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Berglund M, Gonzalez-Izquierdo A, Denaxas S, Lethebe BC, Sajobi TT, Engbers JDT, Wiebe S, Josephson CB. Excess health care use is significantly and persistently reduced following diagnosis of late-onset epilepsy. Epilepsia 2024. [PMID: 39302250 DOI: 10.1111/epi.18105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE The incidence of late-onset epilepsy (LOE) is rising, and these patients may use an excess of health care resources. This study aimed to measure pre-/post-diagnostic health care use (HCU) for patients with LOE compared to controls. METHODS This was an observational open cohort study covering years 1998-2019 using UK population-based linked primary care (Clinical Practice Research Datalink [CPRD]) and hospital (HES) electronic health records. The participants included patients with incident LOE enrolled in CPRD and 1:10 age-, sex-, and general practice-matched controls. The exposure was incident LOE (diagnosed at age ≥65) using a 5-year washout. The main outcome was all HCU (primary care [PC], accident and emergency [A&E], admitted patient and outpatient care) using inverse proportional weighting to PC use and HCU by setting. An interrupted time-series analysis was used to examine pre-/post-diagnostic HCU between patients with LOE and controls over 4 years either side of diagnosis/matching date. An adjusted mixed-effects negative binomial regression was used for post-diagnosis HCU interactions. RESULTS Of 2 569 874 people ≥65 years of age, 1048 (4%) developed incident LOE. Mean weighted total HCU increased by 32 visits per patient-year (95% confidence interval [95% CI]: 13-50, p = .003) until LOE diagnosis, and then dropped by a mean of 60 visits per patient-year (95% CI: -81 to -40). There was an acute rise and fall over the 1-2 years immediately pre-/post-diagnosis. Incident HCU remained higher for LOE compared to controls post-diagnosis (adjusted incidence rate ratio: 1.72; 95% CI: 1.65-1.70; p < .001), including A&E, outpatient, and admitted care. SIGNIFICANCE Health care use demonstrates an acute on chronic rise over the 4 years before diagnosis of LOE. To what extent the partial reversal of the acute pre-diagnosis rise, and the mediators of the accelerated increase compared to controls are attributed to epilepsy, comorbid and bidirectional disease states, or a combination of both warrants further exploration.
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Affiliation(s)
| | - Arturo Gonzalez-Izquierdo
- UCL Institute of Health Informatics, London, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research (HDR) UK, London, UK
| | - Spiros Denaxas
- UCL Institute of Health Informatics, London, UK
- Health Data Research (HDR) UK, London, UK
- Alan Turing Institute, London, UK
| | - B Cord Lethebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - 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
| | | | - Samuel Wiebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- 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
| | - 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
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Lamb KE, Camacho X, Lee PW, Koye DN, Kotevski A, Haurat J, Thornton LE, Turner M, Simpson JA, Burchill L. Health map for HealthGap: Defining a geographical catchment to examine cardiovascular risk in Victoria, Australia. Health Place 2024; 89:103318. [PMID: 39002227 DOI: 10.1016/j.healthplace.2024.103318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 07/08/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
The HealthGap study aimed to understand cardiovascular risk among Indigenous Australians in Victoria using linked administrative data. A key challenge was differing spatial coverages of sources: state-level data for risk factors but cardiovascular outcomes for three hospitals. Catchments were defined based on hospital postcodes to estimate denominator populations for risk modelling: first- and second-order neighbours, and spatial distribution of outcomes ('spatial event distribution'). Catchment coverage was assessed through proportions of patients presenting to study hospitals from catchment postcodes. The spatial event distribution performed best, capturing 82% events overall (first-order:40%; second-order:64%) and 65% Indigenous (27% and 45%). No approach excluded proximal non-study hospitals. Spatial event distributions could help define denominator populations when geographic information on outcome data is available but may not avoid potential misclassification.
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Affiliation(s)
- Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
| | - Ximena Camacho
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | | | - Digsu N Koye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Aneta Kotevski
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | - Lukar E Thornton
- Department of Marketing, Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
| | | | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Luke Burchill
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Ju C, Lau WCY, Manisty C, Chambers P, Brauer R, Forster MD, Mackenzie IS, Wei L. Use of heart failure medical therapy before and after a cancer diagnosis: A longitudinal study. ESC Heart Fail 2024. [PMID: 39041459 DOI: 10.1002/ehf2.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/13/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024] Open
Abstract
AIMS We aim to evaluate change in the use of prognostic guideline-directed medical therapies (GDMTs) for heart failure (HF) before and after a cancer diagnosis as well as the matched non-cancer controls, including renin-angiotensin-system inhibitors (RASIs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs). METHODS AND RESULTS We conducted a longitudinal study in patients with HF in the UK Clinical Practice Research Datalink between 2005 and 2021. We selected patients with probable HF with reduced ejection fraction (HFrEF) based on diagnostic and prescription records. We described the longitudinal trends in the use and dosing of GDMTs before and after receiving an incident cancer diagnosis. HF patients with cancer were matched with a 1:1 ratio to HF patients without cancer to investigate the association between cancer diagnosis and treatment adherence, persistence, initiation, and dose titration as odds ratios (ORs) with 95% confidence intervals (CIs) using multivariable logistic regression models. Of 8504 eligible HFrEF patients with incident cancer, 4890 were matched to controls without cancer. The mean age was 75.7 (±8.4) years and 73.9% were male. In the 12 months following a cancer diagnosis, patients experienced reductions in the use and dosing of GDMT. Compared with the non-cancer controls, patients with cancer had higher risks for poor adherence for all three medication classes (RASIs: OR = 1.51, 95% CI = 1.35-1.68; beta-blockers: OR = 1.22, 95% CI = 1.08-1.37; MRAs: OR = 1.31, 95% CI = 1.08-1.59) and poor persistence (RASIs: OR = 2.04, 95% CI = 1.75-2.37; beta-blockers: OR = 1.35, 95% CI = 1.12-1.63; MRAs: OR = 1.49, 95% CI = 1.16-1.93), and higher risks for dose down-titration for RASIs (OR = 1.69, 95% CI = 1.40-2.04) and beta-blockers (OR = 1.31, 95% CI = 1.05-1.62). Cancer diagnosis was not associated with treatment initiation or dose up-titration. Event rates for HF hospitalization and mortality were higher in patients with poor adherence or persistence to GDMTs. CONCLUSIONS Following a cancer diagnosis, patients with HFrEF were more likely to have reduced use of GDMTs for HF.
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Affiliation(s)
- Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Pinkie Chambers
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Isla S Mackenzie
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
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Lee B, Lee YK, Kim SH, Oh H, Won S, Jang SY, Jeon YJ, Yoo BN, Bak JK. Impact of linkage level on inferences from big data analyses in health and medical research: an empirical study. BMC Med Inform Decis Mak 2024; 24:193. [PMID: 38982481 PMCID: PMC11234607 DOI: 10.1186/s12911-024-02586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Linkage errors that occur according to linkage levels can adversely affect the accuracy and reliability of analysis results. This study aimed to identify the differences in results according to personally identifiable information linkage level, sample size, and analysis methods through empirical analysis. METHODS The difference between the results of linkage in directly identifiable information (DII) and indirectly identifiable information (III) linkage levels was set as III linkage based on name, date of birth, and sex and DII linkage based on resident registration number. The datasets linked at each level were named as databaseIII (DBIII) and databaseDII (DBDII), respectively. Considering the analysis results of the DII-linked dataset as the gold standard, descriptive statistics, group comparison, incidence estimation, treatment effect, and moderation effect analysis results were assessed. RESULTS The linkage rates for DBDII and DBIII were 71.1% and 99.7%, respectively. Regarding descriptive statistics and group comparison analysis, the difference in effect in most cases was "none" to "very little." With respect to cervical cancer that had a relatively small sample size, analysis of DBIII resulted in an underestimation of the incidence in the control group and an overestimation of the incidence in the treatment group (hazard ratio [HR] = 2.62 [95% confidence interval (CI): 1.63-4.23] in DBIII vs. 1.80 [95% CI: 1.18-2.73] in DBDII). Regarding prostate cancer, there was a conflicting tendency with the treatment effect being over or underestimated according to the surveillance, epidemiology, and end results summary staging (HR = 2.27 [95% CI: 1.91-2.70] in DBIII vs. 1.92 [95% CI: 1.70-2.17] in DBDII for the localized stage; HR = 1.80 [95% CI: 1.37-2.36] in DBIII vs. 2.05 [95% CI: 1.67-2.52] in DBDII for the regional stage). CONCLUSIONS To prevent distortion of the analyses results in health and medical research, it is important to check that the patient population and sample size by each factor of interest (FOI) are sufficient when different data are linked using DBDII. In cases involving a rare disease or with a small sample size for FOI, there is a high likelihood that a DII linkage is unavoidable.
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Affiliation(s)
- Bora Lee
- Institute of Health & Environment, Seoul National University, Seoul, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sung Han Kim
- Department of Urology, Urologic Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang-si, Republic of Korea
| | - HyunJin Oh
- Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and Detection of National Cancer Center, Goyang-si, Republic of Korea
| | - Sungho Won
- Institute of Health & Environment, Seoul National University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program for Bioinformatics, College of Natural Science, Seoul National University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Ye Jin Jeon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Bit-Na Yoo
- National Evidence-based Healthcare Collaborating Agency (NECA), 3-5F 400, Neungdong-ro, Gwangin-gu, Seoul, 04933, Republic of Korea
| | - Jean-Kyung Bak
- National Evidence-based Healthcare Collaborating Agency (NECA), 3-5F 400, Neungdong-ro, Gwangin-gu, Seoul, 04933, Republic of Korea.
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Aldridge RW, Evans HER, Yavlinsky A, Moayyeri A, Bhaskaran K, Mathur R, Jordan KP, Croft P, Denaxas S, Shah AD, Blackburn RM, Moller H, Ng ESW, Hughes A, Fox S, Flowers J, Schmidt J, Hayward A, Gilbert R, Smeeth L, Hemingway H. Estimating disease burden using national linked electronic health records: a study using an English population-based cohort. Wellcome Open Res 2024; 8:262. [PMID: 39092423 PMCID: PMC11292189 DOI: 10.12688/wellcomeopenres.19470.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 08/04/2024] Open
Abstract
Background Electronic health records (EHRs) have the potential to be used to produce detailed disease burden estimates. In this study we created disease estimates using national EHR for three high burden conditions, compared estimates between linked and unlinked datasets and produced stratified estimates by age, sex, ethnicity, socio-economic deprivation and geographical region. Methods EHRs containing primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and mortality records (Office for National Statistics) were used. We used existing disease phenotyping algorithms to identify cases of cancer (breast, lung, colorectal and prostate), type 1 and 2 diabetes, and lower back pain. We calculated age-standardised incidence of first cancer, point prevalence for diabetes, and primary care consultation prevalence for low back pain. Results 7.2 million people contributing 45.3 million person-years of active follow-up between 2000-2014 were included. CPRD-HES combined and CPRD-HES-ONS combined lung and bowel cancer incidence estimates by sex were similar to cancer registry estimates. Linked CPRD-HES estimates for combined Type 1 and Type 2 diabetes were consistently higher than those of CPRD alone, with the difference steadily increasing over time from 0.26% (2.99% for CPRD-HES vs. 2.73 for CPRD) in 2002 to 0.58% (6.17% vs. 5.59) in 2013. Low back pain prevalence was highest in the most deprived quintile and when compared to the least deprived quintile the difference in prevalence increased over time between 2000 and 2013, with the largest difference of 27% (558.70 per 10,000 people vs 438.20) in 2013. Conclusions We use national EHRs to produce estimates of burden of disease to produce detailed estimates by deprivation, ethnicity and geographical region. National EHRs have the potential to improve disease burden estimates at a local and global level and may serve as more automated, timely and precise inputs for policy making and global burden of disease estimation.
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Affiliation(s)
- Robert W. Aldridge
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Hannah E. R. Evans
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Alireza Moayyeri
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University of London, London, England, EC1M 6BQ, UK
| | - Kelvin P. Jordan
- School of Medicine, Keele University, Staffordshire, England, ST5 5BG, UK
| | - Peter Croft
- School of Medicine, Keele University, Staffordshire, England, ST5 5BG, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Anoop D. Shah
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Ruth M. Blackburn
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Henrik Moller
- Cancer Epidemiology & Population Health, King's College London, London, England, WC2R 2LS, UK
| | - Edmond S. W. Ng
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Andrew Hughes
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, SW1H 0EU, UK
| | - Sebastian Fox
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, SW1H 0EU, UK
| | - Julian Flowers
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Jurgen Schmidt
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, SW1H 0EU, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 6BT, UK
| | - Ruth Gilbert
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
| | - Liam Smeeth
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, England, NW1 2DA, UK
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Rosillo N, Bueno H. Data source integration: a key tool for optimizing resources and prioritizing areas for improvement in clinical practice and epidemiology. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:459-461. [PMID: 38423175 DOI: 10.1016/j.rec.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 03/02/2024]
Affiliation(s)
- Nicolás Rosillo
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, España. https://twitter.com/@RosilloRN
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España.
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Espinosa EVP, Matute EM, Sosa Guzmán DM, Khasawneh FT. The Polypill: A New Alternative in the Prevention and Treatment of Cardiovascular Disease. J Clin Med 2024; 13:3179. [PMID: 38892892 PMCID: PMC11172978 DOI: 10.3390/jcm13113179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 06/21/2024] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of death and disability worldwide. Although age-standardized CVD mortality rates decreased globally by 14.5% between 2006 and 2016, the burden of CVD remains disproportionately higher in low- and middle-income countries compared to high-income countries. Even though proven, effective approaches based on multiple-drug intake aimed at the prevention and treatment of CVD are currently available, poor adherence, early discontinuation of treatment, and suboptimal daily execution of the prescribed therapeutic regimes give rise to shortfalls in drug exposure, leading to high variability in the responses to the prescribed medications. Wald and Law, in their landmark paper published in BMJ 2003, hypothesized that the use of a fixed-dose combination of statins, β-blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and aspirin (classic Polypill composition) may increase adherence and decrease CVD by up to 80% when prescribed as primary prevention or in substitution of traditional protocols. Since then, many clinical trials have tested this hypothesis, with comparable results. This review aims to describe the available clinical trials performed to assess the impact of fixed-dose combinations on adherence, cost-effectiveness, and the risk factors critical to the onset of CVD.
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Affiliation(s)
- Enma V. Páez Espinosa
- Department of Clinical Laboratory, School of Medicine, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador;
- Center for Research on Health in Latin America (CISeAL), Pontifical Catholic University of Ecuador, Quito 170143, Ecuador
| | - Eugenia Mato Matute
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), C/Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Delia M. Sosa Guzmán
- Department of Clinical Laboratory, School of Medicine, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador;
| | - Fadi T. Khasawneh
- Department of Pharmaceutical Sciences, Rangel School of Pharmacy, Texas A&M University, College Station, TX 77843, USA;
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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] [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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Rouette J, McDonald EG, Schuster T, Matok I, Brophy JM, Azoulay L. Thiazide Diuretics and Risk of Colorectal Cancer: A Population-Based Cohort Study. Am J Epidemiol 2024; 193:47-57. [PMID: 37579305 DOI: 10.1093/aje/kwad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 05/05/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
Evidence from clinical trials and observational studies on the association between thiazide diuretics and colorectal cancer risk is conflicting. We aimed to determine whether thiazide diuretics are associated with an increased colorectal cancer risk compared with dihydropyridine calcium channel blockers (dCCBs). A population-based, new-user cohort was assembled using the UK Clinical Practice Research Datalink. Between 1990-2018, we compared thiazide diuretic initiators with dCCB initiators and estimated hazard ratios (HR) with 95% confidence intervals (CIs) of colorectal cancer using Cox proportional hazard models. Models were weighted using standardized morbidity ratio weights generated from calendar time-specific propensity scores. The cohort included 377,760 thiazide diuretic initiators and 364,300 dCCB initiators, generating 3,619,883 person-years of follow-up. Compared with dCCBs, thiazide diuretics were not associated with colorectal cancer (weighted HR = 0.97, 95% CI: 0.90, 1.04). Secondary analyses yielded similar results, although an increased risk was observed among patients with inflammatory bowel disease (weighted HR = 2.45, 95% CI: 1.13, 5.35) and potentially polyps (weighted HR = 1.46, 95% CI: 0.93, 2.30). Compared with dCCBs, thiazide diuretics were not associated with an overall increased colorectal cancer risk. While these findings provide some reassurance, research is needed to corroborate the elevated risks observed among patients with inflammatory bowel disease and history of polyps.
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10
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Ramroth J, Shakir R, Darby SC, Cutter DJ, Kuan V. Cardiovascular disease incidence rates: a study using routinely collected health data. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:41. [PMID: 37968715 PMCID: PMC10647140 DOI: 10.1186/s40959-023-00189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/02/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND There is substantial evidence that systemic anticancer therapies and radiotherapy can increase the long-term risk of cardiovascular disease (CVD). Optimal management decisions for cancer patients therefore need to take into account the likely risks from a proposed treatment option, as well as its likely benefits. For CVD, the magnitude of the risk depends on the incidence of the disease in the general population to which the patient belongs, including variation with age and sex, as well as on the treatment option under consideration. The aim of this paper is to provide estimates of CVD incidence rates in the general population of England for use in cardio-oncology and in other relevant clinical, research and health policy contexts. METHODS We studied a population-based representative cohort, consisting of 2,633,472 individuals, derived by electronic linkage of records from primary care with those of admitted-patient care in England during April 1, 2010, to April 1, 2015. From 38 individual CVDs available via the linked dataset we identified five relevant categories of CVD whose risk may be increased by cancer treatments: four of heart disease and one of stroke. RESULTS We calculated incidence rates by age-group and sex for all relevant CVD categories combined, for the four relevant categories of heart disease combined, and for the five relevant CVD categories separately. We present separate incidence rates for all 38 individual CVDs available via the linked dataset. We also illustrate how our data can be used to estimate absolute CVD risks in a range of people with Hodgkin lymphoma treated with chemotherapy and radiotherapy. CONCLUSIONS Our results provide population-based CVD incidence rates for a variety of uses, including the estimation of absolute risks of CVD from cancer treatments, thus helping patients and clinicians to make appropriate individualized cancer treatment decisions. Graphical Abstract: Cardiovascular incidence rates for use in cardio-oncology and elsewhere: A presentation of age- and sex-specific cardiovascular disease (CVD) incidence rates for use in calculation of absolute cardiovascular risks of cancer treatments, and in other clinical, research and health policy contexts. Abbreviations - CVD: cardiovascular disease; y: years.
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Affiliation(s)
- Johanna Ramroth
- Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Rebecca Shakir
- Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
- Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Sarah C Darby
- Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - David J Cutter
- Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
- Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Valerie Kuan
- Institute of Health Informatics, University College London, London, WC1N 1AX, UK
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11
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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] [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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12
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Mukadam N, Marston L, Lewis G, Mathur R, Lowther E, Rait G, Livingston G. South Asian, Black and White ethnicity and the effect of potentially modifiable risk factors for dementia: A study in English electronic health records. PLoS One 2023; 18:e0289893. [PMID: 37819899 PMCID: PMC10566703 DOI: 10.1371/journal.pone.0289893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/28/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION We aimed to investigate ethnic differences in the associations of potentially modifiable risk factors with dementia. METHODS We used anonymised data from English electronic primary care records for adults aged 65 and older between 1997 and 2018. We used Cox regression to investigate main effects for each risk factor and interaction effects between each risk factor and ethnicity. RESULTS We included 865,674 people with 8,479,973 person years of follow up. Hypertension, dyslipidaemia, obesity and diabetes were more common in people from minority ethnic groups than White people. The impact of hypertension, obesity, diabetes, low HDL and sleep disorders on dementia risk was increased in South Asian people compared to White people. The impact of hypertension was greater in Black compared to White people. DISCUSSION Dementia prevention efforts should be targeted towards people from minority ethnic groups and tailored to risk factors of particular importance.
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Affiliation(s)
- Naaheed Mukadam
- Division of Psychiatry, University College London, London, United Kingdom
| | - Louise Marston
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University London, London, United Kingdom
| | - Ed Lowther
- Advanced Research Computing Centre, University College London, London, United Kingdom
| | - Greta Rait
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
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13
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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] [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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14
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Kang J, Palmier-Claus J, Wu J, Shiers D, Larvin H, Doran T, Aggarwal VR. Periodontal disease in people with a history of psychosis: Results from the UK biobank population-based study. Community Dent Oral Epidemiol 2023; 51:985-996. [PMID: 36258297 DOI: 10.1111/cdoe.12798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/04/2022] [Accepted: 09/29/2022] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To test the hypotheses that: (1) Prevalence of periodontal disease would be higher in people with a history of psychosis when compared to the general population and (2) Demographic, life-style related factors and co-morbid medical conditions would predict periodontal disease in people experiencing psychosis. METHODS The authors performed cross-sectional analysis of baseline data from the UK Biobank study (2007-2010), identifying cases with psychosis using clinical diagnosis, antipsychotic medication, and self-report. Demographic (age, gender, ethnicity, socioeconomic status), lifestyle-related(BMI, blood pressure, smoking and alcohol intake, physical activity) and physical co-morbidities (cancer, cardiovascular, respiratory, inflammatory disease and metabolic conditions) were included as potential risk factors for periodontal disease among people with a history of psychosis using logistic regression analyses. The analysis sample included 502,505 participants. RESULTS Risk of periodontal disease was higher in people with psychosis, regardless of how cases were identified. Patients with a clinical diagnosis had the highest proportion of periodontal disease compared to the general population (21.3% vs. 14.8%, prevalence ratio 1.40, 95% CI: 1.26-1.56). Older and female cases were more likely to experience periodontal disease. Lifestyle factors (smoking) and comorbidities (cardiovascular, cancer or respiratory disease) were associated with periodontal disease among people with a history of psychosis. CONCLUSIONS The findings suggest that periodontal disease is more common in people with a history of psychosis, compared to the general population. Prevention and early diagnosis of periodontal disease should be a priority for oral health promotion programmes, which should also address modifiable risk factors like smoking which also contribute to co-morbid systemic disease.
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Affiliation(s)
- Jing Kang
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
| | - David Shiers
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
- School of Medicine, Keele University, Keele, UK
| | | | - Tim Doran
- Health Services & Policy, University of York, York, UK
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15
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Dickerman BA, García-Albéniz X, Logan RW, Denaxas S, Hernán MA. Evaluating Metformin Strategies for Cancer Prevention: A Target Trial Emulation Using Electronic Health Records. Epidemiology 2023; 34:690-699. [PMID: 37227368 PMCID: PMC10524586 DOI: 10.1097/ede.0000000000001626] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Metformin users appear to have a substantially lower risk of cancer than nonusers in many observational studies. These inverse associations may be explained by common flaws in observational analyses that can be avoided by explicitly emulating a target trial. METHODS We emulated target trials of metformin therapy and cancer risk using population-based linked electronic health records from the UK (2009-2016). We included individuals with diabetes, no history of cancer, no recent prescription for metformin or other glucose-lowering medication, and hemoglobin A1c (HbA1c) <64 mmol/mol (<8.0%). Outcomes included total cancer and 4 site-specific cancers (breast, colorectal, lung, and prostate). We estimated risks using pooled logistic regression with adjustment for risk factors via inverse-probability weighting. We emulated a second target trial among individuals regardless of diabetes status. We compared our estimates with those obtained using previously applied analytic approaches. RESULTS Among individuals with diabetes, the estimated 6-year risk differences (metformin - no metformin) were -0.2% (95% CI = -1.6%, 1.3%) in the intention-to-treat analysis and 0.0% (95% CI = -2.1%, 2.3%) in the per-protocol analysis. The corresponding estimates for all site-specific cancers were close to zero. Among individuals regardless of diabetes status, these estimates were also close to zero and more precise. By contrast, previous analytic approaches yielded estimates that appeared strongly protective. CONCLUSIONS Our findings are consistent with the hypothesis that metformin therapy does not meaningfully influence cancer incidence. The findings highlight the importance of explicitly emulating a target trial to reduce bias in the effect estimates derived from observational analyses.
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Affiliation(s)
- Barbra A. Dickerman
- CAUSALab, Harvard T.H. Chan School of Public Health,
Boston, Massachusetts, US
- Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, Massachusetts, US
| | - Xabier García-Albéniz
- CAUSALab, Harvard T.H. Chan School of Public Health,
Boston, Massachusetts, US
- Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, Massachusetts, US
- RTI Health Solutions, Barcelona, Spain
| | - Roger W. Logan
- CAUSALab, Harvard T.H. Chan School of Public Health,
Boston, Massachusetts, US
- Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, Massachusetts, US
| | - Spiros Denaxas
- Institute of Health Informatics Research, University
College London, London, UK
- Health Data Research UK (HDR UK) London, University College
London, London, UK
- The Alan Turing Institute, London, UK
| | - Miguel A. Hernán
- CAUSALab, Harvard T.H. Chan School of Public Health,
Boston, Massachusetts, US
- Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, Massachusetts, US
- Department of Biostatistics, Harvard T.H. Chan School of
Public Health, Boston, Massachusetts, US
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16
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Jordan KP, Rathod-Mistry T, van der Windt DA, Bailey J, Chen Y, Clarson L, Denaxas S, Hayward RA, Hemingway H, Kyriacou T, Mamas MA. Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study. Eur J Prev Cardiol 2023; 30:1151-1161. [PMID: 36895179 PMCID: PMC10442054 DOI: 10.1093/eurjpc/zwad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
AIMS Most adults presenting in primary care with chest pain symptoms will not receive a diagnosis ('unattributed' chest pain) but are at increased risk of cardiovascular events. To assess within patients with unattributed chest pain, risk factors for cardiovascular events and whether those at greatest risk of cardiovascular disease can be ascertained by an existing general population risk prediction model or by development of a new model. METHODS AND RESULTS The study used UK primary care electronic health records from the Clinical Practice Research Datalink linked to admitted hospitalizations. Study population was patients aged 18 plus with recorded unattributed chest pain 2002-2018. Cardiovascular risk prediction models were developed with external validation and comparison of performance to QRISK3, a general population risk prediction model. There were 374 917 patients with unattributed chest pain in the development data set. The strongest risk factors for cardiovascular disease included diabetes, atrial fibrillation, and hypertension. Risk was increased in males, patients of Asian ethnicity, those in more deprived areas, obese patients, and smokers. The final developed model had good predictive performance (external validation c-statistic 0.81, calibration slope 1.02). A model using a subset of key risk factors for cardiovascular disease gave nearly identical performance. QRISK3 underestimated cardiovascular risk. CONCLUSION Patients presenting with unattributed chest pain are at increased risk of cardiovascular events. It is feasible to accurately estimate individual risk using routinely recorded information in the primary care record, focusing on a small number of risk factors. Patients at highest risk could be targeted for preventative measures.
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Affiliation(s)
- Kelvin P Jordan
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Trishna Rathod-Mistry
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Danielle A van der Windt
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - James Bailey
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Ying Chen
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
- Wisdom Lake Academy of Pharmacy, Xi'an Jiaotong-Liverpool University, Suzhou 215123, Jiangsu, China
| | - Lorna Clarson
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK
- Health Data Research UK, University College London, 222 Euston Road, London NW1 2DA, UK
| | - Richard A Hayward
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, Maple House 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Theocharis Kyriacou
- School of Computing and Mathematics, Keele University, Staffordshire ST5 5AA, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
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17
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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: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [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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18
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Wang Y, Zheng J, Schneberk T, Ke Y, Chan A, Hu T, Lam J, Gutierrez M, Portillo I, Wu D, Chang CH, Qu Y, Brown L, Nichol MB. What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data. BMC PRIMARY CARE 2023; 24:130. [PMID: 37355573 PMCID: PMC10290298 DOI: 10.1186/s12875-023-02080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.
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Affiliation(s)
- Yun Wang
- School of Pharmacy, Chapman University, Irvine, US.
| | | | - Todd Schneberk
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles, US
| | - Yu Ke
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, US
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, US
| | - Tao Hu
- Department of Geography, Oklahoma State University, Stillwater, US
| | - Jerika Lam
- School of Pharmacy, Chapman University, Irvine, US
| | | | | | - Dan Wu
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London, School of Hygiene and Tropical Medicine, London, UK
| | - Chih-Hung Chang
- Program in Occupational Therapy, Department of Medicine, and Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, US
| | - Yang Qu
- School of Pharmacy, Chapman University, Irvine, US
| | | | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, US
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19
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Pikoula M, Kallis C, Madjiheurem S, Quint JK, Bafadhel M, Denaxas S. Evaluation of data processing pipelines on real-world electronic health records data for the purpose of measuring patient similarity. PLoS One 2023; 18:e0287264. [PMID: 37319288 PMCID: PMC10270623 DOI: 10.1371/journal.pone.0287264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/01/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The ever-growing size, breadth, and availability of patient data allows for a wide variety of clinical features to serve as inputs for phenotype discovery using cluster analysis. Data of mixed types in particular are not straightforward to combine into a single feature vector, and techniques used to address this can be biased towards certain data types in ways that are not immediately obvious or intended. In this context, the process of constructing clinically meaningful patient representations from complex datasets has not been systematically evaluated. AIMS Our aim was to a) outline and b) implement an analytical framework to evaluate distinct methods of constructing patient representations from routine electronic health record data for the purpose of measuring patient similarity. We applied the analysis on a patient cohort diagnosed with chronic obstructive pulmonary disease. METHODS Using data from the CALIBER data resource, we extracted clinically relevant features for a cohort of patients diagnosed with chronic obstructive pulmonary disease. We used four different data processing pipelines to construct lower dimensional patient representations from which we calculated patient similarity scores. We described the resulting representations, ranked the influence of each individual feature on patient similarity and evaluated the effect of different pipelines on clustering outcomes. Experts evaluated the resulting representations by rating the clinical relevance of similar patient suggestions with regard to a reference patient. RESULTS Each of the four pipelines resulted in similarity scores primarily driven by a unique set of features. It was demonstrated that data transformations according to each pipeline prior to clustering can result in a variation of clustering results of over 40%. The most appropriate pipeline was selected on the basis of feature ranking and clinical expertise. There was moderate agreement between clinicians as measured by Cohen's kappa coefficient. CONCLUSIONS Data transformation has downstream and unforeseen consequences in cluster analysis. Rather than viewing this process as a black box, we have shown ways to quantitatively and qualitatively evaluate and select the appropriate preprocessing pipeline.
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Affiliation(s)
- Maria Pikoula
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Constantinos Kallis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sephora Madjiheurem
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Jennifer K. Quint
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, United Kingdom
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20
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Teece L, Sweeting MJ, Hall M, Coles B, Oliver-Williams C, Welch CA, de Belder MA, Deanfield J, Weston C, Rutherford MJ, Paley L, Kadam UT, Lambert PC, Peake MD, Gale CP, Adlam D. Impact of a Prior Cancer Diagnosis on Quality of Care and Survival Following Acute Myocardial Infarction: Retrospective Population-Based Cohort Study in England. Circ Cardiovasc Qual Outcomes 2023; 16:e009236. [PMID: 37339190 PMCID: PMC10281182 DOI: 10.1161/circoutcomes.122.009236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND An increasing proportion of patients with cancer experience acute myocardial infarction (AMI). We investigated differences in quality of AMI care and survival between patients with and without previous cancer diagnoses. METHODS A retrospective cohort study using Virtual Cardio-Oncology Research Initiative data. Patients aged 40+ years hospitalized in England with AMI between January 2010 and March 2018 were assessed, ascertaining previous cancers diagnosed within 15 years. Multivariable regression was used to assess effects of cancer diagnosis, time, stage, and site on international quality indicators and mortality. RESULTS Of 512 388 patients with AMI (mean age, 69.3 years; 33.5% women), 42 187 (8.2%) had previous cancers. Patients with cancer had significantly lower use of ACE (angiotensin-converting enzyme) inhibitors/angiotensin receptor blockers (mean percentage point decrease [mppd], 2.6% [95% CI, 1.8-3.4]) and lower overall composite care (mppd, 1.2% [95% CI, 0.9-1.6]). Poorer quality indicator attainment was observed in patients with cancer diagnosed in the last year (mppd, 1.4% [95% CI, 1.8-1.0]), with later stage disease (mppd, 2.5% [95% CI, 3.3-1.4]), and with lung cancer (mppd, 2.2% [95% CI, 3.0-1.3]). Twelve-month all-cause survival was 90.5% in noncancer controls and 86.3% in adjusted counterfactual controls. Differences in post-AMI survival were driven by cancer-related deaths. Modeling improving quality indicator attainment to noncancer patient levels showed modest 12-month survival benefits (lung cancer, 0.6%; other cancers, 0.3%). CONCLUSIONS Measures of quality of AMI care are poorer in patients with cancer, with lower use of secondary prevention medications. Findings are primarily driven by differences in age and comorbidities between cancer and noncancer populations and attenuated after adjustment. The largest impact was observed in recent cancer diagnoses (<1 year) and lung cancer. Further investigation will determine whether differences reflect appropriate management according to cancer prognosis or whether opportunities to improve AMI outcomes in patients with cancer exist.
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Affiliation(s)
- Lucy Teece
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Michael J. Sweeting
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (M.H., C.P.G.)
| | - Briana Coles
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Clare Oliver-Williams
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Cathy A. Welch
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Mark A. de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (M.A.d.B., J.D., C.W.)
| | - John Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (M.A.d.B., J.D., C.W.)
- Institute of Cardiovascular Science, University College London, United Kingdom (J.D.)
| | - Clive Weston
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (M.A.d.B., J.D., C.W.)
- Department of Cardiology, Glangwili General Hospital, Carmarthen, United Kingdom (C.W.)
| | - Mark J. Rutherford
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
| | - Lizz Paley
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Umesh T. Kadam
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- Leicester Diabetes Centre, United Kingdom (U.T.K.)
| | - Paul C. Lambert
- Department of Health Sciences (L.T., M.J.S., B.C., C.O.-W., C.A.W., M.J.R., U.T.K., P.C.L.), University of Leicester, United Kingdom
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (P.C.L.)
| | - Michael D. Peake
- Department of Respiratory Medicine (M.D.P.), University of Leicester, United Kingdom
- National Cancer Registration and Analysis Service, NHS Digital, London, United Kingdom (L.T., M.J.S., B.C., C.O.-W., C.A.W., L.P., M.D.P.)
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (M.H., C.P.G.)
| | - David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (D.A.), University of Leicester, United Kingdom
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21
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Bean DM, Kraljevic Z, Shek A, Teo J, Dobson RJB. Hospital-wide natural language processing summarising the health data of 1 million patients. PLOS DIGITAL HEALTH 2023; 2:e0000218. [PMID: 37159441 PMCID: PMC10168555 DOI: 10.1371/journal.pdig.0000218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/16/2023] [Indexed: 05/11/2023]
Abstract
Electronic health records (EHRs) represent a major repository of real world clinical trajectories, interventions and outcomes. While modern enterprise EHR's try to capture data in structured standardised formats, a significant bulk of the available information captured in the EHR is still recorded only in unstructured text format and can only be transformed into structured codes by manual processes. Recently, Natural Language Processing (NLP) algorithms have reached a level of performance suitable for large scale and accurate information extraction from clinical text. Here we describe the application of open-source named-entity-recognition and linkage (NER+L) methods (CogStack, MedCAT) to the entire text content of a large UK hospital trust (King's College Hospital, London). The resulting dataset contains 157M SNOMED concepts generated from 9.5M documents for 1.07M patients over a period of 9 years. We present a summary of prevalence and disease onset as well as a patient embedding that captures major comorbidity patterns at scale. NLP has the potential to transform the health data lifecycle, through large-scale automation of a traditionally manual task.
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Affiliation(s)
- Daniel M Bean
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Health Data Research UK London, University College London, London, United Kingdom
| | - Zeljko Kraljevic
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Anthony Shek
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James Teo
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Neuroscience, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Health Data Research UK London, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
- Institute for Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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22
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Lee KK, Doudesis D, Bing R, Astengo F, Perez JR, Anand A, McIntyre S, Bloor N, Sandler B, Lister S, Pollock KG, Qureshi AC, McAllister DA, Shah ASV, Mills NL. Sex Differences in Oral Anticoagulation Therapy in Patients Hospitalized With Atrial Fibrillation: A Nationwide Cohort Study. J Am Heart Assoc 2023; 12:e027211. [PMID: 36864741 PMCID: PMC10111444 DOI: 10.1161/jaha.122.027211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/09/2022] [Indexed: 03/04/2023]
Abstract
Background Important disparities in the treatment and outcomes of women and men with atrial fibrillation (AF) are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain. Methods and Results All patients who had an incident hospitalization from 2010 to 2019 with nonvalvular AF in Scotland were included in the present cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modeling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants. A total of 172 989 patients (48% women [82 833 of 172 989]) had an incident hospitalization with nonvalvular AF in Scotland between 2010 and 2019. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared with men (adjusted odds ratio [aOR], 0.68 [95% CI, 0.67-0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR, 0.68 [95% CI, 0.66-0.70]), while there was less disparity in the use of factor Xa inhibitors between women and men (aOR, 0.92 [95% CI, 0.90-0.95]). Conclusions Women with nonvalvular AF were significantly less likely to be prescribed vitamin K antagonists compared with men. Most patients admitted to the hospital in Scotland with incident nonvalvular AF are now treated with factor Xa inhibitors and this is associated with fewer treatment disparities between women and men.
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Affiliation(s)
- Kuan Ken Lee
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
| | - Dimitrios Doudesis
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
- Usher Institute of Population Health Sciences and Informatics, University of EdinburghEdinburghUnited Kingdom
| | - Rong Bing
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
| | - Federica Astengo
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
| | - Jesus R. Perez
- Institute of Health and Wellbeing, University of GlasgowGlasgowUnited Kingdom
| | - Atul Anand
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
| | - Shauna McIntyre
- Bristol Myers Squibb Pharmaceuticals LtdLondonUnited Kingdom
| | | | - Belinda Sandler
- Bristol Myers Squibb Pharmaceuticals LtdLondonUnited Kingdom
| | - Steven Lister
- Bristol Myers Squibb Pharmaceuticals LtdLondonUnited Kingdom
| | | | | | - David A. McAllister
- Institute of Health and Wellbeing, University of GlasgowGlasgowUnited Kingdom
| | - Anoop S. V. Shah
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Nicholas L. Mills
- BHF Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUnited Kingdom
- Usher Institute of Population Health Sciences and Informatics, University of EdinburghEdinburghUnited Kingdom
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23
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Debray TPA, Collins GS, Riley RD, Snell KIE, Van Calster B, Reitsma JB, Moons KGM. Transparent reporting of multivariable prediction models developed or validated using clustered data: TRIPOD-Cluster checklist. BMJ 2023; 380:e071018. [PMID: 36750242 PMCID: PMC9903175 DOI: 10.1136/bmj-2022-071018] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Thomas P A Debray
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Kym I E Snell
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Johannes B Reitsma
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
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24
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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: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [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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Chung S, Providencia R, Sofat R, Pujades‐Rodriguez M, Torralbo A, Fatemifar G, Fitzpatrick NK, Taylor J, Li K, Dale C, Rossor M, Acosta‐Mena D, Whittaker J, Denaxas S. Incidence, morbidity, mortality and disparities in dementia: A population linked electronic health records study of 4.3 million individuals. Alzheimers Dement 2023; 19:123-135. [PMID: 35290719 PMCID: PMC10078672 DOI: 10.1002/alz.12635] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/08/2021] [Accepted: 01/30/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION We report dementia incidence, comorbidities, reasons for health-care visits, mortality, causes of death, and examined dementia patterns by relative deprivation in the UK. METHOD A longitudinal cohort analysis of linked electronic health records from 4.3 million people in the UK was conducted to investigate dementia incidence and mortality. Reasons for hospitalization and causes of death were compared in individuals with and without dementia. RESULTS From 1998 to 2016 we observed 145,319 (3.1%) individuals with incident dementia. Repeated hospitalizations among senior adults for infection, unknown morbidity, and multiple primary care visits for chronic pain were observed prior to dementia diagnosis. Multiple long-term conditions are present in half of the individuals at the time of diagnosis. Individuals living in high deprivation areas had higher dementia incidence and high fatality. DISCUSSION There is a considerable disparity of dementia that informs priorities of prevention and provision of patient care.
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Affiliation(s)
- Sheng‐Chia Chung
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | | | - Reecha Sofat
- Department of Health InformaticsHealth Data Research UKLondonUK
| | | | - Ana Torralbo
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Ghazaleh Fatemifar
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Natalie K. Fitzpatrick
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Julie Taylor
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Ken Li
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Caroline Dale
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Martin Rossor
- Department of NeurodegenerationUCL Institute of NeurologyLondonUK
| | | | | | - Spiros Denaxas
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
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Rouette J, McDonald EG, Schuster T, Brophy JM, Azoulay L. Dihydropyridine Calcium Channel Blockers and Risk of Pancreatic Cancer: A Population-Based Cohort Study. J Am Heart Assoc 2022; 11:e026789. [PMID: 36515246 PMCID: PMC9798809 DOI: 10.1161/jaha.122.026789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
Abstract
Background Recent studies have reported that dihydropyridine calcium channel blockers (dCCBs) may increase the risk of pancreatic cancer, but these studies had methodological limitations. We thus aimed to determine whether dCCBs are associated with an increased risk of pancreatic cancer compared with thiazide diuretics, a clinically relevant comparator. Methods and Results We conducted a new user, active comparator, population-based cohort study using the UK Clinical Practice Research Datalink. We identified new users of dCCBs and new users of thiazide diuretics between 1990 and 2018, with follow-up until 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% CIs for pancreatic cancer, comparing dCCBs with thiazide diuretics. Models were weighted using standardized morbidity ratio weights based on calendar time-specific propensity scores. We also conducted secondary analyses by cumulative duration of use, time since initiation, and individual drugs and assessed for the presence of effect modification by age, sex, smoking status, body mass index, history of chronic pancreatitis, and diabetes. The cohort included 344 480 initiators of dCCBs and 357 968 initiators of thiazide diuretics, generating 3 360 745 person-years of follow-up. After a median follow-up of 4.5 years, the weighted incidence rate per 100 000 person-years was 37.2 (95% CI, 34.1-40.4) for dCCBs and 39.4 (95% CI, 36.1-42.9) for thiazide diuretics. Overall, dCCBs were not associated with an increased risk of pancreatic cancer (weighted HR, 0.93; 95% CI, 0.80-1.09). Similar results were observed in secondary analyses. Conclusions In this large, population-based cohort study, dCCBs were not associated with an increased risk of pancreatic cancer compared with thiazide diuretics. These findings provide reassurance regarding the long-term pancreatic cancer safety of these drugs.
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Affiliation(s)
- Julie Rouette
- Centre for Clinical EpidemiologyLady Davis Institute, Jewish General HospitalMontrealCanada
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
| | - Emily G. McDonald
- Division of General Internal Medicine, Department of MedicineMcGill University Health CentreMontrealCanada
- Division of Experimental MedicineMcGill UniversityMontrealCanada
| | - Tibor Schuster
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
- Department of Family MedicineMcGill UniversityMontrealCanada
| | - James M. Brophy
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
- Division of Clinical EpidemiologyMcGill University Health Centre–Research InstituteMontrealCanada
- Department of MedicineMcGill UniversityMontrealCanada
| | - Laurent Azoulay
- Centre for Clinical EpidemiologyLady Davis Institute, Jewish General HospitalMontrealCanada
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
- Gerald Bronfman Department of OncologyMcGill UniversityMontrealCanada
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Vauvelle A, Creed P, Denaxas S. Neural-signature methods for structured EHR prediction. BMC Med Inform Decis Mak 2022; 22:320. [PMID: 36476601 PMCID: PMC9730578 DOI: 10.1186/s12911-022-02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Models that can effectively represent structured Electronic Healthcare Records (EHR) are central to an increasing range of applications in healthcare. Due to the sequential nature of health data, Recurrent Neural Networks have emerged as the dominant component within state-of-the-art architectures. The signature transform represents an alternative modelling paradigm for sequential data. This transform provides a non-learnt approach to creating a fixed vector representation of temporal features and has shown strong performances across an increasing number of domains, including medical data. However, the signature method has not yet been applied to structured EHR data. To this end, we follow recent work that enables the signature to be used as a differentiable layer within a neural architecture enabling application in high dimensional domains where calculation would have previously been intractable. Using a heart failure prediction task as an exemplar, we provide an empirical evaluation of different variations of the signature method and compare against state-of-the-art baselines. This first application of neural-signature methods in real-world healthcare data shows a competitive performance when compared to strong baselines and thus warrants further investigation within the health domain.
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Affiliation(s)
- Andre Vauvelle
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK.
| | | | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London, UK
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Al Khalaf S, Khashan AS, Chappell LC, O'Reilly ÉJ, McCarthy FP. Role of Antihypertensive Treatment and Blood Pressure Control in the Occurrence of Adverse Pregnancy Outcomes: a Population-Based Study of Linked Electronic Health Records. Hypertension 2022; 79:1548-1558. [PMID: 35502665 DOI: 10.1161/hypertensionaha.122.18920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic hypertension (CH) adversely impacts pregnancy. It remains unclear whether antihypertensive treatment alters these risks. We examined the role of antihypertensive treatment in the association between CH and adverse pregnancy outcomes. METHODS Electronic health records from the UK Caliber and Clinical Practice Research Datalink were used to define a cohort of women delivering between 1997 and 2016. Primary outcomes were preeclampsia, preterm birth (PTB), and fetal growth restriction (FGR). We used multivariable logistic regression to compare outcomes in women with CH to women without CH and propensity score matching to compare antihypertensive agents. RESULTS The study cohort consisted of 1 304 679 women and 1 894 184 births. 14 595 (0.77%) had CH, and 6786 (0.36%) were prescribed antihypertensive medications in pregnancy. Overall, women with CH (versus no CH), had higher odds of preeclampsia (adjusted odds ratio [aOR], 5.74 [95% CI, 5.44-6.07]); PTB (aOR, 2.53 [2.39-2.67]); and FGR (aOR, 2.51 [2.31-2.72]). Women with CH prescribed treatment (versus untreated women) had higher odds of preeclampsia (aOR, 1.17 [1.05-1.30]), PTB (1.25 [1.12-1.39]), and FGR (1.80 [1.51-2.14]). Women prescribed methyldopa (versus β-blockers) had higher odds of preeclampsia (aOR, 1.43 [1.19-1.73]); PTB (1.59 [1.30-1.93]), but lower odds of FGR (aOR, 0.66 [0.48-0.90]). Odds of adverse outcomes were similar in relation to calcium channel blockers (versus β-blockers) except for PTB (aOR, 1.94 [1.15-3.27]). Among women prescribed treatment, lower average blood pressure (<135/85 mm Hg) was associated with better pregnancy outcomes. CONCLUSIONS Treatment with antihypertensive agents and control of hypertension ameliorates some effects but higher risks of adverse outcomes persist. β-Blockers versus methyldopa may be associated with better pregnancy outcomes except for FGR. Powered trials are needed to inform optimal treatment of CH during pregnancy.
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Affiliation(s)
- Sukainah Al Khalaf
- School of Public Health (S.A.K., A.S.K., E.J.O.), University College Cork, Ireland.,INFANT Research Centre (S.A.K., A.S.K., F.P.M.), University College Cork, Ireland
| | - Ali S Khashan
- School of Public Health (S.A.K., A.S.K., E.J.O.), University College Cork, Ireland.,INFANT Research Centre (S.A.K., A.S.K., F.P.M.), University College Cork, Ireland
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London (L.C.C.)
| | - Éilis J O'Reilly
- School of Public Health (S.A.K., A.S.K., E.J.O.), University College Cork, Ireland.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.J.O.).,Environmental Research Institute, University College Cork, Ireland (E.J.O.).,Environmental Research Institute, University College Cork, Ireland (E.J.O.)
| | - Fergus P McCarthy
- INFANT Research Centre (S.A.K., A.S.K., F.P.M.), University College Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Hospital, Ireland (F.P.M.)
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Larvin H, Kang J, Aggarwal VR, Pavitt S, Wu J. The additive effect of periodontitis with hypertension on risk of systemic disease and mortality. J Periodontol 2022; 93:1024-1035. [PMID: 35460076 PMCID: PMC9544472 DOI: 10.1002/jper.21-0621] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/24/2022] [Accepted: 04/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent evidence suggests that periodontitis (PD) causes hypertension, which is a precursor to development of other systemic diseases. The aim of this study was to examine the effect of hypertension and PD on the risk of subsequent systemic disease. METHODS This longitudinal cohort study included 244,393 UK Biobank participants who were free of systemic disease other than hypertension at baseline. Self-reported responses of painful gums or loose teeth were surrogates for PD. Hypertensives were identified by clinical diagnosis, or elevated blood pressure (≥140/90 mmHg). Systemic diseases including cancer, cardiovascular disease (CVD), and diabetes were identified from linked diagnostic codes. Multivariable Cox proportional hazard models were used to quantify the risk of systemic diseases and all-cause mortality, stratified by hypertensive and PD status. RESULTS The average age of the study population was 55.4 years (standard deviation [SD:] 8.1 years), and 130,220 (53.3%) participants were female. At baseline, 131,566 (53.8%) participants were hypertensive and 4.5% reported PD. The incidence rates of all systemic diseases were higher in hypertensive than non-hypertensive participants of the same PD status. In hypertensives, an additive effect was observed for PD on the risks of CVD (adjusted hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.21-1.53) and respiratory disease (HR: 1.11, 95% CI: 0.95-1.30) compared to hypertensive healthy controls. CONCLUSIONS Hypertensives with PD have exacerbated risks of several systemic diseases. Future interventional studies should consider the effect of periodontal treatment on systemic outcomes in targeted hypertensive populations.
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Affiliation(s)
| | - Jing Kang
- Oral Biology, School of DentistryUniversity of LeedsLeedsUK
| | | | - Sue Pavitt
- School of DentistryUniversity of LeedsLeedsUK
| | - Jianhua Wu
- School of DentistryUniversity of LeedsLeedsUK
- Leeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
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30
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Rouette J, McDonald EG, Schuster T, Brophy JM, Azoulay L. Treatment and prescribing trends of antihypertensive drugs in 2.7 million UK primary care patients over 31 years: a population-based cohort study. BMJ Open 2022; 12:e057510. [PMID: 35688595 PMCID: PMC9189823 DOI: 10.1136/bmjopen-2021-057510] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the prescribing trends of antihypertensive drugs in primary care patients and assess the trajectory of antihypertensive drug prescriptions, from first-line to third-line, in patients with hypertension according to changes to the United Kingdom (UK) hypertension management guidelines. DESIGN Population-based cohort study. SETTING AND PARTICIPANTS We used the UK Clinical Practice Research Datalink, an electronic primary care database representative of the UK population. Between 1988 and 2018, we identified all adult patients with at least one prescription for a thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker, beta-blocker or calcium channel blocker (CCB). PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the period prevalence of patients with antihypertensive drug prescriptions for each calendar year over a 31-year period. Treatment trajectory was assessed by identifying patients with hypertension newly initiating an antihypertensive drug, and treatment changes were defined by a switch or add-on of a new class. This cohort was stratified before and after 2007, the year following important changes to UK hypertension management guidelines. RESULTS The cohort included 2 709 241 patients. The prevalence of primary care patients with antihypertensive drug prescriptions increased from 7.8% (1988) to 21.9% (2018) and was observed for all major classes except thiazide diuretics. Patients with hypertension initiated thiazide diuretics (36.8%) and beta-blockers (23.6%) as first-line drugs before 2007, and ACE inhibitors (39.9%) and CCBs (31.8%) after 2007. After 2007, 17.3% were not prescribed guideline-recommended first-line agents. Overall, patients were prescribed a median of 2 classes (IQR 1-2) after first-line treatment. CONCLUSION Nearly one-quarter of primary care patients were prescribed antihypertensive drugs by the end of the study period. Most patients with hypertension initiated guideline-recommended first-line agents. Not all patients, particularly females, were prescribed recommended agents however, potentially leading to suboptimal cardiovascular outcomes. Future research should aim to better understand the implication of this finding.
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Affiliation(s)
- Julie Rouette
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Emily G McDonald
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Tibor Schuster
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - James M Brophy
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Departmenf of Medicine, McGill University, Montreal, Quebec, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
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31
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Gomes M, Latimer N, Soares M, Dias S, Baio G, Freemantle N, Dawoud D, Wailoo A, Grieve R. Target Trial Emulation for Transparent and Robust Estimation of Treatment Effects for Health Technology Assessment Using Real-World Data: Opportunities and Challenges. PHARMACOECONOMICS 2022; 40:577-586. [PMID: 35332434 DOI: 10.1007/s40273-022-01141-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
Evidence about the relative effects of new treatments is typically collected in randomised controlled trials (RCTs). In many instances, evidence from RCTs falls short of the needs of health technology assessment (HTA). For example, RCTs may not be able to capture longer-term treatment effects, or include all relevant comparators and outcomes required for HTA purposes. Information routinely collected about patients and the care they receive have been increasingly used to complement RCT evidence on treatment effects. However, such routine (or real-world) data are not collected for research purposes, so investigators have little control over the way patients are selected into the study or allocated to the different treatment groups, introducing biases for example due to selection or confounding. A promising approach to minimise common biases in non-randomised studies that use real-world data (RWD) is to apply design principles from RCTs. This approach, known as 'target trial emulation' (TTE), involves (1) developing the protocol with respect to core study design and analysis components of the hypothetical RCT that would answer the question of interest, and (2) applying this protocol to the RWD so that it mimics the data that would have been gathered for the RCT. By making the 'target trial' explicit, TTE helps avoid common design flaws and methodological pitfalls in the analysis of non-randomised studies, keeping each step transparent and accessible. It provides a coherent framework that embeds existing analytical methods to minimise confounding and helps identify potential limitations of RWD and the extent to which these affect the HTA decision. This paper provides a broad overview of TTE and discusses the opportunities and challenges of using this approach in HTA. We describe the basic principles of trial emulation, outline some areas where TTE using RWD can help complement RCT evidence in HTA, identify potential barriers to its adoption in the HTA setting and highlight some priorities for future work.
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Affiliation(s)
- Manuel Gomes
- Department of Applied Health Research, University College London, London, UK.
| | - Nick Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Dalia Dawoud
- Science, Policy and Research group, National Institute for Health and Care Excellence, London, UK
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Grath-Lone LM, Jay MA, Blackburn R, Gordon E, Zylbersztejn A, Wijlaars L, Gilbert R. What makes administrative data "research-ready"? A systematic review and thematic analysis of published literature. Int J Popul Data Sci 2022; 7:1718. [PMID: 35520099 PMCID: PMC9052961 DOI: 10.23889/ijpds.v6i1.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Administrative data are a valuable research resource, but are under-utilised in the UK due to governance, technical and other barriers (e.g., the time and effort taken to gain secure data access). In recent years, there has been considerable government investment in making administrative data "research-ready", but there is no definition of what this term means. A common understanding of what constitutes research-ready administrative data is needed to establish clear principles and frameworks for their development and the realisation of their full research potential. Objective To define the characteristics of research-ready administrative data based on a systematic review and synthesis of existing literature. Methods On 29th June 2021, we systematically searched seven electronic databases for (1) peer-reviewed literature (2) related to research-ready administrative data (3) written in the English language. Following supplementary searches and snowball screening, we conducted a thematic analysis of the identified relevant literature. Results Overall, we screened 2,375 records and identified 38 relevant studies published between 2012 and 2021. Most related to administrative data from the UK and US and particularly to health data. The term research-ready was used inconsistently in the literature and there was some conflation with the concept of data being ready for statistical analysis. From the thematic analysis, we identified five defining characteristics of research-ready administrative data: (a) accessible, (b) broad, (c) curated, (d) documented and (e) enhanced for research purposes. Conclusions Our proposed characteristics of research-ready administrative data could act as a starting point to help data owners and researchers develop common principles and standards. In the more immediate term, the proposed characteristics are a useful framework for cataloguing existing research-ready administrative databases and relevant resources that can support their development.
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Affiliation(s)
| | - Matthew A. Jay
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
| | - Ruth Blackburn
- Institute of Health Informatics, University College London, UK
| | - Emma Gordon
- Administrative Data Research UK, Economic & Social Research Council, UK
| | - Ania Zylbersztejn
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
| | - Linda Wijlaars
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
| | - Ruth Gilbert
- Institute of Health Informatics, University College London, UK
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, UK
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Jordan KP, Rathod‐Mistry T, Bailey J, Chen Y, Clarson L, Denaxas S, Hayward RA, Hemingway H, van der Windt DA, Mamas MA. Long-Term Cardiovascular Risk and Management of Patients Recorded in Primary Care With Unattributed Chest Pain: An Electronic Health Record Study. J Am Heart Assoc 2022; 11:e023146. [PMID: 35301875 PMCID: PMC9075433 DOI: 10.1161/jaha.121.023146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Most adults presenting with chest pain will not receive a diagnosis and be recorded with unattributed chest pain. The objective was to assess if they have increased risk of cardiovascular disease compared with those with noncoronary chest pain and determine whether investigations and interventions are targeted at those at highest risk. Methods and Results We used records from general practices in England linked to hospitalization and mortality information. The study population included patients aged 18 years or over with a new record of chest pain with a noncoronary cause or unattributed between 2002 and 2018, and no cardiovascular disease recorded up to 6 months (diagnostic window) afterward. We compared risk of a future cardiovascular event by type of chest pain, adjusting for cardiovascular risk factors and alternative explanations for chest pain. We determined prevalence of cardiac diagnostic investigations and preventative medication during the diagnostic window in patients with estimated cardiovascular risk ≥10%. There were 375 240 patients with unattributed chest pain (245 329 noncoronary chest pain). There was an increased risk of cardiovascular events for patients with unattributed chest pain, highest in the first year (hazard ratio, 1.25 [95% CI, 1.21-1.29]), persistent up to 10 years. Patients with unattributed chest pain had consistently increased risk of myocardial infarction over time but no increased risk of stroke. Thirty percent of patients at higher risk were prescribed lipid-lowering medication. Conclusions Patients presenting to primary care with unattributed chest pain are at increased risk of cardiovascular events. Primary prevention to reduce cardiovascular events appears suboptimal in those at higher risk.
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Affiliation(s)
| | | | - James Bailey
- School of MedicineKeele UniversityKeeleUnited Kingdom
| | - Ying Chen
- School of MedicineKeele UniversityKeeleUnited Kingdom
- Department of Health and Environmental SciencesXi'an Jiaotong–Liverpool UniversitySuzhouChina
| | - Lorna Clarson
- School of MedicineKeele UniversityKeeleUnited Kingdom
| | - Spiros Denaxas
- Institute of Health InformaticsUniversity College LondonLondonUnited Kingdom
- Health Data Research UKUniversity College LondonLondonUnited Kingdom
| | | | - Harry Hemingway
- Institute of Health InformaticsUniversity College LondonLondonUnited Kingdom
- Health Data Research UKUniversity College LondonLondonUnited Kingdom
- The National Institute for Health ResearchUniversity College London Hospitals Biomedical Research CentreLondonUnited Kingdom
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research GroupSchool of MedicineKeele UniversityKeeleUnited Kingdom
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Dziopa K, Asselbergs FW, Gratton J, Chaturvedi N, Schmidt AF. Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care settings. Diabetologia 2022; 65:644-656. [PMID: 35032176 PMCID: PMC8894164 DOI: 10.1007/s00125-021-05640-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
AIMS/HYPOTHESIS We aimed to compare the performance of risk prediction scores for CVD (i.e., coronary heart disease and stroke), and a broader definition of CVD including atrial fibrillation and heart failure (CVD+), in individuals with type 2 diabetes. METHODS Scores were identified through a literature review and were included irrespective of the type of predicted cardiovascular outcome or the inclusion of individuals with type 2 diabetes. Performance was assessed in a contemporary, representative sample of 168,871 UK-based individuals with type 2 diabetes (age ≥18 years without pre-existing CVD+). Missing observations were addressed using multiple imputation. RESULTS We evaluated 22 scores: 13 derived in the general population and nine in individuals with type 2 diabetes. The Systemic Coronary Risk Evaluation (SCORE) CVD rule derived in the general population performed best for both CVD (C statistic 0.67 [95% CI 0.67, 0.67]) and CVD+ (C statistic 0.69 [95% CI 0.69, 0.70]). The C statistic of the remaining scores ranged from 0.62 to 0.67 for CVD, and from 0.64 to 0.69 for CVD+. Calibration slopes (1 indicates perfect calibration) ranged from 0.38 (95% CI 0.37, 0.39) to 0.74 (95% CI 0.72, 0.76) for CVD, and from 0.41 (95% CI 0.40, 0.42) to 0.88 (95% CI 0.86, 0.90) for CVD+. A simple recalibration process considerably improved the performance of the scores, with calibration slopes now ranging between 0.96 and 1.04 for CVD. Scores with more predictors did not outperform scores with fewer predictors: for CVD+, QRISK3 (19 variables) had a C statistic of 0.68 (95% CI 0.68, 0.69), compared with SCORE CVD (six variables) which had a C statistic of 0.69 (95% CI 0.69, 0.70). Scores specific to individuals with diabetes did not discriminate better than scores derived in the general population: the UK Prospective Diabetes Study (UKPDS) scores performed significantly worse than SCORE CVD (p value <0.001). CONCLUSIONS/INTERPRETATION CVD risk prediction scores could not accurately identify individuals with type 2 diabetes who experienced a CVD event in the 10 years of follow-up. All 22 evaluated models had a comparable and modest discriminative ability.
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Affiliation(s)
- Katarzyna Dziopa
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK.
| | - Folkert W Asselbergs
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jasmine Gratton
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Amand F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13304. [PMID: 34948912 PMCID: PMC8707886 DOI: 10.3390/ijerph182413304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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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Howe LJ, Battram T, Morris TT, Hartwig FP, Hemani G, Davies NM, Smith GD. Assortative mating and within-spouse pair comparisons. PLoS Genet 2021; 17:e1009883. [PMID: 34735433 PMCID: PMC8594845 DOI: 10.1371/journal.pgen.1009883] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 11/16/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022] Open
Abstract
Spousal comparisons have been proposed as a design that can both reduce confounding and estimate effects of the shared adulthood environment. However, assortative mating, the process by which individuals select phenotypically (dis)similar mates, could distort associations when comparing spouses. We evaluated the use of spousal comparisons, as in the within-spouse pair (WSP) model, for aetiological research such as genetic association studies. We demonstrated that the WSP model can reduce confounding but may be susceptible to collider bias arising from conditioning on assorted spouse pairs. Analyses using UK Biobank spouse pairs found that WSP genetic association estimates were smaller than estimates from random pairs for height, educational attainment, and BMI variants. Within-sibling pair estimates, robust to demographic and parental effects, were also smaller than random pair estimates for height and educational attainment, but not for BMI. WSP models, like other within-family models, may reduce confounding from demographic factors in genetic association estimates, and so could be useful for triangulating evidence across study designs to assess the robustness of findings. However, WSP estimates should be interpreted with caution due to potential collider bias.
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Affiliation(s)
- Laurence J. Howe
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Thomas Battram
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tim T. Morris
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Fernando P. Hartwig
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Gibran Hemani
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Neil M. Davies
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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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: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [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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Internal-external cross-validation helped to evaluate the generalizability of prediction models in large clustered datasets. J Clin Epidemiol 2021; 137:83-91. [PMID: 33836256 DOI: 10.1016/j.jclinepi.2021.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/05/2021] [Accepted: 03/29/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To illustrate how to evaluate the need of complex strategies for developing generalizable prediction models in large clustered datasets. STUDY DESIGN AND SETTING We developed eight Cox regression models to estimate the risk of heart failure using a large population-level dataset. These models differed in the number of predictors, the functional form of the predictor effects (non-linear effects and interaction) and the estimation method (maximum likelihood and penalization). Internal-external cross-validation was used to evaluate the models' generalizability across the included general practices. RESULTS Among 871,687 individuals from 225 general practices, 43,987 (5.5%) developed heart failure during a median follow-up time of 5.8 years. For discrimination, the simplest prediction model yielded a good concordance statistic, which was not much improved by adopting complex strategies. Between-practice heterogeneity in discrimination was similar in all models. For calibration, the simplest model performed satisfactorily. Although accounting for non-linear effects and interaction slightly improved the calibration slope, it also led to more heterogeneity in the observed/expected ratio. Similar results were found in a second case study involving patients with stroke. CONCLUSION In large clustered datasets, prediction model studies may adopt internal-external cross-validation to evaluate the generalizability of competing models, and to identify promising modelling strategies.
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Larvin H, Kang J, Aggarwal VR, Pavitt S, Wu J. Multimorbid disease trajectories for people with periodontitis. J Clin Periodontol 2021; 48:1587-1596. [PMID: 34409647 DOI: 10.1111/jcpe.13536] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
AIM Periodontitis is a multifactorial condition linked to increased risk of systemic diseases. This study aimed to identify disease trajectories of people with periodontitis using the process mining technique as a heuristic approach. MATERIALS AND METHODS A total of 188,863 participants from the UK Biobank cohort were included. Self-reported oral health indicators (bleeding gums, painful gums, loose teeth) were surrogates for periodontitis at baseline. Systemic disease diagnoses and dates formed the process mining event log. Relative risk (RR) of systemic diseases, disease trajectories, and Cox proportional hazard ratio models for mortality were compared to age- and sex-matched controls who did not report a history of periodontitis. RESULTS Participants with loose teeth had shorter median time to most systemic diseases, and crude RR was increased for several diseases including cardiovascular disease (crude RR: 1.15, 95% CI: 1.03-1.28), hypertension (crude RR: 1.14, 95% CI: 1.05-1.24), and depression (crude RR: 1.33, 95% CI: 1.09-1.61). Participants with loose teeth had increased RR for 20 disease trajectories, though these were not significant after adjustments. Participants with bleeding/painful gums had similar disease trajectories as those of matched controls. CONCLUSIONS Self-reported periodontitis may be associated with early and frequent multimorbidity development, though further evidence is required to confirm this hypothesis. People with periodontitis should be informed of the risks of disease progression and be targeted in prevention initiatives.
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Affiliation(s)
| | - Jing Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | | | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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Larvin H, Wilmott S, Kang J, Aggarwal V, Pavitt S, Wu J. Additive Effect of Periodontal Disease and Obesity on COVID-19 Outcomes. J Dent Res 2021; 100:1228-1235. [PMID: 34271846 PMCID: PMC8461046 DOI: 10.1177/00220345211029638] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aims to examine the impact of periodontal disease in obesity on COVID-19 infection and associated outcomes. This retrospective longitudinal study included 58,897 UK Biobank participants tested for COVID-19 between March 2020 and February 2021. Self-reported oral health indicators (bleeding gums, painful gums, and loose teeth) were used as surrogates for periodontal disease. Body fat levels were quantified by body mass index (BMI) and categorized as normal weight (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2), and obese (≥30 kg/m2). Multivariable logistic regression and Cox proportional hazard models were used to quantify risk of COVID-19 infection, hospital admission, and mortality, adjusted for participants’ demographics and covariates. Of 58,897 participants, 14,466 (24.6%) tested positive for COVID-19 infection. COVID-19 infection was higher for participants who were overweight (odds ratio, 1.18; 95% CI, 1.12 to 1.24) and obese (odds ratio, 1.33; 95% CI, 1.26 to 1.41) as compared with those of normal weight, but infection was not affected by periodontal disease. The hospital admission rate was 57% higher (hazard ratio, 1.57; 95% CI, 1.25 to 1.97) in the obese group with periodontal disease than without periodontal disease, and admission rates increased with BMI category (normal weight, 4.4%; overweight, 6.8%; obese, 10.1%). Mortality rates also increased with BMI category (normal weight, 1.9%; overweight, 3.17%; obese, 4.5%). In addition, for participants with obesity, the mortality rate was much higher (hazard ratio, 3.11; 95% CI, 1.91 to 5.06) in participants with periodontal disease than those without. Obesity is associated with higher hospitalization and mortality rates, and periodontal disease may exacerbate this impact. The results could inform health providers, policy makers, and the general public of the importance to maintain good oral health through seamless provision of dental services and public oral health prevention initiatives.
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Affiliation(s)
- H. Larvin
- School of Dentistry, University of Leeds, Leeds, UK
| | - S. Wilmott
- Leeds Dental Institute, Leeds Teaching Hospitals Trust, Leeds, UK
| | - J. Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | | | - S. Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - J. Wu
- School of Dentistry, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- J. Wu, University of Leeds, Worsley Building, Level 6, Clarendon Way, Leeds, LS2 9LU, UK.
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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: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [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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Caleyachetty R, Barber TM, Mohammed NI, Cappuccio FP, Hardy R, Mathur R, Banerjee A, Gill P. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol 2021; 9:419-426. [PMID: 33989535 PMCID: PMC8208895 DOI: 10.1016/s2213-8587(21)00088-7] [Citation(s) in RCA: 161] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m2). METHODS In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15·0-50·0 kg/m2 and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data. FINDINGS 1 472 819 people were included in our study, of whom 1 333 816 (90·6%) were White, 75 956 (5·2%) were south Asian, 49 349 (3·4%) were Black, 10 934 (0·7%) were Chinese, and 2764 (0·2%) were Arab. After a median follow-up of 6·5 years (IQR 3·2-11·2), 97 823 (6·6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m2 in White populations, the BMI cutoffs were 23·9 kg/m2 (95% CI 23·6-24·0) in south Asian populations, 28·1 kg/m2 (28·0-28·4) in Black populations, 26·9 kg/m2 (26·7-27·2) in Chinese populations, and 26·6 kg/m2 (26·5-27·0) in Arab populations. INTERPRETATION Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes. FUNDING National Institute for Health Research.
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Affiliation(s)
- Rishi Caleyachetty
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Warwick Medical School, University of Warwick, Coventry, UK.
| | - Thomas M Barber
- Warwick Medical School, University of Warwick, Coventry, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Rebecca Hardy
- Social Research Institute, University College London, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
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Papez V, Moinat M, Payralbe S, Asselbergs FW, Lumbers RT, Hemingway H, Dobson R, Denaxas S. Transforming and evaluating electronic health record disease phenotyping algorithms using the OMOP common data model: a case study in heart failure. JAMIA Open 2021; 4:ooab001. [PMID: 34514354 PMCID: PMC8423424 DOI: 10.1093/jamiaopen/ooab001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/16/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the study was to transform a resource of linked electronic health records (EHR) to the OMOP common data model (CDM) and evaluate the process in terms of syntactic and semantic consistency and quality when implementing disease and risk factor phenotyping algorithms. MATERIALS AND METHODS Using heart failure (HF) as an exemplar, we represented three national EHR sources (Clinical Practice Research Datalink, Hospital Episode Statistics Admitted Patient Care, Office for National Statistics) into the OMOP CDM 5.2. We compared the original and CDM HF patient population by calculating and presenting descriptive statistics of demographics, related comorbidities, and relevant clinical biomarkers. RESULTS We identified a cohort of 502 536 patients with the incident and prevalent HF and converted 1 099 195 384 rows of data from 216 581 914 encounters across three EHR sources to the OMOP CDM. The largest percentage (65%) of unmapped events was related to medication prescriptions in primary care. The average coverage of source vocabularies was >98% with the exception of laboratory tests recorded in primary care. The raw and transformed data were similar in terms of demographics and comorbidities with the largest difference observed being 3.78% in the prevalence of chronic obstructive pulmonary disease (COPD). CONCLUSION Our study demonstrated that the OMOP CDM can successfully be applied to convert EHR linked across multiple healthcare settings and represent phenotyping algorithms spanning multiple sources. Similar to previous research, challenges mapping primary care prescriptions and laboratory measurements still persist and require further work. The use of OMOP CDM in national UK EHR is a valuable research tool that can enable large-scale reproducible observational research.
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Affiliation(s)
- Vaclav Papez
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | | | | | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, 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
| | - Richard Dobson
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- The Alan Turing Institute, London, UK
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Almowil ZA, Zhou SM, Brophy S. Concept libraries for automatic electronic health record based phenotyping: A review. Int J Popul Data Sci 2021; 6:1362. [PMID: 34189274 PMCID: PMC8210840 DOI: 10.23889/ijpds.v5i1.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction Electronic health records (EHR) are linked together to examine disease history and to undertake research into the causes and outcomes of disease. However, the process of constructing algorithms for phenotyping (e.g., identifying disease characteristics) or health characteristics (e.g., smoker) is very time consuming and resource costly. In addition, results can vary greatly between researchers. Reusing or building on algorithms that others have created is a compelling solution to these problems. However, sharing algorithms is not a common practice and many published studies do not detail the clinical code lists used by the researchers in the disease/characteristic definition. To address these challenges, a number of centres across the world have developed health data portals which contain concept libraries (e.g., algorithms for defining concepts such as disease and characteristics) in order to facilitate disease phenotyping and health studies. Objectives This study aims to review the literature of existing concept libraries, examine their utilities, identify the current gaps, and suggest future developments. Methods The five-stage framework of Arksey and O'Malley was used for the literature search. This approach included defining the research questions, identifying relevant studies through literature review, selecting eligible studies, charting and extracting data, and summarising and reporting the findings. Results This review identified seven publicly accessible Electronic Health data concept libraries which were developed in different countries including UK, USA, and Canada. The concept libraries (n = 7) investigated were either general libraries that hold phenotypes of multiple specialties (n = 4) or specialized libraries that manage only certain specialities such as rare diseases (n = 3). There were some clear differences between the general libraries such as archiving data from different electronic sources, and using a range of different types of coding systems. However, they share some clear similarities such as enabling users to upload their own code lists, and allowing users to use/download the publicly accessible code. In addition, there were some differences between the specialized libraries such as difference in ability to search, and if it was possible to use different searching queries such as simple or complex searches. Conversely, there were some similarities between the specialized libraries such as enabling users to upload their own concepts into the libraries and to show where they were published, which facilitates assessing the validity of the concepts. All the specialized libraries aimed to encourage the reuse of research methods such as lists of clinical code and/or metadata. Conclusion The seven libraries identified have been developed independently and appear to replicate similar concepts but in different ways. Collaboration between similar libraries would greatly facilitate the use of these libraries for the user. The process of building code lists takes time and effort. Access to existing code lists increases consistency and accuracy of definitions across studies. Concept library developers should collaborate with each other to raise awareness of their existence and of their various functions, which could increase users’ contributions to those libraries and promote their wide-ranging adoption.
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Affiliation(s)
| | - Shang-Ming Zhou
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, PL4 8AA, UK
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45
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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] [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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46
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Syed S, Gilbert R. Are children who are home from school at an increased risk of child maltreatment? J Public Health (Oxf) 2021; 43:e127-e128. [PMID: 32728709 DOI: 10.1093/pubmed/fdaa115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/13/2020] [Accepted: 06/27/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shabeer Syed
- Population, Policy and Practice, University College London Great Ormond Street, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Ruth Gilbert
- Population, Policy and Practice, University College London Great Ormond Street, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.,Institute of Health Informatics and Health Data Research UK, University College London, 222 Euston Road, NW1 2DA London, UK
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47
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Kashyap M, Seneviratne M, Banda JM, Falconer T, Ryu B, Yoo S, Hripcsak G, Shah NH. Development and validation of phenotype classifiers across multiple sites in the observational health data sciences and informatics network. J Am Med Inform Assoc 2021; 27:877-883. [PMID: 32374408 PMCID: PMC7309227 DOI: 10.1093/jamia/ocaa032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Accurate electronic phenotyping is essential to support collaborative observational research. Supervised machine learning methods can be used to train phenotype classifiers in a high-throughput manner using imperfectly labeled data. We developed 10 phenotype classifiers using this approach and evaluated performance across multiple sites within the Observational Health Data Sciences and Informatics (OHDSI) network. Materials and Methods We constructed classifiers using the Automated PHenotype Routine for Observational Definition, Identification, Training and Evaluation (APHRODITE) R-package, an open-source framework for learning phenotype classifiers using datasets in the Observational Medical Outcomes Partnership Common Data Model. We labeled training data based on the presence of multiple mentions of disease-specific codes. Performance was evaluated on cohorts derived using rule-based definitions and real-world disease prevalence. Classifiers were developed and evaluated across 3 medical centers, including 1 international site. Results Compared to the multiple mentions labeling heuristic, classifiers showed a mean recall boost of 0.43 with a mean precision loss of 0.17. Performance decreased slightly when classifiers were shared across medical centers, with mean recall and precision decreasing by 0.08 and 0.01, respectively, at a site within the USA, and by 0.18 and 0.10, respectively, at an international site. Discussion and Conclusion We demonstrate a high-throughput pipeline for constructing and sharing phenotype classifiers across sites within the OHDSI network using APHRODITE. Classifiers exhibit good portability between sites within the USA, however limited portability internationally, indicating that classifier generalizability may have geographic limitations, and, consequently, sharing the classifier-building recipe, rather than the pretrained classifiers, may be more useful for facilitating collaborative observational research.
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Affiliation(s)
- Mehr Kashyap
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Martin Seneviratne
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Juan M Banda
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA.,Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Borim Ryu
- Office of eHealth and Business, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Sooyoung Yoo
- Office of eHealth and Business, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
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48
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Zhao Y, Fu S, Bielinski SJ, Decker PA, Chamberlain AM, Roger VL, Liu H, Larson NB. Natural Language Processing and Machine Learning for Identifying Incident Stroke From Electronic Health Records: Algorithm Development and Validation. J Med Internet Res 2021; 23:e22951. [PMID: 33683212 PMCID: PMC7985804 DOI: 10.2196/22951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/25/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Stroke is an important clinical outcome in cardiovascular research. However, the ascertainment of incident stroke is typically accomplished via time-consuming manual chart abstraction. Current phenotyping efforts using electronic health records for stroke focus on case ascertainment rather than incident disease, which requires knowledge of the temporal sequence of events. Objective The aim of this study was to develop a machine learning–based phenotyping algorithm for incident stroke ascertainment based on diagnosis codes, procedure codes, and clinical concepts extracted from clinical notes using natural language processing. Methods The algorithm was trained and validated using an existing epidemiology cohort consisting of 4914 patients with atrial fibrillation (AF) with manually curated incident stroke events. Various combinations of feature sets and machine learning classifiers were compared. Using a heuristic rule based on the composition of concepts and codes, we further detected the stroke subtype (ischemic stroke/transient ischemic attack or hemorrhagic stroke) of each identified stroke. The algorithm was further validated using a cohort (n=150) stratified sampled from a population in Olmsted County, Minnesota (N=74,314). Results Among the 4914 patients with AF, 740 had validated incident stroke events. The best-performing stroke phenotyping algorithm used clinical concepts, diagnosis codes, and procedure codes as features in a random forest classifier. Among patients with stroke codes in the general population sample, the best-performing model achieved a positive predictive value of 86% (43/50; 95% CI 0.74-0.93) and a negative predictive value of 96% (96/100). For subtype identification, we achieved an accuracy of 83% in the AF cohort and 80% in the general population sample. Conclusions We developed and validated a machine learning–based algorithm that performed well for identifying incident stroke and for determining type of stroke. The algorithm also performed well on a sample from a general population, further demonstrating its generalizability and potential for adoption by other institutions.
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Affiliation(s)
- Yiqing Zhao
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Sunyang Fu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Suzette J Bielinski
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Veronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Nicholas B Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
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49
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Uijl A, Vaartjes I, Denaxas S, Hemingway H, Shah A, Cleland J, Grobbee D, Hoes A, Asselbergs FW, Koudstaal S. Temporal trends in heart failure medication prescription in a population-based cohort study. BMJ Open 2021; 11:e043290. [PMID: 33653753 PMCID: PMC7929882 DOI: 10.1136/bmjopen-2020-043290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/12/2021] [Accepted: 02/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We examined temporal heart failure (HF) prescription patterns in a large representative sample of real-world patients in the UK, using electronic health records (EHR). METHODS From primary and secondary care EHR, we identified 85 732 patients with a HF diagnosis between 2002 and 2015. Almost 50% of patients with HF were women and the median age was 79.1 (IQR 70.2-85.7) years, with age at diagnosis increasing over time. RESULTS We found several trends in pharmacological HF management, including increased beta blocker prescriptions over time (29% in 2002-2005 and 54% in 2013-2015), which was not observed for mineralocorticoid receptor-antagonists (MR-antagonists) (18% in 2002-2005 and 18% in 2013-2015); higher prescription rates of loop diuretics in women and elderly patients together with lower prescription rates of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers, beta blockers or MR-antagonists in these patients; little change in medication prescription rates occurred after 6 months of HF diagnosis and, finally, patients hospitalised for HF who had no recorded follow-up in primary care had considerably lower prescription rates compared with patients with a HF diagnosis in primary care with or without HF hospitalisation. CONCLUSION In the general population, the use of MR-antagonists for HF remained low and did not change throughout 13 years of follow-up. For most patients, few changes were seen in pharmacological management of HF in the 6 months following diagnosis.
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Affiliation(s)
- Alicia Uijl
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Ilonca Vaartjes
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
- Alan Turing Institute, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
| | - Anoop Shah
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - J Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arno Hoes
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Stefan Koudstaal
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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50
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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: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [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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