, Doidge JC, Feltbower RG, Franklin RC, Gonzalez-Izquierdo A, Gould DW, Norman LJ, Stickley J, Taylor JA, Crowe S. Linkage of National Congenital Heart Disease Audit data to hospital, critical care and mortality national data sets to enable research focused on quality improvement. BMJ Open 2022; 12:e057343. [PMID: 35589356 PMCID: PMC9121475 DOI: 10.1136/bmjopen-2021-057343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To link five national data sets (three registries, two administrative) and create longitudinal healthcare trajectories for patients with congenital heart disease (CHD), describing the quality and the summary statistics of the linked data set. DESIGN Bespoke linkage of record-level patient identifiers across five national data sets. Generation of spells of care defined as periods of time-overlapping events across the data sets. SETTING National Congenital Heart Disease Audit (NCHDA) procedures in public (National Health Service; NHS) hospitals in England and Wales, paediatric and adult intensive care data sets (Paediatric Intensive Care Audit Network; PICANet and the Case Mix Programme from the Intensive Care National Audit & Research Centre; ICNARC-CMP), administrative hospital episodes (hospital episode statistics; HES inpatient, outpatient, accident and emergency; A&E) and mortality registry data. PARTICIPANTS Patients with any CHD procedure recorded in NCHDA between April 2000 and March 2017 from public hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: number of linked records, number of unique patients and number of generated spells of care. Secondary: quality and completeness of linkage. RESULTS There were 143 862 records in NCHDA relating to 96 041 unique patients. We identified 65 797 linked PICANet patient admissions, 4664 linked ICNARC-CMP admissions and over 6 million linked HES episodes of care (1.1M inpatient, 4.7M outpatient). The linked data set had 4 908 153 spells of care after quality checks, with a median (IQR) of 3.4 (1.8-6.3) spells per patient-year. Where linkage was feasible (in terms of year and centre), 95.6% surgical procedure records were linked to a corresponding HES record, 93.9% paediatric (cardiac) surgery procedure records to a corresponding PICANet admission and 76.8% adult surgery procedure records to a corresponding ICNARC-CMP record. CONCLUSIONS We successfully linked four national data sets to the core data set of all CHD procedures performed between 2000 and 2017. This will enable a much richer analysis of longitudinal patient journeys and outcomes. We hope that our detailed description of the linkage process will be useful to others looking to link national data sets to address important research priorities.
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Affiliation(s)
- Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Katherine L Brown
- Cardiorespiratory Division, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - James C Doidge
- Intensive Care National Audit and Research Centre, London, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Rodney C Franklin
- Department of Paediatric Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Doug W Gould
- Intensive Care National Audit and Research Centre, London, UK
| | - Lee J Norman
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - John Stickley
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Julie A Taylor
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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13
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Dashtban M, Mizani M, Gonzalez-Izquierdo A, Corbett R, Quint J, Denaxas S, Mamza J, Morris T, Hemingway H, Banerjee A. POS-283 HIERARCHICAL CLUSTERING FOR SUBTYPE DISCOVERY OF INCIDENT CHRONIC KIDNEY DISEASE FROM LARGE LONGITUDINAL ELECTRONIC HEALTH RECORDS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Pathak N, Zhang CX, Boukari Y, Burns R, Mathur R, Gonzalez-Izquierdo A, Denaxas S, Sonnenberg P, Hayward A, Aldridge RW. Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK. Int J Environ Res Public Health 2021; 18:13304. [PMID: 34948912 PMCID: PMC8707886 DOI: 10.3390/ijerph182413304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Abstract
International migrants comprised 14% of the UK's population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups.
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Affiliation(s)
- Neha Pathak
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Guy’s & St. Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Claire X. Zhang
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK;
| | - Andrew Hayward
- Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Robert W. Aldridge
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
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15
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Josephson CB, Wiebe S, Delgado-Garcia G, Gonzalez-Izquierdo A, Denaxas S, Sajobi TT, Lamidi M, Wang M, Keezer MR. Association of Enzyme-Inducing Antiseizure Drug Use With Long-term Cardiovascular Disease. JAMA Neurol 2021; 78:1367-1374. [PMID: 34605857 DOI: 10.1001/jamaneurol.2021.3424] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Enzyme-inducing antiseizure medications (eiASMs) have been hypothesized to be associated with long-term risks of cardiovascular disease. Objective To quantify and model the putative hazard of cardiovascular disease secondary to eiASM use. Design, Setting, and Participants This cohort study covered January 1990 to March 2019 (median [IQR] follow-up, 9 [4-15], years). The study linked primary care and hospital electronic health records at National Health Service hospitals in England. People aged 18 years or older diagnosed as having epilepsy after January 1, 1990, were included. All eligible patients were included with a waiver of consent. No patients were approached who withdrew consent. Analysis began January 2021 and ended August 2021. Exposures Receipt of 4 consecutive eiASMs (carbamazepine, eslicarbazepine, oxcarbazepine, phenobarbital, phenytoin, primidone, rufinamide, or topiramate) following an adult-onset (age ≥18 years) epilepsy diagnosis or repeated exposure in a weighted cumulative exposure model. Main Outcomes and Measures Three cohorts were isolated, 1 of which comprised all adults meeting a case definition for epilepsy diagnosed after 1990, 1 comprised incident cases diagnosed after 1998 (hospital linkage date), and 1 was limited to adults diagnosed with epilepsy at 65 years or older. Outcome was incident cardiovascular disease (ischemic heart disease or ischemic or hemorrhagic stroke). Hazard of incident cardiovascular disease was evaluated using adjusted propensity-matched survival analyses and weighted cumulative exposure models. Results Of 10 916 166 adults, 50 888 (0.6%) were identified as having period-prevalent cases (median [IQR] age, 32 [19-50] years; 16 584 [53%] female), of whom 31 479 (62%) were diagnosed on or after 1990 and were free of cardiovascular disease at baseline. In a propensity-matched Cox proportional hazards model adjusted for age, sex, baseline socioeconomic status, and cardiovascular risk factors, the hazard ratio for incident cardiovascular disease was 1.21 (95% CI, 1.06-1.39) for those receiving eiASMs. The absolute difference in cumulative hazard diverges by more than 1% and greater after 10 years. For those with persistent exposure beyond 4 prescriptions, the median hazard ratio increased from amedian (IQR) of 1.54 (1.28-1.79) when taking a relative defined daily dose of an eiASM of 1 to 2.38 (1.52-3.56) with a relative defined daily dose of 2 throughout a maximum of 25 years' follow-up compared with those not receiving an eiASM. The hazard was elevated but attenuated when restricting analyses to incident cases or those diagnosed when older than 65 years. Conclusions and Relevance The hazard of incident cardiovascular disease is higher in those receiving eiASMs. The association is dose dependent and the absolute difference in hazard seems to reach clinical significance by approximately 10 years from first exposure.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guillermo Delgado-Garcia
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arturo Gonzalez-Izquierdo
- UCL Institute of Health Informatics, London, United Kingdom.,Health Data Research, London, United Kingdom
| | - Spiros Denaxas
- UCL Institute of Health Informatics, London, United Kingdom.,Health Data Research, London, United Kingdom.,Alan Turing Institute, London, United Kingdom
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Mubasiru Lamidi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meng Wang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark R Keezer
- Department of Neurosciences, Université de Montreal, Montreal, Quebec, Canada
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16
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Subota A, Jetté N, Josephson CB, McMillan J, Keezer MR, Gonzalez-Izquierdo A, Holroyd-Leduc J. Risk factors for dementia development, frailty, and mortality in older adults with epilepsy - A population-based analysis. Epilepsy Behav 2021; 120:108006. [PMID: 33964541 DOI: 10.1016/j.yebeh.2021.108006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although the prevalence of comorbid epilepsy and dementia is expected to increase, the impact is not well understood. Our objectives were to examine risk factors associated with incident dementia and the impact of frailty and dementia on mortality in older adults with epilepsy. METHODS The CALIBER scientific platform was used. People with incident epilepsy at or after age 65 were identified using Read codes and matched by age, sex, and general practitioner to a cohort without epilepsy (10:1). Baseline cohort characteristics were compared using conditional logistic regression models. Multivariate Cox proportional hazard regression models were used to examine the impact of frailty and dementia on mortality, and to assess risk factors for dementia development. RESULTS One thousand forty eight older adults with incident epilepsy were identified. The odds of having dementia at baseline were 7.39 [95% CI 5.21-10.50] times higher in older adults with epilepsy (n = 62, 5.92%) compared to older adults without epilepsy (n = 88, 0.86%). In the final multivariate Cox model (n = 326), age [HR: 1.20, 95% CI 1.09-1.32], Charlson comorbidity index score [HR: 1.26, 95% CI 1.10-1.44], and sleep disturbances [HR: 2.41, 95% CI 1.07-5.43] at baseline epilepsy diagnosis were significantly associated with an increased hazard of dementia development over the follow-up period. In a multivariate Cox model (n = 1047), age [HR: 1.07, 95% CI 1.03-1.11], baseline dementia [HR: 2.66, 95% CI 1.65-4.27] and baseline e-frailty index score [HR: 11.55, 95% CI 2.09-63.84] were significantly associated with a higher hazard of death among those with epilepsy. Female sex [HR: 0.77, 95% CI 0.59-0.99] was associated with a lower hazard of death. SIGNIFICANCE The odds of having dementia were higher in older adults with incident epilepsy. A higher comorbidity burden acts as a risk factor for dementia, while prevalent dementia and increasing frailty were associated with mortality.
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Affiliation(s)
- Ann Subota
- Department of Medicine, University of Calgary, North Tower, 1403-29 St NW, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, New York, NY 10029, USA
| | - Colin B Josephson
- Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Clinical Neurosciences, University of Calgary, 1195 1403-29 Street NW, Calgary, AB T2N 2T9, Canada; Hotchkiss Brain Institute, University of Calgary, 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Health Services, Foothills Medical Centre, 1403-29 St. NW, Calgary, Alberta T2N 2T9, Canada
| | - Jaqueline McMillan
- Department of Medicine, University of Calgary, North Tower, 1403-29 St NW, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Alberta Health Services, Foothills Medical Centre, 1403-29 St. NW, Calgary, Alberta T2N 2T9, Canada; O'Brien Institute for Public Health, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Mark R Keezer
- Research Center of the Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal, QC H2X 3E4, Canada
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Jayna Holroyd-Leduc
- Department of Medicine, University of Calgary, North Tower, 1403-29 St NW, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, 3D10 - 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, 1A10 - 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Health Services, Foothills Medical Centre, 1403-29 St. NW, Calgary, Alberta T2N 2T9, Canada; O'Brien Institute for Public Health, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
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17
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Lewer D, Padmanathan P, Qummer ul Arfeen M, Denaxas S, Forbes H, Gonzalez-Izquierdo A, Hickman M. Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England. Wellcome Open Res 2021; 5:282. [PMID: 33659712 PMCID: PMC7901498 DOI: 10.12688/wellcomeopenres.16431.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background: People who use illicit opioids such as heroin have substantial health needs, but there are few longitudinal studies of general health and healthcare in this population. Most research to date has focused on a narrow set of outcomes, including overdoses and HIV or hepatitis infections. We developed and validated a cohort using UK primary care electronic health records (Clinical Practice Research Datalink GOLD and AURUM databases) to facilitate research into healthcare use by people who use illicit opioid use (HUPIO). Methods: Participants are patients in England with primary care records indicating a history of illicit opioid use. We identified codes including prescriptions of opioid agonist therapies (methadone and buprenorphine) and clinical observations such as 'heroin dependence'. We constructed a cohort of patients with at least one of these codes and aged 18-64 at cohort entry, with follow-up between January 1997 and March 2020. We validated the cohort by comparing patient characteristics and mortality rates to other cohorts of people who use illicit opioids, with different recruitment methods. Results: Up to March 2020, the HUPIO cohort included 138,761 patients with a history of illicit opioid use. Demographic characteristics and all-cause mortality were similar to existing cohorts: 69% were male; the median age at index for patients in CPRD AURUM (the database with more included participants) was 35.3 (interquartile range 29.1-42.6); the average age of new cohort entrants increased over time; 76% had records indicating current tobacco smoking; patients disproportionately lived in deprived neighbourhoods; and all-cause mortality risk was 6.6 (95% CI 6.5-6.7) times the general population of England. Conclusions: Primary care data offer new opportunities to study holistic health outcomes and healthcare of this population. The large sample enables investigation of rare outcomes, whilst the availability of linkage to external datasets allows investigation of hospital use, cancer treatment, and mortality.
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Affiliation(s)
- Dan Lewer
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Healthcare, University College London, London, WC1E 7HB, UK
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | | | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Harriet Forbes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | | | - Matt Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- National Institute of Health Research Biomedical Research Centre, Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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18
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Kuan V, Fraser HC, Hingorani M, Denaxas S, Gonzalez-Izquierdo A, Direk K, Nitsch D, Mathur R, Parisinos CA, Lumbers RT, Sofat R, Wong ICK, Casas JP, Thornton JM, Hemingway H, Partridge L, Hingorani AD. Data-driven identification of ageing-related diseases from electronic health records. Sci Rep 2021; 11:2938. [PMID: 33536532 PMCID: PMC7859412 DOI: 10.1038/s41598-021-82459-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/03/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022] Open
Abstract
Reducing the burden of late-life morbidity requires an understanding of the mechanisms of ageing-related diseases (ARDs), defined as diseases that accumulate with increasing age. This has been hampered by the lack of formal criteria to identify ARDs. Here, we present a framework to identify ARDs using two complementary methods consisting of unsupervised machine learning and actuarial techniques, which we applied to electronic health records (EHRs) from 3,009,048 individuals in England using primary care data from the Clinical Practice Research Datalink (CPRD) linked to the Hospital Episode Statistics admitted patient care dataset between 1 April 2010 and 31 March 2015 (mean age 49.7 years (s.d. 18.6), 51% female, 70% white ethnicity). We grouped 278 high-burden diseases into nine main clusters according to their patterns of disease onset, using a hierarchical agglomerative clustering algorithm. Four of these clusters, encompassing 207 diseases spanning diverse organ systems and clinical specialties, had rates of disease onset that clearly increased with chronological age. However, the ages of onset for these four clusters were strikingly different, with median age of onset 82 years (IQR 82–83) for Cluster 1, 77 years (IQR 75–77) for Cluster 2, 69 years (IQR 66–71) for Cluster 3 and 57 years (IQR 54–59) for Cluster 4. Fitting to ageing-related actuarial models confirmed that the vast majority of these 207 diseases had a high probability of being ageing-related. Cardiovascular diseases and cancers were highly represented, while benign neoplastic, skin and psychiatric conditions were largely absent from the four ageing-related clusters. Our framework identifies and clusters ARDs and can form the basis for fundamental and translational research into ageing pathways.
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Affiliation(s)
- Valerie Kuan
- Institute of Health Informatics, University College London, London, UK. .,Health Data Research UK London, University College London, London, UK. .,University College London British Heart Foundation Research Accelerator, London, UK.
| | - Helen C Fraser
- Institute of Healthy Ageing, Department of Genetics, Evolution and Environment, University College London, London, UK
| | | | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK London, University College London, London, UK.,University College London British Heart Foundation Research Accelerator, London, UK.,Alan Turing Institute, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK London, University College London, London, UK
| | - Kenan Direk
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK London, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK London, University College London, London, UK.,University College London British Heart Foundation Research Accelerator, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Reecha Sofat
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK London, University College London, London, UK.,University College London British Heart Foundation Research Accelerator, London, UK
| | - Ian C K Wong
- School of Pharmacy, University College London, London, WC1N 1AX, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Juan P Casas
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Janet M Thornton
- European Molecular Biology Laboratory - European Bioinformatics Institute EMBL-EBI, Wellcome Genome Campus, Hinxton, Cambridgeshire, CB10 1SD, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK.,Health Data Research UK London, University College London, London, UK.,University College London British Heart Foundation Research Accelerator, London, UK.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, W1T 7DN, UK
| | - Linda Partridge
- Institute of Healthy Ageing, Department of Genetics, Evolution and Environment, University College London, London, UK.,Max Planck Institute for Biology of Ageing, Cologne, Germany
| | - Aroon D Hingorani
- Health Data Research UK London, University College London, London, UK.,University College London British Heart Foundation Research Accelerator, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
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19
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Syed S, Ashwick R, Schlosser M, Gonzalez-Izquierdo A, Li L, Gilbert R. Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis. Arch Dis Child 2021; 106:44-53. [PMID: 32788201 PMCID: PMC7788194 DOI: 10.1136/archdischild-2020-319027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Electronic health records (EHRs) are routinely used to identify family violence, yet reliable evidence of their validity remains limited. We conducted a systematic review and meta-analysis to evaluate the positive predictive values (PPVs) of coded indicators in EHRs for identifying intimate partner violence (IPV) and child maltreatment (CM), including prenatal neglect. METHODS We searched 18 electronic databases between January 1980 and May 2020 for studies comparing any coded indicator of IPV or CM including prenatal neglect defined as neonatal abstinence syndrome (NAS) or fetal alcohol syndrome (FAS), against an independent reference standard. We pooled PPVs for each indicator using random effects meta-analyses. RESULTS We included 88 studies (3 875 183 individuals) involving 15 indicators for identifying CM in the prenatal period and childhood (0-18 years) and five indicators for IPV among women of reproductive age (12-50 years). Based on the International Classification of Disease system, the pooled PPV was over 80% for NAS (16 studies) but lower for FAS (<40%; seven studies). For young children, primary diagnoses of CM, specific injury presentations (eg, rib fractures and retinal haemorrhages) and assaults showed a high PPV for CM (pooled PPVs: 55.9%-87.8%). Indicators of IPV in women had a high PPV, with primary diagnoses correctly identifying IPV in >85% of cases. CONCLUSIONS Coded indicators in EHRs have a high likelihood of correctly classifying types of CM and IPV across the life course, providing a useful tool for assessment, support and monitoring of high-risk groups in health services and research.
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Affiliation(s)
- Shabeer Syed
- UCL Great Ormond Street Institute of Child Health, Population, Policy and Practice, University College London, London, UK
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Rachel Ashwick
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Marco Schlosser
- Division of Psychiatry, University College London, London, UK
| | | | - Leah Li
- UCL Great Ormond Street Institute of Child Health, Population, Policy and Practice, University College London, London, UK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, Population, Policy and Practice, University College London, London, UK
- Institute of Health Informatics and Health Data Research UK, University College London, London, UK
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20
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Lewer D, Padmanathan P, Qummer ul Arfeen M, Denaxas S, Forbes H, Gonzalez-Izquierdo A, Hickman M. Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England. Wellcome Open Res 2020; 5:282. [PMID: 33659712 PMCID: PMC7901498 DOI: 10.12688/wellcomeopenres.16431.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/20/2022] Open
Abstract
Background: People who use illicit opioids such as heroin have substantial health needs, but there are few longitudinal studies of general health and healthcare in this population. Most research to date has focused on a narrow set of outcomes, including overdoses and HIV or hepatitis infections. We developed and validated a cohort using UK primary care electronic health records (Clinical Practice Research Datalink GOLD and AURUM databases) to facilitate research into healthcare use by people who use illicit opioid use (HUPIO). Methods: Participants are patients in England with primary care records indicating a history of illicit opioid use. We identified codes including prescriptions of opioid agonist therapies (methadone and buprenorphine) and clinical observations such as 'heroin dependence'. We constructed a cohort of patients with at least one of these codes and aged 18-64 at cohort entry, with follow-up between January 1997 and March 2020. We validated the cohort by comparing patient characteristics and mortality rates to other cohorts of people who use illicit opioids, with different recruitment methods. Results: Up to March 2020, the HUPIO cohort included 138,761 patients with a history of illicit opioid use. Demographic characteristics and all-cause mortality were similar to existing cohorts: 69% were male; the median age at index for patients in CPRD AURUM (the database with more included participants) was 35.3 (IQR 29.1-42.6); the average age of new cohort entrants increased over time; 76% had records indicating current tobacco smoking; patients disproportionately lived in deprived neighbourhoods; and all-cause mortality risk was 5.4 (95% CI 5.3-5.5) times the general population of England. Conclusions: Primary care data offer new opportunities to study holistic health outcomes and healthcare of this population. The large sample enables investigation of rare outcomes, whilst the availability of linkage to external datasets allows investigation of hospital use, cancer treatment, and mortality.
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Affiliation(s)
- Dan Lewer
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Healthcare, University College London, London, WC1E 7HB, UK
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | | | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Harriet Forbes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | | | - Matt Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- National Institute of Health Research Biomedical Research Centre, Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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21
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Pathak N, Patel P, Mathur R, Burns R, Gonzalez-Izquierdo A, Denaxas S, Sonnenberg P, Hayward A, Aldridge R. Validity of UK electronic health records to study migrant health: a population-based cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.768] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
An estimated 14.3% (9.4 million people) of people living in the UK in 2019 were international migrants. Despite this, little is known about how migrants access and use healthcare services. To use electronic healthcare records (EHRs) to study migration health, a valid migration phenotype is necessary: a transparent reproducible algorithm using clinical terminology codes to determine migration status. We have previously described the validity of a migration phenotype in CALIBER data using the Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR. This study further evaluates the phenotype by examining certainty of migration status.
Methods
This is a population-based cohort study of individuals in CPRD Gold (1997-2018) with a Read term indicating migration to the UK. We describe completeness of recording of migration over time: percentage of individuals recorded as migrants. We also describe cohort size based on certainty of migration status: “definite” (country of birth or visa status terms), “probable” (non-English first/main language terms), and “possible” (non-UK origin terms).
Results
Overall, 2.5% (403,768/16,071,111) of CPRD had ≥1 of 434 terms indicating migration to the UK. The percentage of recorded migrants per year increased from 0.2% (4,417/2,210,551) in 1997 to 3.64% (100,626/2,761,397) in 2018, following a similar trend to national migration data. 44.27% (178,749/403,768) were “definite” migrants and 53.68% (216,731/403,768) were “probable” migrants. Only 2.05%(8,288/16,071,111) were “possible” migrants.
Conclusions
We have created a large cohort of international migrants in the UK and certainty of migration status is high. This cohort can be used to study migration health in UK primary care EHR. The large contribution of language terms make this phenotype particularly suitable for understanding healthcare access and use by non-English speaking migrants who may face additional barriers to care.
Key messages
We have developed a way to study migration health in UK primary care electronic health records. Our method is particularly useful to study healthcare for non-English speaking migrants who may face additional barriers to care.
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Affiliation(s)
- N Pathak
- Institute of Health Informatics, University College London, London, UK
| | - P Patel
- Institute of Health Informatics, University College London, London, UK
| | - R Mathur
- Department of Non-communicable Disease Epidemiology, LSHTM, London, UK
| | - R Burns
- Institute of Health Informatics, University College London, London, UK
| | | | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - P Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - A Hayward
- Institute for Epidemiology and Healthcare, University College London, London, UK
| | - R Aldridge
- Institute of Health Informatics, University College London, London, UK
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22
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Banerjee A, Pasea L, Harris S, Gonzalez-Izquierdo A, Torralbo A, Shallcross L, Noursadeghi M, Pillay D, Sebire N, Holmes C, Pagel C, Wong WK, Langenberg C, Williams B, Denaxas S, Hemingway H. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. Lancet 2020; 395:1715-1725. [PMID: 32405103 PMCID: PMC7217641 DOI: 10.1016/s0140-6736(20)30854-0] [Citation(s) in RCA: 306] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The medical, societal, and economic impact of the coronavirus disease 2019 (COVID-19) pandemic has unknown effects on overall population mortality. Previous models of population mortality are based on death over days among infected people, nearly all of whom thus far have underlying conditions. Models have not incorporated information on high-risk conditions or their longer-term baseline (pre-COVID-19) mortality. We estimated the excess number of deaths over 1 year under different COVID-19 incidence scenarios based on varying levels of transmission suppression and differing mortality impacts based on different relative risks for the disease. METHODS In this population-based cohort study, we used linked primary and secondary care electronic health records from England (Health Data Research UK-CALIBER). We report prevalence of underlying conditions defined by Public Health England guidelines (from March 16, 2020) in individuals aged 30 years or older registered with a practice between 1997 and 2017, using validated, openly available phenotypes for each condition. We estimated 1-year mortality in each condition, developing simple models (and a tool for calculation) of excess COVID-19-related deaths, assuming relative impact (as relative risks [RRs]) of the COVID-19 pandemic (compared with background mortality) of 1·5, 2·0, and 3·0 at differing infection rate scenarios, including full suppression (0·001%), partial suppression (1%), mitigation (10%), and do nothing (80%). We also developed an online, public, prototype risk calculator for excess death estimation. FINDINGS We included 3 862 012 individuals (1 957 935 [50·7%] women and 1 904 077 [49·3%] men). We estimated that more than 20% of the study population are in the high-risk category, of whom 13·7% were older than 70 years and 6·3% were aged 70 years or younger with at least one underlying condition. 1-year mortality in the high-risk population was estimated to be 4·46% (95% CI 4·41-4·51). Age and underlying conditions combined to influence background risk, varying markedly across conditions. In a full suppression scenario in the UK population, we estimated that there would be two excess deaths (vs baseline deaths) with an RR of 1·5, four with an RR of 2·0, and seven with an RR of 3·0. In a mitigation scenario, we estimated 18 374 excess deaths with an RR of 1·5, 36 749 with an RR of 2·0, and 73 498 with an RR of 3·0. In a do nothing scenario, we estimated 146 996 excess deaths with an RR of 1·5, 293 991 with an RR of 2·0, and 587 982 with an RR of 3·0. INTERPRETATION We provide policy makers, researchers, and the public a simple model and an online tool for understanding excess mortality over 1 year from the COVID-19 pandemic, based on age, sex, and underlying condition-specific estimates. These results signal the need for sustained stringent suppression measures as well as sustained efforts to target those at highest risk because of underlying conditions with a range of preventive interventions. Countries should assess the overall (direct and indirect) effects of the pandemic on excess mortality. FUNDING National Institute for Health Research University College London Hospitals Biomedical Research Centre, Health Data Research UK.
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK; University College London Hospitals NHS Trust, London, UK; Barts Health NHS Trust, The Royal London Hospital, London, UK.
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | - Steve Harris
- University College London Hospitals NHS Trust, London, UK
| | | | - Ana Torralbo
- Institute of Health Informatics, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, UK
| | | | - Chris Holmes
- University of Oxford, Oxford, UK; Alan Turing Institute, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Wai Keong Wong
- University College London Hospitals NHS Trust, London, UK
| | | | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, UK; University College London Hospitals NHS Trust, London, UK; University College London Hospitals National Institute for Health Research Biomedical Research Centre, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK; Alan Turing Institute, London, UK; Health Data Research UK, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, London, UK
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23
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Rafiq M, Hayward A, Warren-Gash C, Denaxas S, Gonzalez-Izquierdo A, Lyratzopoulos G, Thomas S. Allergic disease, corticosteroid use, and risk of Hodgkin lymphoma: A United Kingdom nationwide case-control study. J Allergy Clin Immunol 2020; 145:868-876. [PMID: 31730878 PMCID: PMC7057259 DOI: 10.1016/j.jaci.2019.10.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Immunodeficiency syndromes (acquired/congenital/iatrogenic) are known to increase Hodgkin lymphoma (HL) risk, but the effects of allergic immune dysregulation and corticosteroids are poorly understood. OBJECTIVE We sought to assess the risk of HL associated with allergic disease (asthma, eczema, and allergic rhinitis) and corticosteroid use. METHODS We conducted a case-control study using the United Kingdom Clinical Practice Research Datalink (CPRD) linked to hospital data. Multivariable logistic regression investigated associations between allergic diseases and HL after adjusting for established risk factors. Potential confounding or effect modification by steroid treatment were examined. RESULTS One thousand two hundred thirty-six patients with HL were matched to 7416 control subjects. Immunosuppression was associated with 6-fold greater odds of HL (adjusted odds ratio [aOR], 6.18; 95% CI, 3.04-12.57), with minimal change after adjusting for steroids. Any prior allergic disease or eczema alone was associated with 1.4-fold increased odds of HL (aOR, 1.41 [95% CI, 1.24-1.60] and 1.41 [95% CI, 1.20-1.65], respectively). These associations decreased but remained significant after adjustment for steroids (aOR, 1.25 [95% CI, 1.09-1.43] and 1.27 [95% CI, 1.08-1.49], respectively). There was no effect modification by steroid use. Previous steroid treatment was associated with 1.4-fold greater HL odds (aOR, 1.38; 95% CI, 1.20-1.59). CONCLUSIONS In addition to established risk factors (immunosuppression and infectious mononucleosis), allergic disease and eczema are risk factors for HL. This association is only partially explained by steroids, which are associated with increased HL risk. These findings add to the growing evidence that immune system malfunction after allergic disease or immunosuppression is central to HL development.
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Affiliation(s)
- Meena Rafiq
- Institute of Health Informatics, UCL, London, United Kingdom.
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, UCL, London, United Kingdom
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Spiros Denaxas
- Institute of Health Informatics, UCL, London, United Kingdom
| | | | | | - Sara Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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24
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Bromage DI, Godec TR, Pujades-Rodriguez M, Gonzalez-Izquierdo A, Denaxas S, Hemingway H, Yellon DM. Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study. Cardiovasc Diabetol 2019; 18:168. [PMID: 31815634 PMCID: PMC6900858 DOI: 10.1186/s12933-019-0972-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background The use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortality in people with type 2 diabetes mellitus (T2DM). However, it is not known if it is acutely cardioprotective in patients taking metformin at the time of AMI. We compared patient outcomes according to metformin status at the time of admission for fatal and non-fatal AMI in a large cohort of patients in England. Methods This study used linked data from primary care, hospital admissions and death registry from 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of acute myocardial infarction requiring hospitalisation, stroke and cardiovascular death. The secondary endpoints were heart failure (HF) hospitalisation and all-cause mortality. Results 4,030 patients with T2DM and incident AMI recorded between January 1998 and October 2010 were included. At AMI admission, 63.9% of patients were receiving metformin and 36.1% another oral hypoglycaemic drug. Median follow-up was 343 (IQR: 1–1436) days. Adjusted analyses showed an increased hazard of the composite endpoint in metformin users compared to non-users (HR 1.09 [1.01–1.19]), but not of the secondary endpoints. The higher risk of the composite endpoint in metformin users was only observed in people taking metformin at AMI admission, whereas metformin use post-AMI was associated with a reduction in risk of all-cause mortality (0.76 [0.62–0.93], P = 0.009). Conclusions Our study suggests that metformin use at the time of first AMI is associated with increased risk of cardiovascular disease and death in patients with T2DM, while its use post-AMI might be beneficial. Further investigation in well-designed randomised controlled trials is indicated, especially in view of emerging evidence of cardioprotection from sodium-glucose co-transporter-2 (SGLT2) inhibitors.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.,School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Tom R Godec
- The London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Mar Pujades-Rodriguez
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JL, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.,Health Data Research UK London, University College London, 222 Euston Road, London, NW1 2DA, UK.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.,Health Data Research UK London, University College London, 222 Euston Road, London, NW1 2DA, UK.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.,Health Data Research UK London, University College London, 222 Euston Road, London, NW1 2DA, UK.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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25
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Denaxas S, Gonzalez-Izquierdo A, Direk K, Fitzpatrick NK, Fatemifar G, Banerjee A, Dobson RJB, Howe LJ, Kuan V, Lumbers RT, Pasea L, Patel RS, Shah AD, Hingorani AD, Sudlow C, Hemingway H. UK phenomics platform for developing and validating electronic health record phenotypes: CALIBER. J Am Med Inform Assoc 2019; 26:1545-1559. [PMID: 31329239 PMCID: PMC6857510 DOI: 10.1093/jamia/ocz105] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/25/2019] [Accepted: 05/29/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Electronic health records (EHRs) are a rich source of information on human diseases, but the information is variably structured, fragmented, curated using different coding systems, and collected for purposes other than medical research. We describe an approach for developing, validating, and sharing reproducible phenotypes from national structured EHR in the United Kingdom with applications for translational research. MATERIALS AND METHODS We implemented a rule-based phenotyping framework, with up to 6 approaches of validation. We applied our framework to a sample of 15 million individuals in a national EHR data source (population-based primary care, all ages) linked to hospitalization and death records in England. Data comprised continuous measurements (for example, blood pressure; medication information; coded diagnoses, symptoms, procedures, and referrals), recorded using 5 controlled clinical terminologies: (1) read (primary care, subset of SNOMED-CT [Systematized Nomenclature of Medicine Clinical Terms]), (2) International Classification of Diseases-Ninth Revision and Tenth Revision (secondary care diagnoses and cause of mortality), (3) Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, Fourth Revision (hospital surgical procedures), and (4) DM+D prescription codes. RESULTS Using the CALIBER phenotyping framework, we created algorithms for 51 diseases, syndromes, biomarkers, and lifestyle risk factors and provide up to 6 validation approaches. The EHR phenotypes are curated in the open-access CALIBER Portal (https://www.caliberresearch.org/portal) and have been used by 40 national and international research groups in 60 peer-reviewed publications. CONCLUSIONS We describe a UK EHR phenomics approach within the CALIBER EHR data platform with initial evidence of validity and use, as an important step toward international use of UK EHR data for health research.
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Affiliation(s)
- Spiros Denaxas
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
- British Heart Foundation Research Accelerator, University College London, London, United Kingdom
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
| | - Kenan Direk
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Ghazaleh Fatemifar
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- British Heart Foundation Research Accelerator, University College London, London, United Kingdom
| | - Richard J B Dobson
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
- British Heart Foundation Research Accelerator, University College London, London, United Kingdom
| | - Laurence J Howe
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Valerie Kuan
- Health Data Research UK, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - R Tom Lumbers
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- British Heart Foundation Research Accelerator, University College London, London, United Kingdom
| | - Laura Pasea
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Riyaz S Patel
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- British Heart Foundation Research Accelerator, University College London, London, United Kingdom
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- British Heart Foundation Research Accelerator, University College London, London, United Kingdom
| | - Aroon D Hingorani
- Health Data Research UK, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Cathie Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Science and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Health Data Research UK, Scotland, United Kingdom
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London,United Kingdom
- Health Data Research UK, London, United Kingdom
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, United Kingdom
- British Heart Foundation Research Accelerator, University College London, London, United Kingdom
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26
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Williamson E, Denaxas S, Morris S, Clarke CS, Thomas M, Evans H, Direk K, Gonzalez-Izquierdo A, Little P, Lund V, Blackshaw H, Schilder A, Philpott C, Hopkins C, Carpenter J, Programme Team OBOTM. Risk of mortality and cardiovascular events following macrolide prescription in chronic rhinosinusitis patients: a cohort study using linked primary care electronic health records. Rhinology 2019; 57:252-260. [PMID: 30928998 DOI: 10.4193/rhin18.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes, associated with macrolide use. METHODOLOGY Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac arrhythmia. RESULTS Analysis included 320,798 prescriptions received by 66,331 patients. There were 3,251 deaths, 815 due to cardiovascular causes, 925 incident myocardial infarctions, 859 strokes, 637 diagnoses of peripheral vascular disease, and 1,436 cardiac arrhythmias. A non-statistically significant trend towards increased risk of myocardial infarction during the first 30 days following macrolide prescription was observed. No statistically significant short- or long-term risks were observed for macrolide prescription. No significant risks were identified for clarithromycin in particular. CONCLUSIONS Although not statistically significant, our best estimates suggest an increased short-term risk of myocardial infarction in patients with CRS following macrolide prescription, supporting previous observational evidence. However, confounding by indication remains a possible explanation for this apparent increased risk. We found no evidence of longer term increased risks.
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Affiliation(s)
- E Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK; HDR UK, London, UK
| | - S Denaxas
- HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
| | - C S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - M Thomas
- Primary Care and Population Science, University of Southampton, UK
| | - H Evans
- HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK; Ear Institute, UCL, London, UK
| | - K Direk
- Institute of Health Informatics, UCL, London, UK
| | | | - P Little
- Primary Care and Population Science, University of Southampton, UK
| | - V Lund
- Ear Institute, UCL, London, UK
| | | | | | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
| | - C Hopkins
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Carpenter
- Department of Medical Statistics, London School of Hygiene
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27
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Leon LJ, McCarthy FP, Direk K, Gonzalez-Izquierdo A, Prieto-Merino D, Casas JP, Chappell L. Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records. Circulation 2019; 140:1050-1060. [DOI: 10.1161/circulationaha.118.038080] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The associations between pregnancy hypertensive disorders and common cardiovascular disorders have not been investigated at scale in a contemporaneous population. We aimed to investigate the association between preeclampsia, hypertensive disorders of pregnancy, and subsequent diagnosis of 12 different cardiovascular disorders.
Methods:
We used linked electronic health records from 1997 to 2016 to recreate a UK population-based cohort of 1.3 million women, mean age at delivery 28 years, with nearly 1.9 million completed pregnancies. We used multivariable Cox models to determine the associations between hypertensive disorders of pregnancy, and preeclampsia alone (term and preterm), with 12 cardiovascular disorders in addition to chronic hypertension. We estimated the cumulative incidence of a composite end point of any cardiovascular disorder according to preeclampsia exposure.
Results:
During the 20-year study period, 18 624 incident cardiovascular disorders were observed, 65% of which had occurred in women under 40 years. Compared to women without hypertension in pregnancy, women who had 1 or more pregnancies affected by preeclampsia had a hazard ratio of 1.9 (95% confidence interval 1.53–2.35) for any stroke, 1.67 (1.54–1.81) for cardiac atherosclerotic events, 1.82 (1.34–2.46) for peripheral events, 2.13 (1.64–2.76) for heart failure, 1.73 (1.38–2.16) for atrial fibrillation, 2.12 (1.49–2.99) for cardiovascular deaths, and 4.47 (4.32–4.62) for chronic hypertension. Differences in cumulative incidence curves, according to preeclampsia status, were apparent within 1 year of the first index pregnancy. Similar patterns of association were observed for hypertensive disorders of pregnancy, while preterm preeclampsia conferred slightly further elevated risks.
Conclusions:
Hypertensive disorders of pregnancy, including preeclampsia, have a similar pattern of increased risk across all 12 cardiovascular disorders and chronic hypertension, and the impact was evident soon after pregnancy. Hypertensive disorders of pregnancy should be considered as a natural screening tool for cardiovascular events, enabling cardiovascular risk prevention through national initiatives.
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Affiliation(s)
- Lydia J. Leon
- Department of Women and Children’s Health, King’s College London, United Kingdom (L.J.L., F.P.M., L.C.)
- Institute of Health Informatics, University College London, United Kingdom (L.J.L., K.D., A.G.I., D.P.M.)
| | - Fergus P. McCarthy
- Department of Women and Children’s Health, King’s College London, United Kingdom (L.J.L., F.P.M., L.C.)
- The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork University Maternity Hospital, Cork, Ireland (F.P.M.)
| | - Kenan Direk
- Institute of Health Informatics, University College London, United Kingdom (L.J.L., K.D., A.G.I., D.P.M.)
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, United Kingdom (L.J.L., K.D., A.G.I., D.P.M.)
| | - David Prieto-Merino
- Institute of Health Informatics, University College London, United Kingdom (L.J.L., K.D., A.G.I., D.P.M.)
- Applied Statistical Methods in Medical Research Group, Universidad Catolica San Antonio de Murcia, Spain (D.P.M.)
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare, MA (J.P.C.)
| | - Lucy Chappell
- Department of Women and Children’s Health, King’s College London, United Kingdom (L.J.L., F.P.M., L.C.)
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28
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Rafiq M, Hayward A, Warren-Gash C, Denaxas S, Gonzalez-Izquierdo A, Lyratzopoulos G, Thomas S. Socioeconomic deprivation and regional variation in Hodgkin's lymphoma incidence in the UK: a population-based cohort study of 10 million individuals. BMJ Open 2019; 9:e029228. [PMID: 31542744 PMCID: PMC6756616 DOI: 10.1136/bmjopen-2019-029228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/18/2019] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hodgkin's lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development. DESIGN Population-based cohort study. SETTING Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used. PARTICIPANTS Data on 10 million individuals in the UK from 1992 to 2016 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES Poisson models were used to explore differences in HL incidence by age, sex, region and deprivation. Age-specific HL incidence rates by sex and directly age-standardised incidence rates by region and deprivation group were calculated. RESULTS A total of 2402 new cases of HL were identified over 78 569 436 person-years. There was significant variation in HL incidence by deprivation group. Individuals living in the most affluent areas had HL incidence 60% higher than those living in the most deprived (incidence rate ratios (IRR) 1.60, 95% CI 1.40 to 1.83), with strong evidence of a marked linear trend towards increasing HL incidence with decreasing deprivation (p=<0.001). There was significant regional variation in HL incidence across the UK, which persisted after adjusting for age, sex and deprivation (IRR 0.80-1.42, p=<0.001). CONCLUSIONS This study identified high-risk regions for HL development in the UK and observed a trend towards higher incidence of HL in individuals living in less deprived areas. Consistent with findings from other immune-mediated diseases, this study supports the hypothesis that an affluent childhood environment may predispose to development of immune-related neoplasms, potentially through fewer immune challenges interfering with immune maturation in early life. Understanding the mechanisms behind this immune dysfunction could inform prevention, detection and treatment of HL and other immune diseases.
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Affiliation(s)
- Meena Rafiq
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Charlotte Warren-Gash
- Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
| | | | - Georgios Lyratzopoulos
- Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare & Outcomes) Research Group, University College London, London, UK
| | - Sara Thomas
- Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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29
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Denaxas S, Gonzalez-Izquierdo A, Fitzpatrick N, Direk K, Hemingway H. Phenotyping UK Electronic Health Records from 15 Million Individuals for Precision Medicine: The CALIBER Resource. Stud Health Technol Inform 2019; 262:220-223. [PMID: 31349307 DOI: 10.3233/shti190058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electronic health records (EHR) are increasingly being used for observational research at scale. In the UK, we have established the CALIBER research resource which utilizes national primary and hospital EHR data sources and enables researchers to create and validate longitudinal disease phenotypes at scale. In this work, we will describe the core components of the resource and provide results from three exemplar research studies on high-resolution epidemiology, disease risk prediction and subtype discovery which demonstrate both the opportunities and challenges of using EHR for research.
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Affiliation(s)
- Spiros Denaxas
- Institute of Health Informatics, University College London, United Kingdom.,Health Data Research UK, University College London, United Kingdom.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, United Kingdom.,Health Data Research UK, University College London, United Kingdom.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Natalie Fitzpatrick
- Institute of Health Informatics, University College London, United Kingdom.,Health Data Research UK, University College London, United Kingdom.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Kenan Direk
- Institute of Health Informatics, University College London, United Kingdom.,Health Data Research UK, University College London, United Kingdom.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom
| | - Harry Hemingway
- Institute of Health Informatics, University College London, United Kingdom.,Health Data Research UK, University College London, United Kingdom.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom
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Kuan V, Denaxas S, Gonzalez-Izquierdo A, Direk K, Bhatti O, Husain S, Sutaria S, Hingorani M, Nitsch D, Parisinos CA, Lumbers RT, Mathur R, Sofat R, Casas JP, Wong ICK, Hemingway H, Hingorani AD. A chronological map of 308 physical and mental health conditions from 4 million individuals in the English National Health Service. Lancet Digit Health 2019; 1:e63-e77. [PMID: 31650125 PMCID: PMC6798263 DOI: 10.1016/s2589-7500(19)30012-3] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background To effectively prevent, detect, and treat health conditions that affect people during their lifecourse, health-care professionals and researchers need to know which sections of the population are susceptible to which health conditions and at which ages. Hence, we aimed to map the course of human health by identifying the 50 most common health conditions in each decade of life and estimating the median age at first diagnosis. Methods We developed phenotyping algorithms and codelists for physical and mental health conditions that involve intensive use of health-care resources. Individuals older than 1 year were included in the study if their primary-care and hospital-admission records met research standards set by the Clinical Practice Research Datalink and they had been registered in a general practice in England contributing up-to-standard data for at least 1 year during the study period. We used linked records of individuals from the CALIBER platform to calculate the sex-standardised cumulative incidence for these conditions by 10-year age groups between April 1, 2010, and March 31, 2015. We also derived the median age at diagnosis and prevalence estimates stratified by age, sex, and ethnicity (black, white, south Asian) over the study period from the primary-care and secondary-care records of patients. Findings We developed case definitions for 308 disease phenotypes. We used records of 2 784 138 patients for the calculation of cumulative incidence and of 3 872 451 patients for the calculation of period prevalence and median age at diagnosis of these conditions. Conditions that first gained prominence at key stages of life were: atopic conditions and infections that led to hospital admission in children (<10 years); acne and menstrual disorders in the teenage years (10-19 years); mental health conditions, obesity, and migraine in individuals aged 20-29 years; soft-tissue disorders and gastro-oesophageal reflux disease in individuals aged 30-39 years; dyslipidaemia, hypertension, and erectile dysfunction in individuals aged 40-59 years; cancer, osteoarthritis, benign prostatic hyperplasia, cataract, diverticular disease, type 2 diabetes, and deafness in individuals aged 60-79 years; and atrial fibrillation, dementia, acute and chronic kidney disease, heart failure, ischaemic heart disease, anaemia, and osteoporosis in individuals aged 80 years or older. Black or south-Asian individuals were diagnosed earlier than white individuals for 258 (84%) of the 308 conditions. Bone fractures and atopic conditions were recorded earlier in male individuals, whereas female individuals were diagnosed at younger ages with nutritional anaemias, tubulointerstitial nephritis, and urinary disorders. Interpretation We have produced the first chronological map of human health with cumulative-incidence and period-prevalence estimates for multiple morbidities in parallel from birth to advanced age. This can guide clinicians, policy makers, and researchers on how to formulate differential diagnoses, allocate resources, and target research priorities on the basis of the knowledge of who gets which diseases when. We have published our phenotyping algorithms on the CALIBER open-access Portal which will facilitate future research by providing a curated list of reusable case definitions. Funding Wellcome Trust, National Institute for Health Research, Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Department of Health and Social Care (England), Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Social Care and Health Research, and The Alan Turing Institute.
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Affiliation(s)
- Valerie Kuan
- Institute of Cardiovascular Science, London
- Health Data Research UK London
| | - Spiros Denaxas
- Health Data Research UK London
- Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
| | - Arturo Gonzalez-Izquierdo
- Health Data Research UK London
- Institute of Health Informatics, University College London, London, UK
| | - Kenan Direk
- Health Data Research UK London
- Institute of Health Informatics, University College London, London, UK
| | - Osman Bhatti
- Chrisp Street Health Centre, London, UK
- Tower Hamlets Clinical Commissioning Group, London, UK
| | | | - Shailen Sutaria
- Clinical Effectiveness Group, Queen Mary University of London, London, UK
| | | | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - R Thomas Lumbers
- Health Data Research UK London
- Institute of Health Informatics, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Rohini Mathur
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Reecha Sofat
- Health Data Research UK London
- Institute of Health Informatics, University College London, London, UK
| | - Juan P Casas
- Institute of Health Informatics, University College London, London, UK
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| | - Ian C K Wong
- School of Pharmacy, University College London, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Harry Hemingway
- Health Data Research UK London
- Institute of Health Informatics, University College London, London, UK
- National Institute for Health Research, London, UK
- University College London British Heart Foundation Research Accelerator, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, London
- Health Data Research UK London
- University College London British Heart Foundation Research Accelerator, London, UK
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Leon LJ, Mccarthy F, Direk K, Gonzalez-Izquierdo A, Daniel R, Prieto-Merino D, Casas Romero JP, Chappell L. 242. Preeclampsia and premature cardiovascular disease in a large UK pregnancy cohort. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pujades-Rodriguez M, Assi V, Gonzalez-Izquierdo A, Wilkinson T, Schnier C, Sudlow C, Hemingway H, Whiteley WN. Correction: The diagnosis, burden and prognosis of dementia: A record-linkage cohort study in England. PLoS One 2018; 13:e0201213. [PMID: 30024957 PMCID: PMC6053215 DOI: 10.1371/journal.pone.0201213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0199026.].
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Pujades-Rodriguez M, Assi V, Gonzalez-Izquierdo A, Wilkinson T, Schnier C, Sudlow C, Hemingway H, Whiteley WN. The diagnosis, burden and prognosis of dementia: A record-linkage cohort study in England. PLoS One 2018; 13:e0199026. [PMID: 29944675 PMCID: PMC6019102 DOI: 10.1371/journal.pone.0199026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Electronic health records (EHR) might be a useful resource to study the risk factors and clinical care of people with dementia. We sought to determine the diagnostic validity of dementia captured in linked EHR. METHODS AND FINDINGS A cohort of adults in linked primary care, hospital, disease registry and mortality records in England, [CALIBER (CArdiovascular disease research using LInked Bespoke studies and Electronic health Records)]. The proportion of individuals with dementia, Alzheimer's disease, vascular and rare dementia in each data source was determined. A comparison was made of symptoms and care between people with dementia and age-, sex- and general practice-matched controls, using conditional logistic regression. The lifetime risk and prevalence of dementia and mortality rates in people with and without dementia were estimated with random-effects Poisson models. There were 47,386 people with dementia: 12,633 with Alzheimer's disease, 9540 with vascular and 1539 with rare dementia. Seventy-four percent of cases had corroborating evidence of dementia. People with dementia were more likely to live in a deprived area (conditional OR 1.26;95%CI:1.20-1.31 most vs least deprived), have documented memory impairment (cOR = 11.97;95%CI:11.24-12.75), falls (cOR = 2.36;95%CI:2.31-2.41), depression (cOR = 2.03; 95%CI:1.98-2.09) or anxiety (cOR = 1.27; 95%CI:1.23-1.32). The lifetime risk of dementia at age 65 was 9.2% (95%CI:9.0%-9.4%), in men and 14.9% (95%CI:14.7%-15.1%) in women. The population prevalence of recorded dementia increased from 0.3% in 2000 to 0.7% in 2010. A higher mortality rate was observed in people with than without dementia (IRR = 1.56;95%CI:1.54-1.58). CONCLUSIONS Most people with a record of dementia in linked UK EHR had some corroborating evidence for diagnosis. The estimated 10-year risk of dementia was higher than published population-based estimations. EHR are therefore a promising source of data for dementia research.
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Affiliation(s)
| | - Valentina Assi
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, London, United Kingdom
- Health Data Research UK London, London, United Kingdom
| | - Tim Wilkinson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Health Data Research UK Scotland, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Christian Schnier
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Cathie Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Health Data Research UK Scotland, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, United Kingdom
- Health Data Research UK London, London, United Kingdom
| | - William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Pujades-Rodriguez M, Guttmann OP, Gonzalez-Izquierdo A, Duyx B, O’Mahony C, Elliott P, Hemingway H. Identifying unmet clinical need in hypertrophic cardiomyopathy using national electronic health records. PLoS One 2018; 13:e0191214. [PMID: 29324812 PMCID: PMC5764451 DOI: 10.1371/journal.pone.0191214] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/29/2017] [Indexed: 12/11/2022] Open
Abstract
Introduction To evaluate unmet clinical need in unselected hypertrophic cardiomyopathy (HCM) patients to determine the risk of a wide range of subsequent cardiovascular disease endpoints and safety endpoints relevant for trial design. Methods Population based cohort (CALIBER, linked primary care, hospital and mortality records in England, period 1997–2010), all people diagnosed with HCM were identified and matched by age, sex and general practice with ten randomly selected people without HCM. Random-effects Poisson models were used to assess the associations between HCM and cardiovascular diseases and bleeding. Results Among 3,290,455 eligible people a diagnosis of hypertrophic cardiomyopathy was found in 4 per 10,000. Forty-one percent of the 1,160 individuals with hypertrophic cardiomyopathy were women and the median age was 57 years. The median follow-up was 4.0 years. Compared to general population controls, people with HCM had higher risk of ventricular arrhythmia (incidence rate ratio = 23.53, [95% confidence interval 12.67–43.72]), cardiac arrest or sudden cardiac death (6.33 [3.69–10.85]), heart failure (4.31, [3.30–5.62]), and atrial fibrillation (3.80 [3.04–4.75]). HCM was also associated with a higher incidence of myocardial infarction ([MI] 1.90 [1.27–2.84]) and coronary revascularisation (2.32 [1.46–3.69]).The absolute Kaplan-Meier risks at 3 years were 8.8% for the composite endpoint of cardiovascular death or heart failure, 8.4% for the composite of cardiovascular death, stroke or myocardial infarction, and 1.5% for major bleeding. Conclusions Our study identified major unmet need in HCM and highlighted the importance of implementing improved cardiovascular prevention strategies to increase life-expectancy of the contemporary HCM population. They also show that national electronic health records provide an effective method for identifying outcomes and clinically relevant estimates of composite efficacy and safety endpoints essential for trial design in rare diseases.
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Affiliation(s)
- Mar Pujades-Rodriguez
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
- * E-mail:
| | - Oliver P. Guttmann
- Institute for Cardiovascular Science, University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew’s Hospital, St Bartholomew’s Hospital, London, United Kingdom
| | - Arturo Gonzalez-Izquierdo
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
| | - Bram Duyx
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel, Maastricht, the Netherlands
| | - Constantinos O’Mahony
- Institute for Cardiovascular Science, University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew’s Hospital, St Bartholomew’s Hospital, London, United Kingdom
| | - Perry Elliott
- Institute for Cardiovascular Science, University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew’s Hospital, St Bartholomew’s Hospital, London, United Kingdom
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, United Kingdom
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Josephson CB, Gonzalez-Izquierdo A, Denaxas S, Fitzpatrick NK, Sajobi TT, Engbers JDT, Patten S, Jette N, Wiebe S. Serotonin reuptake inhibitors and mortality in epilepsy: A linked primary-care cohort study. Epilepsia 2017; 58:2002-2009. [PMID: 28944447 DOI: 10.1111/epi.13904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Preliminary evidence suggests that serotonin reuptake inhibitor (SRI) use may increase postictal respiratory drive and prevent death. We sought to determine whether SRIs are associated with improved all-cause and possible seizure-specific mortality in patients with epilepsy. METHODS Patients with epilepsy and a random 10:1 sample without epilepsy were extracted from The ClinicAl research using LInked Bespoke studies and Electronic health Records (CALIBER) resource. The hazard ratio (HR) of all-cause and possible seizure-specific mortality, treating SRI use as a time-varying covariate, was determined using the date of a second SRI prescription as exposure and in discrete 6-month periods over the entire duration of follow-up. We used Cox regression and competing risk models with Firth correction to calculate the HR. We controlled for age, sex, depression, comorbidity, (Charlson comorbidity index) and socioeconomic status (Index of Multiple Deprivation). RESULTS We identified 2,718,952 eligible patients in CALIBER, of whom 16,379 (0.60%) had epilepsy. Median age and follow-up were 44 (interquartile range [IQR] 29-61]) and 6.4 years (IQR 2.4-10.4 years), respectively, and 53% were female. A total of 2,178 patients (13%) had at least two SRI prescriptions. Hazard of all-cause mortality was significantly elevated following a second prescription for an SRI (HR 1.64 95% confidence interval [95% CI] 1.44-1.86; p < 0.001). The HR was similar in 163,778 age, sex, and general practitioner (GP) practice-matched controls without epilepsy. Exposure to an SRI was not associated with seizure-related death (HR 1.08, 95% CI 0.59-1.97; 0.796). SIGNIFICANCE There is no evidence in this large population-based cohort that SRIs protect against all-cause mortality or seizure-specific mortality. Rather, SRI use was associated with increased mortality, irrespective of epilepsy, which is probably due to various factors associated with the use of antidepressants. Larger studies with systematically collected clinical data are needed to shed further light on these findings.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Arturo Gonzalez-Izquierdo
- Farr Institute of Health Informatics Research, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Spiros Denaxas
- Farr Institute of Health Informatics Research, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Natalie K Fitzpatrick
- Farr Institute of Health Informatics Research, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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O’Donnell M, Sims S, Maclean MJ, Gonzalez-Izquierdo A, Gilbert R, Stanley FJ. Trends in alcohol-related injury admissions in adolescents in Western Australia and England: population-based cohort study. BMJ Open 2017; 7:e014913. [PMID: 28554923 PMCID: PMC5623454 DOI: 10.1136/bmjopen-2016-014913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Alcohol-related harm in young people is now a global health priority. We examined trends in hospital admissions for alcohol-related injuries for adolescents in Western Australia (WA) and in England, identified groups most at risk and determined causes of injuries. METHODS Annual incidence rates for alcohol-related injury rates were calculated using population-level hospital admissions data for WA and England. We compared trends in different types of alcohol-related injury by age and gender. RESULTS Despite a decrease in the overall rate of injury admissions for people aged 13-17 years in WA, alcohol-related injuries have increased significantly from 1990 to 2009 (from 8 to 12 per 10 000). Conversely, alcohol-related injury rates have declined in England since 2007. In England, self-harm is the most frequently recorded cause of alcohol-related injury. In WA, unintentional injury is most common; however, violence-related harm is increasing for boys and girls. CONCLUSION Alcohol-related harm of sufficient severity to require hospital admission is increasing among adolescents in WA. Declining trends in England suggest that this trend is not inevitable or irreversible. More needs to be done to address alcohol-related harm, and on-going monitoring is required to assess the effectiveness of strategies.
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Affiliation(s)
- Melissa O’Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Scott Sims
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Miriam J Maclean
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - Ruth Gilbert
- Institute of Child Health, University College London, London, UK
| | - Fiona J Stanley
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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O'Donnell M, Sims S, Maclean M, Gonzalez-Izquierdo A, Gilbert R, Stanley F. Alcohol-related injury admission trends in adolescents: A comparison between Western Australia and England. Int J Popul Data Sci 2017. [PMCID: PMC8480702 DOI: 10.23889/ijpds.v1i1.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ABSTRACTObjectivesThis study aims to determine trends in hospital admissions for alcohol-related injuries among young people in Western Australia and England and whether these admissions are intentionally or unintentionally caused. In addition, this study examines variation in trends by sex and age-groups to determine groups most at risk.
ApproachAnnual incidence rates for alcohol-related injury rates were calculated using hospital admissions data for Western Australia and England. We compared trends in different types of alcohol-related injury by age and gender.
ResultsAlcohol-related injuries have increased significantly from 1980-2009 (from 2 to 12 per 10,000). Conversely, alcohol-related injury rates have declined in England since 2007. In England self-harm is the most frequently recorded cause of alcohol-related injury. In Western Australia, unintentional injury is most common, however violence-related harm is increasing for boys and girls. Boys aged 16-17 in Western Australia had the highest rate of alcohol-related injury (27.1/10,000), which was markedly higher than for 16-17 year old girls in Western Australia (16.6/10,000), girls in England (14.1/10,000), or boys in England (13.2/10,000).
ConclusionAlcohol-related harm is a significant public health issue, and in Western Australia there is a concerning trend of increasing alcohol-related injuries among young people. Alcohol-related harm of sufficient severity to require hospital admission is increasing among adolescents in Western Australia. Declining trends in England suggests this trend is not inevitable or irreversible. More needs to be done to address alcohol-related harm, and ongoing monitoring is required to assess the effectiveness of strategies.
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Herbert A, Gilbert R, Cottrell DJ, Gonzalez-Izquierdo A, Li L. Causes of death in the decade after hospitalisation for injury during adolescence: a study using linked hospital admissions and death registrations data. Int J Popul Data Sci 2017. [DOI: 10.23889/ijpds.v1i1.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ABSTRACT
ObjectivesTo quantify risks of cause-specific death up to ten years after discharge from an emergency admission to hospital for violent, self-inflicted, or drug/alcohol-related injury, during adolescence. To compare these risks by type of original injury, and with risks after accident-related injury.
ApproachWe used admissions data for England linked to death registrations from 1997 to 2012. We identified emergency admissions for injury in 10-19y olds and categorised type of injury as either violent, self-inflicted, drug/alcohol-related, or accident-related (no record of violent, self-inflicted, or drug/alcohol-related injury, but record of an accident), using ICD-10 codes in admission records. We categorised causes of death as homicide, suicide, drug/alcohol-related, accidental (excluding drug/alcohol-related accidents), or ‘other’ (remaining causes), using ICD-9 and ICD-10 codes from death registration records. We estimated cumulative risks of cause-specific death in the ten years after discharge, by sex and type of original injury. We used time-to-event regression models to estimate risks of cause-specific death, after violent, self-inflicted or drug/alcohol-related injury (relative to those after accident-related injury), adjusted for age-group (10-15, 16-17, 18-19y) and chronic condition status (yes/no; indicated by ICD-10 codes in past year admission records), and stratified by sex.
ResultsThere were 333,009 adolescents admitted for violent, self-inflicted, or drug/alcohol-related injury (girls 181,926, boys 181,053), and 649,818 for accident-related injury (girls 166,462, boys 483,356). There were 4,782 deaths in the ten years after discharge: 2,415 after violent, self-inflicted or drug/alcohol-related injury (girls 873, boys 1,542) and 2,367 after accident-related injury (girls 439, boys 1,928). Deaths after violent, self-inflicted or drug/alcohol-related injury injury were mostly accounted for by suicide (girls 35.8% of all deaths, boys 34.2%) or drug/alcohol-related death (girls 31.7%, boys 35.6%). Risks of suicide were similar to those for drug/alcohol-related death, regardless of the type of original injury. Adjusted risks of death were 1.4 to 6.8 times greater than after accident-related injury (by cause and sex).
ConclusionAdolescent girls and boys discharged after violent, self-inflicted, or drug/alcohol-related injury had similar risks of suicide and drug/alcohol related death, regardless of the category of the original injury. These adolescents also had increased risks of cause-specific deaths compared to those discharged after accident-related injury. Current practice to assess and reduce risks of future harm after self-inflicted injury should be extended to adolescents discharged after violent or drug/alcohol-related injury. Preventive strategies should address risks of drug/alcohol-related death as well as risks of suicide.
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Denaxas S, Kunz H, Smeeth L, Gonzalez-Izquierdo A, Boutselakis H, Pikoula M, Hemingway H. Methods for enhancing the reproducibility of clinical epidemiology research in linked electronic health records: results and lessons learned from the CALIBER platform. Int J Popul Data Sci 2017. [PMCID: PMC8362485 DOI: 10.23889/ijpds.v1i1.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ABSTRACTObjectivesElectronic health records (EHR) across primary, secondary, and tertiary care are increasingly being linked for research at a population level. The increasing volume, variety, velocity, and veracity of big biomedical data makes research reproducibility challenging. Research reproducibility and replicability is essential for the external validity and generalizability of scientific findings and the lack of standardized approaches and tools and relative opaqueness of data manipulation methods is detrimental to their integrity. The objective of this study was to explore, evaluate and propose methods, tools and approaches for addressing some of the challenges associated with reproducibility when using linked national electronic health records for research.
ApproachWe systematically searched literature and internet resources for well-established and appropriate methods, tools, and approaches used in related scientific disciplines. The identified techniques were systematically evaluated in terms of their capacity to facilitate reproducible research in routinely collected health data across the life course of a research project: from protocol creation and raw data curation to data transformation and statistical analysis though to finding dissemination and impact. Most importantly, the identified techniques were tested and applied in a contemporary database of linked electronic health records. CALIBER is a research data platform of linked national electronic health records from primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics), acute coronary syndrome disease registry (Myocardial Ischaemia National Audit Project) and cause-specific mortality (Office for National Statistics) for roughly 2 million adults.
ResultsFirstly, we present the review of methods and approaches which we identified through our search. Secondly, we propose a set of recommendations for applying them within the context of research projects making use of linked routinely collected health data. Focal interests included: a) documentation of data (attributes, relationships, and interpretation), b) data processing (source code, instructions, and parameters), c) results (visualizations, figures), and any supplementary material. Thirdly, we present approaches around a) raw data curation using international metadata standards, b) study protocol encoding, c) provenance and sharing of data transformation and statistical analysis operations, d) public and private data retention, and e) computable EHR-driven phenotypes.
ConclusionThe complexity and size of routinely collected health data is increasing through linkages across distributed data sources. The scientific community benefits from findings which can be replicated. This study presents a number of methods, tools and approaches across the project life course for ensuring that their research studies are reproducible and replicable from the wider scientific community.
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He Z, Gonzalez-Izquierdo A, Denaxas S, Sura A, Guo Y, Hogan WR, Shenkman E, Bian J. Comparing and Contrasting A Priori and A Posteriori Generalizability Assessment of Clinical Trials on Type 2 Diabetes Mellitus. AMIA Annu Symp Proc 2017; 2017:849-858. [PMID: 29854151 PMCID: PMC5977671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Clinical trials are indispensable tools for evidence-based medicine. However, they are often criticized for poor generalizability. Traditional trial generalizability assessment can only be done after the trial results are published, which compares the enrolled patients with a convenience sample of real-world patients. However, the proliferation of electronic data in clinical trial registries and clinical data warehouses offer a great opportunity to assess the generalizability during the design phase of a new trial. In this work, we compared and contrasted a priori (based on eligibility criteria) and a posteriori (based on enrolled patients) generalizability of Type 2 diabetes clinical trials. Further, we showed that comparing the study population selected by the clinical trial eligibility criteria to the real-world patient population is a good indicator of the generalizability of trials. Our findings demonstrate that the a priori generalizability of a trial is comparable to its a posteriori generalizability in identifying restrictive quantitative eligibility criteria.
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Affiliation(s)
- Zhe He
- Florida State University, Tallahassee, FL, USA
| | | | | | | | - Yi Guo
- University of Florida, Gainesville, FL, USA
| | | | | | - Jiang Bian
- University of Florida, Gainesville, FL, USA
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Denaxas S, Direk K, Gonzalez-Izquierdo A, Pikoula M, Cakiroglu A, Moore J, Hemingway H, Smeeth L. Methods for enhancing the reproducibility of biomedical research findings using electronic health records. BioData Min 2017; 10:31. [PMID: 28912836 PMCID: PMC5594436 DOI: 10.1186/s13040-017-0151-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/28/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The ability of external investigators to reproduce published scientific findings is critical for the evaluation and validation of biomedical research by the wider community. However, a substantial proportion of health research using electronic health records (EHR), data collected and generated during clinical care, is potentially not reproducible mainly due to the fact that the implementation details of most data preprocessing, cleaning, phenotyping and analysis approaches are not systematically made available or shared. With the complexity, volume and variety of electronic health record data sources made available for research steadily increasing, it is critical to ensure that scientific findings from EHR data are reproducible and replicable by researchers. Reporting guidelines, such as RECORD and STROBE, have set a solid foundation by recommending a series of items for researchers to include in their research outputs. Researchers however often lack the technical tools and methodological approaches to actuate such recommendations in an efficient and sustainable manner. RESULTS In this paper, we review and propose a series of methods and tools utilized in adjunct scientific disciplines that can be used to enhance the reproducibility of research using electronic health records and enable researchers to report analytical approaches in a transparent manner. Specifically, we discuss the adoption of scientific software engineering principles and best-practices such as test-driven development, source code revision control systems, literate programming and the standardization and re-use of common data management and analytical approaches. CONCLUSION The adoption of such approaches will enable scientists to systematically document and share EHR analytical workflows and increase the reproducibility of biomedical research using such complex data sources.
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Affiliation(s)
- Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Kenan Direk
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Aylin Cakiroglu
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK
| | - Jason Moore
- Institute of Biomedical Informatics, University of Pennsylvania, Richards Medical Research Laboratories, 3700 Hamilton Walk, Philadelphia, 19104 USA
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Liam Smeeth
- EHR Research Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Streeet, London, WC1E 7HT UK
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Davies H, Gilbert R, Johnson K, Petersen I, Nazareth I, O'Donnell M, Guttmann A, Gonzalez-Izquierdo A. Neonatal drug withdrawal syndrome: cross-country comparison using hospital administrative data in England, the USA, Western Australia and Ontario, Canada. Arch Dis Child Fetal Neonatal Ed 2016; 101:F26-30. [PMID: 26290479 DOI: 10.1136/archdischild-2015-308948] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/24/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined trends over time in the prevalence of neonatal drug withdrawal syndrome (NWS) in England compared with that reported in the USA, Western (W) Australia and Ontario, Canada. We also examined variation in prevalence of NWS according to maternal age, birth weight and across the English NHS by hospital trusts. DESIGN AND SETTING Retrospective study using national hospital administrative data (Hospital Episode Statistics) for the NHS in England between 1997 and 2011. NWS was identified using international classification of disease codes in hospital admission records. We searched the research literature and contacted researchers to identify studies reporting trends in the prevalence of NWS. MAIN OUTCOME MEASURES Prevalence of NWS by calendar year per 1000 live births for each country/state. For births in England, prevalence by maternal age group and birth weight group. Prevalence by NHS trust and region at birth, and funnel plot to show outlying English NHS hospital trusts (>3 SD of mean prevalence). MAIN RESULTS Mean prevalence rates of recorded NWS increased in all four countries. Rates stabilised in England and W. Australia from the early 2000s and rose steeply in the USA and Ontario during the late 2000s. The most recent prevalence rates were 2.7/1000 live births in England (2011; 1544 cases); 2.7/1000 in W. Australia (2009); 3.6/1000 in the USA (2009) and 5.1/1000 in Ontario (2011). The highest prevalence in England was among babies born to mothers aged 25-34 years at delivery and among babies born with low birth weight (1500-2500 g). In England in 2011, 8.6% of hospital trusts had a recorded prevalence outside 3 SD of the overall average (7% above, 1% below). The North East region of England had the highest recorded prevalence of NWS. CONCLUSIONS Although recorded NWS is stable in England and W. Australia, rising rates in the USA and Ontario may reflect better recognition and/or increased use of prescribed opiate analgesics and highlight the need for surveillance. The extent to which different prevalence rates by hospital trust reflect variation in occurrence, recognition or recording requires further investigation.
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Affiliation(s)
- Hilary Davies
- Department of Primary Care and Population Health, UCL, London, UK
| | - Ruth Gilbert
- Department of Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | | | - Irene Petersen
- Department of Primary Care and Population Health, UCL, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, UCL, London, UK
| | | | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Hagger-Johnson G, Harron K, Gonzalez-Izquierdo A, Cortina-Borja M, Dattani N, Muller-Pebody B, Parslow R, Gilbert R, Goldstein H. Identifying Possible False Matches in Anonymized Hospital Administrative Data without Patient Identifiers. Health Serv Res 2015; 50:1162-78. [PMID: 25523215 PMCID: PMC4545352 DOI: 10.1111/1475-6773.12272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify data linkage errors in the form of possible false matches, where two patients appear to share the same unique identification number. DATA SOURCE Hospital Episode Statistics (HES) in England, United Kingdom. STUDY DESIGN Data on births and re-admissions for infants (April 1, 2011 to March 31, 2012; age 0-1 year) and adolescents (April 1, 2004 to March 31, 2011; age 10-19 years). DATA COLLECTION/EXTRACTION METHODS Hospital records pseudo-anonymized using an algorithm designed to link multiple records belonging to the same person. Six implausible clinical scenarios were considered possible false matches: multiple births sharing HESID, re-admission after death, two birth episodes sharing HESID, simultaneous admission at different hospitals, infant episodes coded as deliveries, and adolescent episodes coded as births. PRINCIPAL FINDINGS Among 507,778 infants, possible false matches were relatively rare (n = 433, 0.1 percent). The most common scenario (simultaneous admission at two hospitals, n = 324) was more likely for infants with missing data, those born preterm, and for Asian infants. Among adolescents, this scenario (n = 320) was more common for males, younger patients, the Mixed ethnic group, and those re-admitted more frequently. CONCLUSIONS Researchers can identify clinically implausible scenarios and patients affected, at the data cleaning stage, to mitigate the impact of possible linkage errors.
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Affiliation(s)
- Gareth Hagger-Johnson
- Address correspondence to Gareth Hagger-Johnson, Ph.D., Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, 30 Guilford Street, London WC1N 1EH, UK;
| | - Katie Harron
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Arturo Gonzalez-Izquierdo
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Mario Cortina-Borja
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Nirupa Dattani
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Berit Muller-Pebody
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Roger Parslow
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Ruth Gilbert
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Harvey Goldstein
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
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Gonzalez-Izquierdo A, Ward A, Smith P, Walford C, Begent J, Ioannou Y, Gilbert R. Notifications for child safeguarding from an acute hospital in response to presentations to healthcare by parents. Child Care Health Dev 2015; 41:186-93. [PMID: 24635011 PMCID: PMC4340040 DOI: 10.1111/cch.12134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Consideration of child safeguarding is routine within maternity services but less common in other health services for adults. We audited notifications for child safeguarding from an acute general hospital where the policy includes questioning adults presenting with violence, mental health problems or drug or alcohol misuse to any department within the hospital about children at home and notifying to the local authority children's social care services if there are safeguarding concerns. METHODS Cross-sectional audit of notifications for child safeguarding, including abuse, neglect or victimization, from all departments in one hospital to the local authority children's social care department during 12 months (2010/11). RESULTS Of 681 notifications (57 per month), 40% (270/681) were triggered by parents' presentation to acute hospital services. Of these, 37% (100/270; 12 teenage mothers) presented for maternity care and 60% (162/270; 8 teenage parents) presented to the emergency department (ED). Of the 60% (411/681) of notifications prompted by children presenting for healthcare, most originated from the ED (358/411; 87%): two-thirds of these presented with injury (250/358; 70%). CONCLUSION Given a policy to ask adults about children at home, a substantial proportion of children notified for child safeguarding were recognized through presentations to acute healthcare by their parents. Further research and development of this policy needs to ensure that questioning results in effective interventions for the children and their parents.
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Affiliation(s)
- A Gonzalez-Izquierdo
- Centre of Paediatric Epidemiology and Biostatistics, UCL Institute of Child HealthLondon, UK
| | - A Ward
- General and Adolescent Paediatrics Unit, UCL Institute of Child HealthLondon, UK
| | - P Smith
- University College London NHS TrustLondon, UK
| | - C Walford
- University College London NHS TrustLondon, UK
| | - J Begent
- University College London NHS TrustLondon, UK
| | - Y Ioannou
- Chelsea and Westminster Hospital NHS Foundation TrustLondon, UK
| | - R Gilbert
- Centre of Paediatric Epidemiology and Biostatistics, UCL Institute of Child HealthLondon, UK
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Gonzalez-Izquierdo A, Cortina-Borja M, Woodman J, Mok J, McGhee J, Taylor J, Parkin C, Gilbert R. Maltreatment or violence-related injury in children and adolescents admitted to the NHS: comparison of trends in England and Scotland between 2005 and 2011. BMJ Open 2014; 4:e004474. [PMID: 24755210 PMCID: PMC4010840 DOI: 10.1136/bmjopen-2013-004474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Legislation to safeguard children from maltreatment by carers or violence by others was advanced in England and Scotland around 2004-2005 and resulted in different policies and services. We examined whether subsequent trends in injury admissions to hospital related to maltreatment or violence varied between the two countries. SETTING AND PARTICIPANTS We analysed rates of all unplanned injury admission to National Health Service (NHS) hospitals in England and Scotland between 2005 and 2011 for children and adolescents aged less than 19 years. OUTCOMES We compared incidence trends for maltreatment or violence-related (MVR) injury and adjusted rate differences between 2005 and 2011 using Poisson or negative binomial regression models to adjust for seasonal effects and secular trends in non-MVR injury. Infants, children 1-10 years and adolescents 11-18 years were analysed separately. RESULTS In 2005, MVR rates were similar in England and Scotland for infants and 1-10-year-olds, but almost twice as high in Scotland for 11-18-year-olds. MVR rates for infants increased by similar amounts in both countries, in line with rising non-MVR rates in England but contrary to declines in Scotland. Among 1-10-year-olds, MVR rates increased in England and declined in Scotland, in line with increasing non-MVR rates in England and declining rates in Scotland. Among 11-18-year-olds, MVR rates declined more steeply in Scotland than in England along with declines in non-MVR trends. CONCLUSIONS Diverging trends in England and Scotland may reflect true changes in the occurrence of MVR injury or differences in the way services recognise and respond to these children, record such injuries or a combination of these factors. Further linkage of data from surveys and services for child maltreatment and violence could help distinguish the impact of policies.
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Affiliation(s)
| | - Mario Cortina-Borja
- Centre of Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Jenny Woodman
- Centre of Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Jacqueline Mok
- NHS Lothian University Hospitals Division, Edinburgh, UK
| | - Janice McGhee
- School of Social and Political Science, the Chrystal Macmillan Building, Edinburgh, UK
| | - Julie Taylor
- Child Protection Research Centre, University of Edinburgh, St Leonard's Land, Edinburgh, UK
| | - Chloe Parkin
- Centre of Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Ruth Gilbert
- Centre of Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
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Gonzalez-Izquierdo A, Ward A, O'Donnell M, Li L, Roposch A, Stanley F, Gilbert R. Cross-country comparison of victimisation-related injury admission in children and adolescents in England and Western Australia. BMC Health Serv Res 2013; 13:260. [PMID: 23829876 PMCID: PMC3716984 DOI: 10.1186/1472-6963-13-260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 06/07/2013] [Indexed: 11/10/2022] Open
Abstract
Background A single, standardised measure of victimisation-related (VR) injury admission in hospital administrative datasets could allow monitoring of preventive and response strategies and international comparisons of policy. Consistency of risk factors and incidence rates for a measure of victimisation-related injury in different countries with similar access to healthcare services would provide indirect evidence for measure validity. Methods Cohorts were derived from hospital administrative data for children aged less than 18 years who were admitted for acute injury to hospitals in England or Western Australia (WA) in 2000 to 2008. We compared the effects of age, sex and deprivation on the annual incidence of acute admission for VR injury defined by a cluster of ICD-10 codes reflecting characteristics that should alert clinicians to consider victimisation as a cause of injury. Four subcategories comprised codes specifically indicating child maltreatment, assault, undetermined cause, or adverse social circumstances. Results The incidence of VR injury followed a similar ‘J’-shaped association with age in both countries with increasing rates from 10 years onwards and peaks in infancy and in 16–17 year-olds. In both countries, rates increased with deprivation. Girls had lower rates than boys except in the 11–15 age group where girls had higher rates than boys in WA but not in England. Adjusted incidence rates were similar in both countries for children aged 3 to 15 years old, but were higher in WA compared with England in children under 3 years old and in those aged 16–17 years. Higher rates in WA in 16–17 year-olds were explained by more admissions coded for the subcategories of adverse social circumstances, and to a lesser extent, assault, than in England. Children less than 3 years old were more often coded specifically for maltreatment in WA than in England. Conclusions The similarities in risk factors and in the adjusted rates of victimisation-related injury admission in both countries suggest that the VR cluster of ICD-10 codes is measuring a similar underlying problem. Differential use of coding subcategories highlights the need to use the entire VR cluster for comparisons across settings.
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Lee JJ, Gonzalez-Izquierdo A, Gilbert R. Risk of maltreatment-related injury: a cross-sectional study of children under five years old admitted to hospital with a head or neck injury or fracture. PLoS One 2012; 7:e46522. [PMID: 23118853 PMCID: PMC3485294 DOI: 10.1371/journal.pone.0046522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 09/03/2012] [Indexed: 11/30/2022] Open
Abstract
Objectives To determine the predictive value and sensitivity of demographic features and injuries (indicators) for maltreatment-related codes in hospital discharge records of children admitted with a head or neck injury or fracture. Methods Study design: Population-based, cross sectional study. Setting: NHS hospitals in England. Subjects: Children under five years old admitted acutely to hospital with head or neck injury or fracture. Data source: Hospital Episodes Statistics, 1997 to 2009. Main outcome measure: Maltreatment-related injury admissions, defined by ICD10 codes, were used to calculate for each indicator (demographic feature and/or type of injury): i) the predictive value (proportion of injury admissions that were maltreatment-related); ii) sensitivity (proportion of all maltreatment-related injury admissions with the indicator). Results Of 260,294 childhood admissions for fracture or head or neck injury, 3.2% (8,337) were maltreatment-related. With increasing age of the child, the predictive value for maltreatment-related injury declined but sensitivity increased. Half of the maltreatment-related admissions occurred in children older than one year, and 63% occurred in children with head injuries without fractures or intracranial injury. Conclusions Highly predictive injuries accounted for very few maltreatment-related admissions. Protocols that focus on high-risk injuries may miss the majority of maltreated children.
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Affiliation(s)
| | | | - Ruth Gilbert
- Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
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Gilbert R, Fluke J, O'Donnell M, Gonzalez-Izquierdo A, Brownell M, Gulliver P, Janson S, Sidebotham P. Child maltreatment: variation in trends and policies in six developed countries. Lancet 2012; 379:758-72. [PMID: 22169108 DOI: 10.1016/s0140-6736(11)61087-8] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada). One or more child protection agency indicators increased in five of six countries, particularly in infants, possibly as a result of early intervention policies. Comparisons of mean rates between countries showed five-fold to ten-fold differences in rates of agency indicators, but less than two-fold variation in violent deaths or maltreatment-related injury, apart from high rates of violent child death in the USA. These analyses draw attention to the need for robust research to establish whether the high and rising rates of agency contacts and out-of-home care in some settings are effectively reducing child maltreatment.
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Affiliation(s)
- Ruth Gilbert
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK.
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McCarthy M, Gonzalez-Izquierdo A, Sherlaw-Johnson C, Khachatryan A, Coleman MP, Rachet B. Comparative indicators for cancer network management in England: availability, characteristics and presentation. BMC Health Serv Res 2008; 8:45. [PMID: 18304315 PMCID: PMC2292168 DOI: 10.1186/1472-6963-8-45] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 06/08/2007] [Accepted: 02/27/2008] [Indexed: 11/17/2022] Open
Abstract
Background In 2000, the national cancer plan for England created 34 cancer networks, new organisational structures to coordinate services across populations varying between a half and three million people. We investigated the availability of data sets reflecting measures of structure, process and outcome that could be used to support network management. Methods We investigated the properties of national data sets relating to four common cancers – breast, colorectal, lung and prostate. We reviewed the availability and completeness of these data sets, identified leading items within each set and put them into tables of the 34 cancer networks. We also investigated methods of presentation. Results The Acute Hospitals Portfolio and the Cancer Standards Peer Review recorded structural characteristics at hospital and cancer service level. Process measures included Hospital Episode Statistics, recording admissions, and Hospital Waiting-List data. Patient outcome measures included the National Survey of Patient Satisfaction for cancer, and cancer survival, drawn from cancer registration. Data were drawn together to provide an exemplar indicator set a single network, and methods of graphical presentation were considered. Conclusion While not as yet used together in practice, comparative indicators are available within the National Health Service in England for use in performance assessment by cancer networks.
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Affiliation(s)
- Mark McCarthy
- UCL Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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