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Soltani F, Jenkins DA, Kaura A, Bradley J, Black N, Farrant JP, Williams SG, Mulla A, Glampson B, Davies J, Papadimitriou D, Woods K, Shah AD, Thursz MR, Williams B, Asselbergs FW, Mayer EK, Herbert C, Grant S, Curzen N, Squire I, Johnson T, O'Gallagher K, Shah AM, Perera D, Kharbanda R, Patel RS, Channon KM, Lee R, Peek N, Mayet J, Miller CA. Phenogrouping heart failure with preserved or mildly reduced ejection fraction using electronic health record data. BMC Cardiovasc Disord 2024; 24:343. [PMID: 38969974 PMCID: PMC11229019 DOI: 10.1186/s12872-024-03987-9] [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: 01/03/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Heart failure (HF) with preserved or mildly reduced ejection fraction includes a heterogenous group of patients. Reclassification into distinct phenogroups to enable targeted interventions is a priority. This study aimed to identify distinct phenogroups, and compare phenogroup characteristics and outcomes, from electronic health record data. METHODS 2,187 patients admitted to five UK hospitals with a diagnosis of HF and a left ventricular ejection fraction ≥ 40% were identified from the NIHR Health Informatics Collaborative database. Partition-based, model-based, and density-based machine learning clustering techniques were applied. Cox Proportional Hazards and Fine-Gray competing risks models were used to compare outcomes (all-cause mortality and hospitalisation for HF) across phenogroups. RESULTS Three phenogroups were identified: (1) Younger, predominantly female patients with high prevalence of cardiometabolic and coronary disease; (2) More frail patients, with higher rates of lung disease and atrial fibrillation; (3) Patients characterised by systemic inflammation and high rates of diabetes and renal dysfunction. Survival profiles were distinct, with an increasing risk of all-cause mortality from phenogroups 1 to 3 (p < 0.001). Phenogroup membership significantly improved survival prediction compared to conventional factors. Phenogroups were not predictive of hospitalisation for HF. CONCLUSIONS Applying unsupervised machine learning to routinely collected electronic health record data identified phenogroups with distinct clinical characteristics and unique survival profiles.
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Affiliation(s)
- Fardad Soltani
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - David A Jenkins
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Amit Kaura
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK
| | - Joshua Bradley
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Nicholas Black
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - John P Farrant
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Simon G Williams
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Abdulrahim Mulla
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK
- Imperial Clinical Analytics, Research and Evaluation, Digital Collaboration Space, Faculty of Medicine, Imperial College London and Paddington Life Sciences, London, UK
| | - Benjamin Glampson
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK
- Imperial Clinical Analytics, Research and Evaluation, Digital Collaboration Space, Faculty of Medicine, Imperial College London and Paddington Life Sciences, London, UK
| | - Jim Davies
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dimitri Papadimitriou
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK
- Imperial Clinical Analytics, Research and Evaluation, Digital Collaboration Space, Faculty of Medicine, Imperial College London and Paddington Life Sciences, London, UK
| | - Kerrie Woods
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anoop D Shah
- London Biomedical Research Centre, NIHR University College, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark R Thursz
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK
| | - Bryan Williams
- London Biomedical Research Centre, NIHR University College, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Folkert W Asselbergs
- London Biomedical Research Centre, NIHR University College, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Erik K Mayer
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK
- Imperial Clinical Analytics, Research and Evaluation, Digital Collaboration Space, Faculty of Medicine, Imperial College London and Paddington Life Sciences, London, UK
| | - Christopher Herbert
- NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Stuart Grant
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Nick Curzen
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Iain Squire
- NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Thomas Johnson
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kevin O'Gallagher
- King's College London British Heart Foundation Centre of Excellence and King's College Hospital NHS Foundation Trust, London, UK
| | - Ajay M Shah
- King's College London British Heart Foundation Centre of Excellence and King's College Hospital NHS Foundation Trust, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Rajesh Kharbanda
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Riyaz S Patel
- London Biomedical Research Centre, NIHR University College, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Keith M Channon
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Lee
- NIHR Biomedical Research Centre, The Royal Marsden and Institute of Cancer Research, London, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jamil Mayet
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK.
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
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2
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Gillespie IA, Barnes E, Wong ICK, Matthews PC, Cooke GS, Tipple C, Elston RC, Liu Y, Smith DA, Wang T, Davies J, Várnai KA, Freeman O, Man KKC, Lau WCY, Glampson B, Meng X, Morais E, Liu S, Mercuri L, Boxall N, Jenner S, Kendrick S, Dong J, Theodore D. Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies. Infect Dis Ther 2023; 12:2513-2532. [PMID: 37432642 PMCID: PMC10651815 DOI: 10.1007/s40121-023-00824-y] [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: 02/17/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Chronic hepatitis B virus (HBV) infection is associated with significant global morbidity and mortality. Low treatment rates are observed in patients living with HBV; the reasons for this are unclear. This study sought to describe patients' demographic, clinical and biochemical characteristics across three continents and their associated treatment need. METHODS This retrospective cross-sectional post hoc analysis of real-world data used four large electronic databases from the United States, United Kingdom and China (specifically Hong Kong and Fuzhou). Patients were identified by first evidence of chronic HBV infection in a given year (their index date) and characterized. An algorithm was designed and applied, wherein patients were categorized as treated, untreated but indicated for treatment and untreated and not indicated for treatment based on treatment status and demographic, clinical, biochemical and virological characteristics (age; evidence of fibrosis/cirrhosis; alanine aminotransferase [ALT] levels, HCV/HIV coinfection and HBV virology markers). RESULTS In total, 12,614 US patients, 503 UK patients, 34,135 patients from Hong Kong and 21,614 from Fuzhou were included. Adults (99.4%) and males (59.0%) predominated. Overall, 34.5% of patients were treated at index (range 15.9-49.6%), with nucleos(t)ide analogue monotherapy most commonly prescribed. The proportion of untreated-but-indicated patients ranged from 12.9% in Hong Kong to 18.2% in the UK; almost two-thirds of these patients (range 61.3-66.7%) had evidence of fibrosis/cirrhosis. A quarter (25.3%) of untreated-but-indicated patients were aged ≥ 65 years. CONCLUSION This large real-world dataset demonstrates that chronic hepatitis B infection remains a global health concern; despite the availability of effective suppressive therapy, a considerable proportion of predominantly adult patients apparently indicated for treatment are currently untreated, including many patients with fibrosis/cirrhosis. Causes of disparity in treatment status warrant further investigation.
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Affiliation(s)
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
- University College London, Gower St, London, WC1E 6BT, UK
| | - Graham S Cooke
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Craig Tipple
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Robert C Elston
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Yunhao Liu
- GSK, 1250 S Collegeville Rd, Collegeville, PA, 19426, USA
| | - David A Smith
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
| | - Jim Davies
- Department of Computer Science, University of Oxford, 7 Parks Rd, Oxford, OX1 3QG, UK
| | - Kinga A Várnai
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Oliver Freeman
- Nuffield Department of Population Health, University of Oxford, University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Ben Glampson
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Xing Meng
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
| | | | - Sen Liu
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
| | - Luca Mercuri
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Naomi Boxall
- IQVIA, The Point, 37 N Wharf Rd, London, W2 1AF, UK
| | - Sarah Jenner
- IQVIA, The Point, 37 N Wharf Rd, London, W2 1AF, UK
| | - Stuart Kendrick
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Jane Dong
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
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Zhang J, Morley J, Gallifant J, Oddy C, Teo JT, Ashrafian H, Delaney B, Darzi A. Mapping and evaluating national data flows: transparency, privacy, and guiding infrastructural transformation. Lancet Digit Health 2023; 5:e737-e748. [PMID: 37775190 DOI: 10.1016/s2589-7500(23)00157-7] [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: 02/10/2023] [Revised: 06/07/2023] [Accepted: 08/02/2023] [Indexed: 10/01/2023]
Abstract
The importance of big health data is recognised worldwide. Most UK National Health Service (NHS) care interactions are recorded in electronic health records, resulting in an unmatched potential for population-level datasets. However, policy reviews have highlighted challenges from a complex data-sharing landscape relating to transparency, privacy, and analysis capabilities. In response, we used public information sources to map all electronic patient data flows across England, from providers to more than 460 subsequent academic, commercial, and public data consumers. Although NHS data support a global research ecosystem, we found that multistage data flow chains limit transparency and risk public trust, most data interactions do not fulfil recommended best practices for safe data access, and existing infrastructure produces aggregation of duplicate data assets, thus limiting diversity of data and added value to end users. We provide recommendations to support data infrastructure transformation and have produced a website (https://DataInsights.uk) to promote transparency and showcase NHS data assets.
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Affiliation(s)
- Joe Zhang
- Institute of Global Health Innovation, Imperial College London, London, UK; Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Jess Morley
- Oxford Internet Institute, University of Oxford, Oxford, UK
| | - Jack Gallifant
- Department of Intensive Care, Imperial College Healthcare NHS Trust, London, UK; Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Chris Oddy
- Department of Anaesthesia, Critical Care and Pain, St George's Healthcare NHS Trust, London, UK
| | - James T Teo
- London Medical Imaging and AI Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK; Leeds University Business School, Leeds, UK
| | - Brendan Delaney
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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4
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Wang T, Smith DA, Campbell C, Freeman O, Moysova Z, Noble T, Várnai KA, Harris S, Salih H, Roadknight G, Little S, Glampson B, Mercuri L, Papadimitriou D, Jones CR, Taylor V, Chaudhry A, Phan H, Borca F, Olza J, Warricker F, Romão L, Ramlakhan D, English L, Klenerman P, Andersson M, Collier J, Stockdale AJ, Todd S, McIntyre K, Frankland A, Nastouli E, Khakoo SI, Gelson W, Cooke GS, Woods K, Davies J, Barnes E, Matthews PC. Cohort Profile: The National Institute for Health Research Health Informatics Collaborative: Hepatitis B Virus (NIHR HIC HBV) research dataset. Int J Epidemiol 2023; 52:e27-e37. [PMID: 35708657 PMCID: PMC9908046 DOI: 10.1093/ije/dyac127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/03/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tingyan Wang
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David A Smith
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cori Campbell
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver Freeman
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zuzana Moysova
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Theresa Noble
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kinga A Várnai
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Steve Harris
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Hizni Salih
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | | | - Ben Glampson
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Luca Mercuri
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Dimitri Papadimitriou
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Christopher R Jones
- NIHR Imperial Biomedical Research Centre, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Vince Taylor
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Afzal Chaudhry
- Department of Nephrology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hang Phan
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Josune Olza
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Frazer Warricker
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Luis Romão
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - David Ramlakhan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Louise English
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jane Collier
- Department of Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander J Stockdale
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Tropical Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Stacy Todd
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Karl McIntyre
- Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Andrew Frankland
- Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Eleni Nastouli
- Department of Clinical Virology, University College London Hospital, London, UK
- Department of Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Salim I Khakoo
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - William Gelson
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graham S Cooke
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, London, UK
| | - Kerrie Woods
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jim Davies
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Francis Crick Institute, London, UK
- Division of Infection and Immunity, University College London, London, UK
- Department of Infectious Diseases, University College London Hospital, London, UK
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5
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Tamm A, Jones HJ, Perry W, Campbell D, Carten R, Davies J, Galdikas A, English L, Garbett A, Glampson B, Harris S, Khan K, Little S, Malcomson L, Matharu S, Mayer E, Mercuri L, Morris EJ, Muirhead R, Norris R, O'Hara C, Papadimitriou D, Peek N, Renehan A, Roadknight G, Starling N, Teare M, Turner R, Várnai KA, Wasan H, Woods K, Cunningham C. Establishing a colorectal cancer research database from routinely collected health data: the process and potential from a pilot study. BMJ Health Care Inform 2022; 29:bmjhci-2021-100535. [PMID: 35738723 PMCID: PMC9226931 DOI: 10.1136/bmjhci-2021-100535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/25/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectiveColorectal cancer is a common cause of death and morbidity. A significant amount of data are routinely collected during patient treatment, but they are not generally available for research. The National Institute for Health Research Health Informatics Collaborative in the UK is developing infrastructure to enable routinely collected data to be used for collaborative, cross-centre research. This paper presents an overview of the process for collating colorectal cancer data and explores the potential of using this data source.MethodsClinical data were collected from three pilot Trusts, standardised and collated. Not all data were collected in a readily extractable format for research. Natural language processing (NLP) was used to extract relevant information from pseudonymised imaging and histopathology reports. Combining data from many sources allowed reconstruction of longitudinal histories for each patient that could be presented graphically.ResultsThree pilot Trusts submitted data, covering 12 903 patients with a diagnosis of colorectal cancer since 2012, with NLP implemented for 4150 patients. Timelines showing individual patient longitudinal history can be grouped into common treatment patterns, visually presenting clusters and outliers for analysis. Difficulties and gaps in data sources have been identified and addressed.DiscussionAlgorithms for analysing routinely collected data from a wide range of sites and sources have been developed and refined to provide a rich data set that will be used to better understand the natural history, treatment variation and optimal management of colorectal cancer.ConclusionThe data set has great potential to facilitate research into colorectal cancer.
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Affiliation(s)
- Andres Tamm
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute and the Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Js Jones
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Perry
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Des Campbell
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Rachel Carten
- Royal Marsden NHS Foundation Trust, London, UK
- Croydon University Hospital, Croydon, UK
| | - Jim Davies
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, Oxfordshire, UK
| | - Algirdas Galdikas
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Louise English
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Alex Garbett
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Ben Glampson
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Steve Harris
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, Oxfordshire, UK
| | - Khurum Khan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephanie Little
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lee Malcomson
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Sheila Matharu
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Erik Mayer
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery & Cancer, Imperial College London, London, London, UK
| | - Luca Mercuri
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Eva Ja Morris
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Big Data Institute and the Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rebecca Muirhead
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Norris
- NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Catherine O'Hara
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Dimitri Papadimitriou
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Niels Peek
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
| | - Andrew Renehan
- NIHR Manchester Biomedical Research Centre, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Gail Roadknight
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Marion Teare
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Rachel Turner
- Royal Marsden NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research (ICR), London, UK
| | - Kinga A Várnai
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Harpreet Wasan
- NIHR Imperial Biomedical Research Centre, London, UK
- iCare & Imperial College Healthcare NHS Trust, London, UK
| | - Kerrie Woods
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris Cunningham
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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6
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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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Campbell C, Wang T, Smith DA, Freeman O, Noble T, Várnai KA, Harris S, Salih H, Roadknight G, Little S, Glampson B, Mercuri L, Papadimitriou D, Jones CR, Taylor V, Chaudhry A, Phan H, Borca F, Olza J, Warricker F, Romão L, Ramlakhan D, English L, Klenerman P, Andersson MI, Collier J, Nastouli E, Khakoo SI, Gelson W, Cooke GS, Woods K, Davies J, Barnes E, Matthews PC. Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17522.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: To determine the impact of the COVID-19 pandemic on the population with chronic Hepatitis B virus (HBV) infection under hospital follow-up in the UK, we quantified the coverage and frequency of measurements of biomarkers used for routine surveillance (alanine transferase [ALT] and HBV viral load). Methods: We used anonymized electronic health record data from the National Institute for Health Research (NIHR) Health Informatics Collaborative (HIC) pipeline representing five UK National Health Service (NHS) Trusts. Results: We report significant reductions in surveillance of both biomarkers during the pandemic compared to pre-COVID-19 years, both in terms of the proportion of patients who had ≥1 measurement annually, and the mean number of measurements per patient. Conclusions: These results demonstrate the real-time utility of HIC data in monitoring health-care provision, and support interventions to provide catch-up services to minimise the impact of the pandemic. Further investigation is required to determine whether these disruptions will be associated with increased rates of adverse chronic HBV outcomes.
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8
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Wang T, Smith DA, Campbell C, Harris S, Salih H, Várnai KA, Woods K, Noble T, Freeman O, Moysova Z, Marjot T, Webb GJ, Davies J, Barnes E, Matthews PC. Longitudinal Analysis of the Utility of Liver Biochemistry as Prognostic Markers in Hospitalized Patients With Corona Virus Disease 2019. Hepatol Commun 2021; 5:1586-1604. [PMID: 34510830 PMCID: PMC8239606 DOI: 10.1002/hep4.1739] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/22/2021] [Accepted: 04/11/2021] [Indexed: 02/04/2023] Open
Abstract
The association of liver biochemistry with clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is currently unclear, and the utility of longitudinally measured liver biochemistry as prognostic markers for mortality is unknown. We aimed to determine whether abnormal liver biochemistry, assessed at baseline and at repeat measures over time, was associated with death in hospitalized patients with COVID-19 compared to those without COVID-19, in a United Kingdom population. We extracted routinely collected clinical data from a large teaching hospital in the United Kingdom, matching 585 hospitalized patients who were SARS-CoV-2 real-time reverse transcription-polymerase chain reaction (RT-PCR) positive to 1,165 hospitalized patients who were RT-PCR negative for age, sex, ethnicity, and preexisting comorbidities. A total of 26.8% (157/585) of patients with COVID-19 died compared to 11.9% (139/1,165) in the group without COVID-19 (P < 0.001). At presentation, a significantly higher proportion of the group with COVID-19 had elevated alanine aminotransferase (20.7% vs. 14.6%, P = 0.004) and hypoalbuminemia (58.7% vs. 35.0%, P < 0.001) compared to the group without COVID-19. Within the group with COVID-19, those with hypoalbuminemia at presentation had 1.83-fold increased hazards of death compared to those with normal albumin (adjusted hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.25-2.67), while the hazard of death was ~4-fold higher in those aged ≥75 years (adjusted HR, 3.96; 95% CI, 2.59-6.04) and ~3-fold higher in those with preexisting liver disease (adjusted HR, 3.37; 95% CI, 1.58-7.16). In the group with COVID-19, alkaline phosphatase (ALP) increased (R = 0.192, P < 0.0001) and albumin declined (R = -0.123, P = 0.0004) over time in patients who died. Conclusion: In this United Kingdom population, liver biochemistry is commonly deranged in patients with COVID-19. Baseline hypoalbuminemia and rising ALP over time could be prognostic markers for death, but investigation of larger cohorts is required to develop a better understanding of the relationship between liver biochemistry and disease outcome.
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Affiliation(s)
- Tingyan Wang
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - David A. Smith
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Oxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
| | - Cori Campbell
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Steve Harris
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Department of Computer ScienceUniversity of OxfordOxfordUnited Kingdom
| | - Hizni Salih
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
| | - Kinga A. Várnai
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Oxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
| | - Kerrie Woods
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Oxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
| | - Theresa Noble
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Oxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
| | - Oliver Freeman
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
| | - Zuzana Moysova
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Oxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
| | - Thomas Marjot
- Oxford Liver Unit, Translational Gastroenterology UnitJohn Radcliffe HospitalOxford University HospitalsOxfordUnited Kingdom
| | - Gwilym J. Webb
- Cambridge Liver UnitAddenbrooke's HospitalCambridgeUnited Kingdom
| | - Jim Davies
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUnited Kingdom
- Department of Computer ScienceUniversity of OxfordOxfordUnited Kingdom
| | - Eleanor Barnes
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Oxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
| | - Philippa C. Matthews
- Oxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
- Department of Infectious Diseases and MicrobiologyOxford University Hospitals National Health Service Foundation TrustOxfordUnited Kingdom
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9
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Wang T, Smith DA, Campbell C, Mokaya J, Freeman O, Salih H, McNaughton AL, Cripps S, Várnai KA, Noble T, Woods K, Collier J, Jeffery K, Davies J, Barnes E, Matthews PC. Hepatitis B virus (HBV) viral load, liver and renal function in adults treated with tenofovir disoproxil fumarate (TDF) vs. untreated: a retrospective longitudinal UK cohort study. BMC Infect Dis 2021; 21:610. [PMID: 34174833 PMCID: PMC8235844 DOI: 10.1186/s12879-021-06226-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Current clinical guidelines recommend treating chronic hepatitis B virus (HBV) infection in a minority of cases, but there are relatively scarce data on evolution or progression of liver inflammation and fibrosis in cases of chronic HBV (CHB) that do not meet treatment criteria. We aimed to assess the impact of TDF on liver disease, and the risk of renal impairment in treated CHB patients in comparison to untreated patients. METHODS We studied a longitudinal ethnically diverse CHB cohort in the UK attending out-patient clinics between 2005 and 2018. We examined TDF treatment (vs. untreated) as the main exposure, with HBV DNA viral load (VL), ALT, elastography scores and eGFR as the main outcomes, using paired tests and mixed effects model for longitudinal measurements. Additionally, decline of eGFR during follow-up was quantified within individuals by thresholds based on clinical guidelines. Baseline was defined as treatment initiation for TDF group and the beginning of clinical follow-up for untreated group respectively. RESULTS We included 206 adults (60 on TDF, 146 untreated), with a median ± IQR follow-up duration of 3.3 ± 2.8 years. The TDF group was significantly older (median age 39 vs. 35 years, p = 0.004) and more likely to be male (63% vs. 47%, p = 0.04) compared to the untreated group. Baseline difference between TDF and untreated groups reflected treatment eligibility criteria. As expected, VL and ALT declined significantly over time in TDF-treated patients. Elastography scores normalised during treatment in the TDF group reflecting regression of inflammation and/or fibrosis. However, 6/81 (7.4%) of untreated patients had a progression of fibrosis stage from F0-F1 to F2 or F3. There was no evidence of difference in rates or incidence of renal impairment during follow-up in the TDF vs. untreated group. CONCLUSIONS Risk of liver inflammation and fibrosis may be raised in untreated patients compared to those receiving TDF, and TDF may benefit a larger percentage of the CHB population.
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Affiliation(s)
- Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - David A Smith
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.,NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cori Campbell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver Freeman
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.,Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Hizni Salih
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.,Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Sarah Cripps
- Pharmacy Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kinga A Várnai
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.,NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Theresa Noble
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.,NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kerrie Woods
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.,NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jane Collier
- Department of Hepatology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Katie Jeffery
- Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jim Davies
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.,Department of Computer Science, University of Oxford, Oxford, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. .,Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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10
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Hanna CR, Lemmon E, Ennis H, Jones RJ, Hay J, Halliday R, Clark S, Morris E, Hall P. Creation of the first national linked colorectal cancer dataset in Scotland: prospects for future research and a reflection on lessons learned. Int J Popul Data Sci 2021; 6:1654. [PMID: 34007905 PMCID: PMC8111382 DOI: 10.23889/ijpds.v6i1.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Current understanding of cancer patients, their treatment pathways and outcomes relies mainly on information from clinical trials and prospective research studies representing a selected sub-set of the patient population. Whole-population analysis is necessary if we are to assess the true impact of new interventions or policy in a real-world setting. Accurate measurement of geographic variation in healthcare use and outcomes also relies on population-level data. Routine access to such data offers efficiency in research resource allocation and a basis for policy that addresses inequalities in care provision. OBJECTIVE Acknowledging these benefits, the objective of this project was to create a population level dataset in Scotland of patients with a diagnosis of colorectal cancer (CRC). METHODS This paper describes the process of creating a novel, national dataset in Scotland. RESULTS In total, thirty two separate healthcare administrative datasets have been linked to provide a comprehensive resource to investigate the management pathways and outcomes for patients with CRC in Scotland, as well as the costs of providing CRC treatment. This is the first time that chemotherapy prescribing and national audit datasets have been linked with the Scottish Cancer Registry on a national scale. CONCLUSIONS We describe how the acquired dataset can be used as a research resource and reflect on the data access challenges relating to its creation. Lessons learned from this process and the policy implications for future studies using administrative cancer data are highlighted.
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Affiliation(s)
- Catherine R Hanna
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1042 Great Western Road, Glasgow, G12 OYN
| | - Elizabeth Lemmon
- Edinburgh Health Economics, University of Edinburgh,NINE BioQuarter 9 Little France Road Edinburgh EH16 4UX
| | - Holly Ennis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, NINE, 9 Little France Road, Edinburgh BioQuarter, Edinburgh EH16 4UX
| | - Robert J Jones
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1042 Great Western Road, Glasgow, G12 OYN
| | - Joy Hay
- Electronic Data Research and Innovation Service (eDRIS) Public Health Scotland, NINE BioQuarter 9 Little France Road Edinburgh EH16 4UX
| | - Roger Halliday
- University of Glasgow and Chief Statistician, Scottish Government, St Andrew’s house, Regent Road, Edinburgh, EH1 3DG
| | - Steve Clark
- Patient Public Group Member, Bowel Cancer Intelligence (BCI) UK, University of Leeds, LIDA, Worsely Building, Leeds, LS2 9JT
| | - Eva Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Old Road Campus OX3 7LF
| | - Peter Hall
- Edinburgh Cancer Research Centre and Edinburgh Health Economics, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XR
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