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Jonuscheit S, Geue C, Laidlaw R, Fischbacher C, Melia B, Lewsey J, King C. Towards transforming community eye care: an observational study and time-series analysis of optometrists' prescribing for eye disorders. Public Health 2021; 196:107-113. [PMID: 34182255 DOI: 10.1016/j.puhe.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/29/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to provide evidence on the therapeutic prescribing activity by community optometrists in Scotland and to determine its impact on workload in general practice and ophthalmology clinics. STUDY DESIGN Scottish administrative healthcare data for a 53-month period (November 2013-April 2018) were used to analyse non-medical prescribing practice by optometrists. METHODS Using interrupted time-series regression (Autoregressive Integrated Moving Average), we assessed the impact of optometrist prescribing on ophthalmology outpatient attendances and general practice prescribing for eye disorders. RESULTS A total of 54,246 items were prescribed by 205 optometrists over the study period. Since the commencement of data recording, optometrist prescribing activity increased steadily from a baseline of zero to 1.2% of all ophthalmic items prescribed. Neither the monthly number of items prescribed nor the size of optometric workforce were associated with a reduction in ophthalmology outpatient appointments over time. CONCLUSIONS Optometrists increasingly contribute to community ophthalmic prescribing in Scotland, releasing capacity and lessening general practice, but not secondary care workload. There appears to be an underutilisation of optometrists related to the management of dry eye, which represents an opportunity to release further capacity.
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Affiliation(s)
- S Jonuscheit
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - C Geue
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8RZ, UK
| | - R Laidlaw
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - C Fischbacher
- Information Services Division, Public Health Scotland, Edinburgh, UK
| | - B Melia
- Information Services Division, Public Health Scotland, Edinburgh, UK
| | - J Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8RZ, UK
| | - C King
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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Borschmann R, Tibble H, Spittal MJ, Preen D, Pirkis J, Larney S, Rosen DL, Young JT, Love AD, Altice FL, Binswanger IA, Bukten A, Butler T, Chang Z, Chen CY, Clausen T, Christensen PB, Culbert GJ, Degenhardt L, Dirkzwager AJE, Dolan K, Fazel S, Fischbacher C, Giles M, Graham L, Harding D, Huang YF, Huber F, Karaminia A, Keen C, Kouyoumdjian FG, Lim S, Møller L, Moniruzzaman A, Morenoff J, O’Moore E, Pizzicato LN, Pratt D, Proescholdbell SK, Ranapurwala SI, Shanahan ME, Shaw J, Slaunwhite A, Somers JM, Spaulding AC, Stern MF, Viner KM, Wang N, Willoughby M, Zhao B, Kinner SA. The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis. Int J Popul Data Sci 2020; 5:1145. [PMID: 32935053 PMCID: PMC7473255 DOI: 10.23889/ijpds.v5i1.1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.
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Affiliation(s)
- R Borschmann
- Justice Health Unit, Centre for Health Equity, The University of Melbourne, 207 Bouverie street, Carlton 3010, Melbourne, Victoria, AUSTRALIA
| | - H Tibble
- Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - MJ Spittal
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - D Preen
- The University of Western Australia, School of Population and Global Health, Nedlands, AUSTRALIA
| | - J Pirkis
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - S Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - DL Rosen
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - JT Young
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - AD Love
- University of Melbourne, Melbourne School of Population Health, Melbourne, AUSTRALIA
| | - FL Altice
- Yale University School of Medicine and Public Health, New Haven, Connecticut, USA
| | - IA Binswanger
- Kaiser Permanente Colorado, Colorado Permanente Medical Group, USA
| | - A Bukten
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - T Butler
- University of New South Wales, Kirby Institute, Sydney, AUSTRALIA
| | - Z Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SWEDEN
| | - C-Y Chen
- National Yang-Ming University, Institute of Public Health, TAIWAN
| | - T Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - PB Christensen
- Department of Infectious Diseases, Odense University Hospital and Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, DENMARK
| | - GJ Culbert
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, USA
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - AJE Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, NETHERLANDS
| | - K Dolan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - S Fazel
- University of Oxford, Department of Psychiatry, Medical Sciences Division, Oxford, ENGLAND
| | - C Fischbacher
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - M Giles
- Edith Cowan University, School of Arts and Humanities, Joondalup, AUSTRALIA
| | - L Graham
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - D Harding
- University of California Berkeley, USA
| | - Y-F Huang
- Taiwan Centers for Disease Control, Taipei, TAIWAN
| | - F Huber
- Cayenne General Hospital, COREVIH Guyane, and Reseau Kikiwi, Cayenne, French Guiana, FRANCE
| | - A Karaminia
- University of New South Wales, Sydney, AUSTRALIA
| | - C Keen
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - FG Kouyoumdjian
- McMaster University, Department of Family Medicine, Hamilton, Ontario, CANADA
| | - S Lim
- New York City Department of Health and Mental Hygiene, Bureau of Epidemiology Services, Division of Epidemiology, New York, USA
| | - L Møller
- World Health Organization, Division of Noncommunicable Diseases and Promoting Health through the Life-course, Marmorvej, DENMARK
| | - A Moniruzzaman
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - J Morenoff
- University of Michigan, Department of Sociology, USA
| | - E O’Moore
- Public Health England, London, ENGLAND
| | - LN Pizzicato
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - D Pratt
- University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Manchester, ENGLAND
| | - SK Proescholdbell
- North Carolina Department of Health and Human Services, North Carolina, USA
| | - SI Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, USA
| | - ME Shanahan
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, USA
| | - J Shaw
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, ENGLAND
| | - A Slaunwhite
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - JM Somers
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - AC Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - MF Stern
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - KM Viner
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - N Wang
- Institute of Public Health, National Yang-Ming University, TAIWAN
| | - M Willoughby
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - B Zhao
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - SA Kinner
- Murdoch Children’s Research Institute, Centre for Adolescent Health, Melbourne, Victoria, AUSTRALIA
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Walsh D, Buchanan D, Douglas A, Erdman J, Fischbacher C, McCartney G, Norman P, Whyte B. 5.3-O6The changing ethnic profiles of Scotland and Glasgow, and the implications for population health. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Walsh
- Glasgow Centre for Population Health, Scotland
| | | | | | - J Erdman
- NHS Greater Glasgow & Clyde, Scotland
| | | | | | | | - B Whyte
- Glasgow Centre for Population Health, Scotland
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Müller U, Mertes B, Fischbacher C, Jageman K, Danzer K. Non-Invasive Blood Glucose Monitoring by Means of near Infrared Spectroscopy: Methods for Improving the Reliability of the Calibration Models. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000509] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The feasibility of using near infrared reflection spectroscopy for non-invasive blood glucose monitoring is discussed. Spectra were obtained using a diode-array spectrometer with a fiberoptic measuring head with a wavelength ranging from 800 nm to 1350 nm. Calibration was performed using partial least-squares regression and radial basis function networks. The results of different methods used to evaluate the quality of the recorded spectra in order to improve the reliability of the calibration models, are presented.
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Affiliation(s)
- U.A. Müller
- Department for Internal Medicine II, Medical School
| | - B. Mertes
- Department for Internal Medicine II, Medical School
| | - C. Fischbacher
- Institute of Inorganic and Analytical Chemistry, Friedrich Schiller University, Jena - Germany
| | - K.U. Jageman
- Institute of Inorganic and Analytical Chemistry, Friedrich Schiller University, Jena - Germany
| | - K. Danzer
- Institute of Inorganic and Analytical Chemistry, Friedrich Schiller University, Jena - Germany
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Read SH, McAllister DA, Colhoun HM, Farran B, Fischbacher C, Kerssens JJ, Leese GP, Lindsay RS, McCrimmon RJ, McGurnaghan S, Philip S, Sattar N, Wild SH. Incident ischaemic stroke and Type 2 diabetes: trends in incidence and case fatality in Scotland 2004-2013. Diabet Med 2018; 35:99-106. [PMID: 29044687 DOI: 10.1111/dme.13528] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
Abstract
AIM To describe trends in first ischaemic stroke incidence and case fatality in adults with and without a diagnosis of Type 2 diabetes prior to their ischaemic stroke event in Scotland between 2004 and 2013. METHODS Using population-wide hospital admission, death and diabetes datasets, we conducted a retrospective cohort study. Negative binomial and logistic regression models were used to calculate year-specific incidence and case-fatality rates for people with Type 2 diabetes and for people without diabetes. RESULTS During 41.0 million person-years of follow-up there were 69 757 ischaemic stroke events. Type 2 diabetes prevalence among patients who experienced ischaemic stroke increased from 13.5% to 20.3% between 2004 and 2013. Stroke incidence rates declined by 2.7% (95% CI 2.4, 3.0) annually for people with and without diabetes [diabetes/year interaction: rate ratio 0.99 (95% CI 0.98, 1.01)]. Type 2 diabetes was associated with an increased risk of ischaemic stroke in men [rate ratio 1.23 (95% CI 1.17, 1.30)] and women [rate ratio 1.41 (95% CI 1.35, 1.48)]. Case-fatality rates were 14.2% and 12.7% in people with Type 2 diabetes and without diabetes, respectively. Case fatality declined by 3.5% (95% CI 2.7, 4.5) annually [diabetes/year interaction: odds ratio 1.01 (95% CI 0.98, 1.02)]. CONCLUSIONS Ischaemic stroke incidence declined no faster in people with a diagnosis of Type 2 diabetes than in people without diabetes. Increasing prevalence of Type 2 diabetes among stroke patients may mean that declines in case fatality over time will be less marked in the future.
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Affiliation(s)
- S H Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - D A McAllister
- Institutes of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - H M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - B Farran
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Fischbacher
- Information Services Division, NHS National Services, Edinburgh, UK
| | - J J Kerssens
- Information Services Division, NHS National Services, Edinburgh, UK
| | - G P Leese
- Department of Diabetes and Endocrinology, University of Dundee, Dundee, UK
| | - R S Lindsay
- Institutes of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - R J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - S McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - S Philip
- Department of Diabetes and Endocrinology, NHS Grampian, Aberdeen, UK
| | - N Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Brewster DH, Fischbacher CM, Nolan J, Nowell S, Redpath D, Nabi G. Risk of hospitalization and death following prostate biopsy in Scotland. Public Health 2017; 142:102-110. [PMID: 27810089 PMCID: PMC5226055 DOI: 10.1016/j.puhe.2016.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/22/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the risk of hospitalization and death following prostate biopsy. STUDY DESIGN Retrospective cohort study. METHODS Our study population comprised 10,285 patients with a record of first ever prostate biopsy between 2009 and 2013 on computerized acute hospital discharge or outpatient records covering Scotland. Using the general population as a comparison group, expected numbers of admissions/deaths were derived by applying age-, sex-, deprivation category-, and calendar year-specific rates of hospital admissions/deaths to the study population. Indirectly standardized hospital admission ratios (SHRs) and mortality ratios (SMRs) were calculated by dividing the observed numbers of admissions/deaths by expected numbers. RESULTS Compared with background rates, patients were more likely to be admitted to hospital within 30 days (SHR 2.7; 95% confidence interval 2.4, 2.9) and 120 days (SHR 4.0; 3.8, 4.1) of biopsy. Patients with prior co-morbidity had higher SHRs. The risk of death within 30 days of biopsy was not increased significantly (SMR 1.6; 0.9, 2.7), but within 120 days, the risk of death was significantly higher than expected (SMR 1.9; 1.5, 2.4). The risk of death increased with age and tended to be higher among patients with prior co-morbidity. Overall risks of hospitalization and of death up to 120 days were increased both in men diagnosed and those not diagnosed with prostate cancer. CONCLUSIONS Higher rates of adverse events in older patients and patients with prior co-morbidity emphasizes the need for careful patient selection for prostate biopsy and justifies ongoing efforts to minimize the risk of complications.
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Affiliation(s)
- D H Brewster
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
| | - C M Fischbacher
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - J Nolan
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - S Nowell
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - D Redpath
- NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland, UK
| | - G Nabi
- Section of Academic Urology, Cancer Research Division, School of Medicine, Ninewells Hospital, Dundee, Scotland, UK; Department of Surgical Urology, Ninewells Hospital, NHS Tayside, Dundee, Scotland, UK
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Ward HJT, Douglas A, Cezard G, Simpson C, Fischbacher C, Steiner MFC, Sheikh A, Bhopal R. Developing health information by ethnic status in Europe: a pilot data linkage study in Scotland. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fischbacher CM, Steiner M, Bhopal R, Chalmers J, Jamieson J, Knowles D, Povey C. Variations in all Cause and Cardiovascular Mortality by Country of Birth in Scotland, 1997-2003. Scott Med J 2016; 52:5-10. [PMID: 18092629 DOI: 10.1258/rsmsmj.52.4.5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background and Aims Country of birth provides a proxy for ethnic group for recent migrants. Major differences in mortality by country of birth have been demonstrated in England and Wales, but similar published data for Scotland are lacking. We aimed to examine variations in mortality by country of birth for Scottish residents. Methods We calculated standardised mortality ratios by country of birth for Scottish residents aged 25 years and over between January 1997 and March 2003. Results and Conclusion Comparisons with England and Wales showed high allcause, coronary heart disease (CHD) and stroke mortality among Scottish residents born in Scotland, Northern Ireland, the Republic of Ireland, India and Hong Kong. However, most country of birth groups had similar or lower mortality than the Scottish born. These are the first data on mortality by country of birth in Scotland and they demonstrate major variations. Comparisons within the Scottish population might be interpreted as reassuring, since they do not show the excesses in CHD mortality by country of birth reported in England and Wales. However, the use of England and Wales as a comparison group shows a substantial excess of CHD risk among South Asians in Scotland, comparable to that reported in England and Wales.
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Affiliation(s)
- CM Fischbacher
- Consultant in Public Health Medicine, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
- Honorary Senior Lecturer, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - M Steiner
- Senior Registrar, Department of Environmental and Occupational Medicine, Liberty Safe Work Research Centre, Forresterhill Road, Aberdeen, AB25 2ZP. (Formerly, Department of Public Health Sciences, University of Edinburgh, EH8 9AG)
| | - R Bhopal
- Professor of Public Health, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - J Chalmers
- Consultant in Public Health Medicine, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
- Honorary Senior Lecturer, Department of Public Health Sciences, University of Edinburgh, EH8 9AG
| | - J Jamieson
- Programme Manager, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
| | - D Knowles
- Head of Group, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
| | - C Povey
- Information Analyst, Information Services Division, NHS National Services Gyle Square, 1 South Gyle Crescent, Edinburgh, EH 12 9EB
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Hunter LC, Lee RJ, Butcher I, Weir CJ, Fischbacher CM, McAllister D, Wild SH, Hewitt N, Hardie RM. Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records. BMJ Open 2016; 6:e009121. [PMID: 26801463 PMCID: PMC4735181 DOI: 10.1136/bmjopen-2015-009121] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DESIGN Retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. SETTING Primary care; Lothian (population approximately 800,000), Scotland. PARTICIPANTS Data from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. Patients were followed up until 2010, death or they left a participating practice. MAIN OUTCOME MEASURES First and subsequent admissions for AECOPD (International Classification of Diseases (ICD) 10 codes J44.0, J44.1 in any diagnostic position) after COPD diagnosis in primary care. RESULTS 1756 (25%) patients had at least 1 AECOPD admission; 794 (11%) had at least 1 readmission and the risk of readmission increased with each admission. Older age at diagnosis, more severe COPD, low body mass index (BMI), current smoking, increasing deprivation, COPD admissions and interventions for COPD prior to diagnosis in primary care, and comorbidities were associated with higher risk of first AECOPD admission in an adjusted Cox proportional hazards regression model. More severe COPD and COPD admission prior to primary care diagnosis were associated with increased risk of AECOPD readmission in an adjusted Prentice-Williams-Peterson model. High BMI was associated with a lower risk of first AECOPD admission and readmission. CONCLUSIONS Several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission. Prompt diagnosis in primary care may reduce the risk of AECOPD admission and readmission. The study highlights the important role of primary care in preventing or delaying a first AECOPD admission.
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Affiliation(s)
- L C Hunter
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Midlothian, UK
| | - R J Lee
- Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - I Butcher
- Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - C J Weir
- Reader in Medical Statistics and Associate Director (Statistics) Health Services Research Unit, Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - C M Fischbacher
- Clinical Director for Information Services, Information Services Division (ISD), NHS National Services Scotland, Edinburgh, Midlothian, UK
| | - D McAllister
- Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - S H Wild
- Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - N Hewitt
- Clinical Lead, Lothian Respiratory Managed Clinical Network, NHS Lothian, Edinburgh, Midlothian, UK
| | - R M Hardie
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Midlothian, UK
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Mukherjee M, Stoddart A, Gupta R, Nwaru B, Heaven M, Farr A, Fitzsimmons D, Bandyopadhyay A, Aftab C, Simpson C, Lyons R, Fischbacher C, Dibben C, Shields M, Phillips C, Strachan D, Davies G, McKinstry B, Sheikh A. P218 The epidemiological, healthcare and societal burden and costs of asthma in the UK and member nations: analyses of national databases. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fischbacher CM, Muirie J, McCartney G, Lewsey J, McKay D, Geue C. Using routine data to monitor population level interventions: the example of the Keep Well health check programme in Scotland. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Cezard G, Bhopal R, Douglas A, Bansal N, Steiner M, Simpson C, Fischbacher C, Sheikh A. Ethnic variations in respiratory disorders in Scotland: asthma, COPD and infections. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Hunter LC, Weir CJ, Fischbacher CM, Wild S, McAllister D, Hewitt N, Hardie RM. Health care inequalities in chronic obstructive pulmonary disease management in primary care in the United Kingdom. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jones NRV, Fischbacher CM, Guthrie B, Leese G, Lindsay RS, McKnight JA, Pearson D, Philip S, Sattar N, Wild SH. Factors associated with statin treatment for the primary prevention of cardiovascular disease in people within 2 years following diagnosis of diabetes in Scotland, 2006-2008. Diabet Med 2014; 31:640-6. [PMID: 24533646 PMCID: PMC4232871 DOI: 10.1111/dme.12409] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/14/2013] [Accepted: 11/27/2013] [Indexed: 12/15/2022]
Abstract
AIM To describe characteristics associated with statin prescribing for the primary prevention of cardiovascular disease in people with newly diagnosed diabetes. METHODS Data from the Scottish Care Information-Diabetes Collaboration data set for 2006-2008 were used. This data set contains socio-demographic and prescribing data for over 99% of people with diagnosed diabetes in Scotland. Analyses were conducted on people aged over 40 years diagnosed with Type 1 or Type 2 diabetes between 2006 and 2008 with complete data and no previous history of cardiovascular or statin prescription. Logistic regression was used to calculate odds ratios for statin prescription in the 2 years following diagnosis of diabetes. RESULTS There were 7157 men and 5601 women who met the inclusion criteria, 68% of whom had a statin prescription recorded in the 2 years following diagnosis of diabetes. The proportions receiving statins were lower above 65 years of age in men and 75 years of age in women. People with Type 1 diabetes had lower odds of receiving statins than people with Type 2 diabetes [odds ratio (95% CI) 0.42 (0.29-0.61) for men and 0.48 (0.28-0.81) for women, after adjustment for age, BMI, smoking status, cholesterol level and deprivation]. Higher total cholesterol, BMI and being a current smoker were associated with greater odds of statin prescription. CONCLUSION Approximately one third of the study population had no record of statin prescription during the 2 years after diagnosis of diabetes. Cardiovascular disease risk reduction opportunities may be missed in some of these people.
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Affiliation(s)
- N R V Jones
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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15
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Walker JJ, Brewster DH, Colhoun HM, Fischbacher CM, Leese GP, Lindsay RS, McKnight JA, Philip S, Sattar N, Stockton DL, Wild SH. Type 2 diabetes, socioeconomic status and risk of cancer in Scotland 2001-2007. Diabetologia 2013; 56:1712-5. [PMID: 23661106 PMCID: PMC4131139 DOI: 10.1007/s00125-013-2937-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS The objective of this study was to use Scottish national data to assess the influence of type 2 diabetes on the risk of cancer at 16 different sites, while specifically investigating the role of confounding by socioeconomic status in the diabetes-cancer relationship. METHODS All people in Scotland aged 55-79 years diagnosed with any of the cancers of interest during the period 2001-2007 were identified and classified by the presence/absence of co-morbid type 2 diabetes. The influence of diabetes on cancer risk for each site was assessed via Poisson regression, initially with adjustment for age only, then adjusted for both age and socioeconomic status. RESULTS There were 4,285 incident cancers in people with type 2 diabetes. RR for any cancers (adjusted for age only) was 1.11 (95% CI 1.05, 1.17) for men and 1.33 (1.28, 1.40) for women. Corresponding values after additional adjustment for socioeconomic status were 1.10 (1.04, 1.15) and 1.31 (1.25, 1.38), respectively. RRs for individual cancer sites varied markedly. CONCLUSIONS/INTERPRETATION Socioeconomic status was found to have little influence on the association between type 2 diabetes and cancer.
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Affiliation(s)
- J J Walker
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, EH8 9AG, UK.
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16
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Walker JJ, Brewster DH, Colhoun HM, Fischbacher CM, Lindsay RS, Wild SH. Cause-specific mortality in Scottish patients with colorectal cancer with and without type 2 diabetes (2000-2007). Diabetologia 2013; 56:1531-41. [PMID: 23624531 DOI: 10.1007/s00125-013-2917-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/05/2013] [Indexed: 01/02/2023]
Abstract
AIMS/HYPOTHESIS The objective of this study was to use Scottish national data to assess the influence of type 2 diabetes on (1) survival (overall and cause-specific) in multiple time intervals after diagnosis of colorectal cancer and (2) cause of death. METHODS Data from the Scottish Cancer Registry were linked to data from a population-based national diabetes register. All people in Scotland diagnosed with non-metastatic cancer of the colon or rectum in 2000-2007 were included. The effect of pre-existing type 2 diabetes on survival over four discrete time intervals (<1, 1-2, 3-5 and >5 years) after cancer diagnosis was assessed by Cox regression. Cumulative incidence functions were calculated representing the respective probabilities of death from the competing causes of colorectal cancer, cardiovascular disease, other cancers and any other cause. RESULTS Data were available for 19,505 people with colon or rectal cancer (1,957 with pre-existing diabetes). Cause-specific mortality analyses identified a stronger association between diabetes and cardiovascular disease mortality than that between diabetes and cancer mortality. Beyond 5 years after colon cancer diagnosis, diabetes was associated with a detrimental effect on all-cause mortality after adjustment for age, socioeconomic status and cancer stage (HR [95% CI]: 1.57 [1.19, 2.06] in men; 1.84 [1.36, 2.50] in women). For patients with rectal cancer, diabetes was not associated with differential survival in any time interval. CONCLUSIONS/INTERPRETATION Poorer survival observed for colon cancer associated with type 2 diabetes in Scotland may be explained by higher mortality from causes other than cancer.
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Affiliation(s)
- J J Walker
- Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
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17
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Phillips RL, Noyes KJ, Bath LE, Fischbacher CM, Wild SH. Evaluation of discharge coding for paediatric diabetic ketoacidosis. Diabet Med 2013; 30:760-1. [PMID: 23323924 DOI: 10.1111/dme.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 12/20/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
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18
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Jackson CA, Jones NRV, Walker JJ, Fischbacher CM, Colhoun HM, Leese GP, Lindsay RS, McKnight JA, Morris AD, Petrie JR, Sattar N, Wild SH. Area-based socioeconomic status, type 2 diabetes and cardiovascular mortality in Scotland. Diabetologia 2012; 55:2938-45. [PMID: 22893029 PMCID: PMC4215193 DOI: 10.1007/s00125-012-2667-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/22/2012] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to explore the relationships between type 2 diabetes mellitus, area-based socioeconomic status (SES) and cardiovascular disease mortality in Scotland. METHODS We used an area-based measure of SES, Scottish national diabetes register data linked to mortality records, and general population cause-specific mortality data to investigate the relationships between SES, type 2 diabetes and mortality from ischaemic heart disease (IHD) and cerebrovascular disease (CbVD), for 2001-2007. We used negative binomial regression to obtain age-adjusted RRs of mortality (by sex), comparing people with type 2 diabetes with the non-diabetic population. RESULTS Among 216,652 people aged 40 years or older with type 2 diabetes (980,687 person-years), there were 10,554 IHD deaths and 4,378 CbVD deaths. Age-standardised mortality increased with increasing deprivation, and was higher among men. IHD mortality RRs were highest among the least deprived quintile and lowest in the most deprived quintile (men: least deprived, RR 1.94 [95% CI 1.61, 2.33]; most deprived, RR 1.46 [95% CI 1.23, 1.74]) and were higher in women than men (women: least deprived, RR 2.84 [95% CI 2.12, 3.80]; most deprived, RR 2.04 [95% CI 1.55, 2.69]). A similar, weaker, pattern was observed for cerebrovascular mortality. CONCLUSIONS/INTERPRETATION Absolute risk of cardiovascular mortality is higher in people with diabetes than in the non-diabetic population and increases with increasing deprivation. The relative impact of diabetes on cardiovascular mortality differs by SES, and further efforts to reduce cardiovascular risk both in deprived groups and people with diabetes are required. Prevention of diabetes may reduce socioeconomic health inequalities.
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Affiliation(s)
- C A Jackson
- Scottish Collaboration for Public Health Research and Policy, MRC Human Genetics Unit, Western General Hospital, Edinburgh, UK
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Turner SL, Lyons RA, Stone D, Macey SM, Barron S, Slater W, Brown P, Verne J, Lumsden E, McErlean I, Quigg Z, Hughes K, Towner E, Shepherd J, Fischbacher C, Quinn J, Frame S, McMahon S, Jessop V. Creation and development of an Injury Observatory for Britain and Ireland (IOBI). Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590p.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Millard A, Guthrie C, Fischbacher C, Jamieson J. Pilot ethnic analysis of routine hospital admissions data and comparison with census linked data: CHD rates remain high in Pakistanis. ACTA ACUST UNITED AC 2012. [DOI: 10.1108/17570981211319393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeRoutine data are needed to monitor ethnic health inequalities. The proportion of hospital discharge records with ethnicity information has been improving in Scotland. The aim of this paper is to assess whether routine data can provide valid comparisons of admission rates by ethnic group.Design/methodology/approachRoutine hospital admissions data in four NHS Boards were analysed by ethnic group and sex to compare incidence rate ratios (IRRs) for acute myocardial infarction (AMI) and coronary heart disease (CHD). A previous study linking health and census ethnicity information for 2001‐2003 provided the comparison standard.FindingsThere was a similar risk of AMI for South Asian compared to non‐South Asian people in 2009‐2011 and 2001‐2003. South Asian people and Pakistani women had higher risk of CHD than White Scottish people. The Other White group had higher and the White Irish lower risk of AMI admission in comparison to 2001‐2003 data.Research limitations/implicationsThe comparison used a different age range, did not include community deaths, covered a part of Scotland rather than the whole, and may have been affected by changes to denominators, which were based on the UK census 2001.Originality/valueThe similar IRRs for AMI from census linkage in 2001‐2003 and NHS data from 2009‐2011 suggest routine ethnicity data are valid in some NHS Boards. Analyses can reveal previously unknown variations to justify health improvement action. To maximise the precision of analyses, data completeness needs to be increased and sustained.
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21
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Govan L, Maietti E, Torsney B, Wu O, Briggs A, Colhoun HM, Fischbacher CM, Leese GP, McKnight JA, Morris AD, Sattar N, Wild SH, Lindsay RS. The effect of deprivation and HbA1c on admission to hospital for diabetic ketoacidosis in type 1 diabetes. Diabetologia 2012; 55:2356-60. [PMID: 22733482 PMCID: PMC4209851 DOI: 10.1007/s00125-012-2601-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/08/2012] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Diabetic ketoacidosis is a potentially life-threatening complication of diabetes and has a strong relationship with HbA(1c). We examined how socioeconomic group affects the likelihood of admission to hospital for diabetic ketoacidosis. METHODS The Scottish Care Information - Diabetes Collaboration (SCI-DC), a dynamic national register of all cases of diagnosed diabetes in Scotland, was linked to national data on hospital admissions. We identified 24,750 people with type 1 diabetes between January 2005 and December 2007. We assessed the relationship between HbA(1c) and quintiles of deprivation with hospital admissions for diabetic ketoacidosis in people with type 1 diabetes adjusting for patient characteristics. RESULTS We identified 23,479 people with type 1 diabetes who had complete recording of covariates. Deprivation had a substantial effect on odds of admission to hospital for diabetic ketoacidosis (OR 4.51, 95% CI 3.73, 5.46 in the most deprived quintile compared with the least deprived). This effect persisted after the inclusion of HbA(1c) and other risk factors (OR 2.81, 95% CI 2.32, 3.39). Men had a reduced risk of admission to hospital for diabetic ketoacidosis (OR 0.71, 95% CI 0.63, 0.79) and those with a history of smoking had increased odds of admission to hospital for diabetic ketoacidosis by a factor of 1.55 (95% CI 1.36, 1.78). CONCLUSIONS/INTERPRETATION Women, smokers, those with high HbA(1c) and those living in more deprived areas have an increased risk of admission to hospital for diabetic ketoacidosis. The effect of deprivation was present even after inclusion of other risk factors. This work highlights that those in poorer areas of the community with high HbA(1c) represent a group who might be usefully supported to try to reduce hospital admissions.
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Affiliation(s)
- L Govan
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.
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22
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Bhopal RS, Bansal N, Fischbacher CM, Brown H, Capewell S. Ethnic variations in heart failure: Scottish Health and Ethnicity Linkage Study (SHELS): Table 1. Heart 2012; 98:468-73. [DOI: 10.1136/heartjnl-2011-301191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Anwar H, Fischbacher CM, Leese GP, Lindsay RS, McKnight JA, Wild SH. Assessment of the under-reporting of diabetes in hospital admission data: a study from the Scottish Diabetes Research Network Epidemiology Group. Diabet Med 2011; 28:1514-9. [PMID: 21883441 PMCID: PMC4215191 DOI: 10.1111/j.1464-5491.2011.03432.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Good quality data are required to plan and evaluate diabetes services and to assess progress against targets for reducing hospital admissions and bed days. The aim of this study was to assess the completeness of recording of diabetes in hospital admissions using recent national data for Scotland. METHODS Data derived from linkage of the Scottish National Diabetes Register and hospital admissions data were analysed to assess the completeness of coding of diabetes in hospital inpatient admissions between 2000 and 2007 for patients identified with diabetes prior to hospital admission. RESULTS In 2007, only 59% of hospital inpatient admissions for people previously diagnosed with diabetes mentioned diabetes, whereas over 99% of people with a mention of diabetes on hospital records were included in the diabetes register. The completeness of diabetes recording varied from 44 to 82% among mainland National Health Service Boards and from 34 to 89% among large general hospitals. Completeness of recording of diabetes as a co-morbidity also varied by primary diagnosis: 70 and 41% of admissions with coronary heart disease and cancer as the primary diagnosis mentioned co-existing diabetes, respectively. CONCLUSIONS There is wide variation in the completeness of recording of diabetes in hospital admission data. Hospital data alone considerably underestimate the number of admissions and bed days but overestimate length of stay for people with diabetes. Linkage of diabetes register data to hospital admissions data provides a more accurate source for measuring hospital admissions among people diagnosed with diabetes than hospital admissions data.
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Affiliation(s)
- H Anwar
- Information Services Division, NHS National Services Scotland, Edinburgh, UK.
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24
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Bhopal RS, Bansal N, Fischbacher CM, Brown H, Capewell S. Ethnic variations in the incidence and mortality of stroke in the Scottish Health and Ethnicity Linkage Study of 4.65 million people. Eur J Prev Cardiol 2011; 19:1503-8. [DOI: 10.1177/1741826711423217] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- RS Bhopal
- University of Edinburgh, Edinburgh, UK
| | - N Bansal
- University of Edinburgh, Edinburgh, UK
| | - CM Fischbacher
- University of Edinburgh, Edinburgh, UK
- NHS Scotland National Services, Edinburgh, UK
| | - H Brown
- University of Edinburgh, Edinburgh, UK
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25
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Fischbacher C, Brin G, Bansal N, Pearce J, Bhopal R. P1-22 Which measures of socio-economic position perform most consistently across ethnic groups? Retrospective cohort study using census data linkage. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976c.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bansal N, Fischbacher C, Bhopal R, Brown H, Steiner M, Capewell S. P2-21 Ethnic inequalities in myocardial infarction incidence, interventions and survival in Scotland: the Scottish Health and Ethnicity Linkage Study (SHELS). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976h.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hunter L, Fischbacher C, Wild S, Hardie R. P1-28 Linkage of primary and secondary care data to identify risk factors for emergency hospital admission for COPD: negotiating the legal and ethical hurdles. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976c.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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28
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Graham L, Fischbacher C, Stockton D, Fraser A, Fleming M, Grieg K. P2-101 Prisoner mortality in Scotland 1996-2007: retrospective cohort study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Bansal N, Bhopal R, Fischbacher C, Povey C, Chalmers J, Brewster D, Mueller G, Steiner M, Brown H. O3-2.1 Linkage of data in the study of ethnic inequalities and inequities in health outcomes in Scotland: the Scottish Health and Ethnicity Linkage Study (SHELS). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976a.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Verne J, Brown P, Slater W, Towner E, Bellis MA, Anderson Z, Hughes K, Lyons RA, Turner S, Shepherd J, Barron S, Stone D, Fischbacher C, Lumsden E, Pollock A, Kirkwood G. Injury Prevention News (IPN): a free e-newsletter for the UK and Ireland. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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31
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Stone D, Lyons RA, Turner S, Quigg Z, Barron S, Bellis MA, Brown P, Fischbacher C, Hughes K, Kirkwood G, Lumsden E, Pollock A, Shepherd J, Slater W, Towner E, Verne J. Creation and early development of an injury observatory for Britain and Ireland (IOBI). Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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32
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Gordon D, Fischbacher C, Stockton D. Improving the view of Scotland’s health: The impact of a public health observatory upon health improvement policy, action and monitoring in a devolved nation. Public Health 2010; 124:259-64. [DOI: 10.1016/j.puhe.2010.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 10/19/2022]
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33
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Anandan C, Gupta R, Simpson CR, Fischbacher C, Sheikh A. Epidemiology and disease burden from allergic disease in Scotland: analyses of national databases. J R Soc Med 2009; 102:431-42. [PMID: 19797601 DOI: 10.1258/jrsm.2009.090027] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are ongoing concerns about the quality of care provided to patients with allergic disorders in Scotland, but there are relatively few reliable data on the overall disease burden. We sought to: (1) describe the incidence, prevalence and outcome of allergic disorders; (2) estimate healthcare burden and costs; and (3) investigate ethnic variations in the epidemiology and outcomes from allergic disorders in Scotland. METHODS DATA SOURCES national surveys; primary care data; prescribing and medication data; hospital admissions data and mortality data. RESULTS Allergic disorders are extremely common in Scotland, affecting about one in three of the population at some time in their lives. Incidence was highest for eczema (10.2 per 1000 registered patients). Over 4% of all GP consultations and 1.5% of hospital admissions were for allergic disorders. There were 100 asthma deaths in 2005 (20 per million people). Direct healthcare costs for allergic disorders were an estimated pound130 million per year, the majority of these being incurred in primary care and related to asthma. CONCLUSIONS Allergic disorders are common in Scotland and given the very high proportion of children now affected, the high disease burden associated with these conditions is likely to persist for many decades.
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Affiliation(s)
- C Anandan
- Allergy & Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9DX, UK
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34
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Pell JP, Haw S, Cobbe S, Newby DE, Pell ACH, Fischbacher C, Pringle S, Murdoch D, Dunn F, Oldroyd K, MacIntyre P, O'Rourke B, Borland W. Secondhand smoke exposure and survival following acute coronary syndrome: prospective cohort study of 1261 consecutive admissions among never-smokers. Heart 2009; 95:1415-8. [PMID: 19684191 DOI: 10.1136/hrt.2009.171702] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether exposure to secondhand smoke is associated with early prognosis following acute coronary syndrome. DESIGN, SETTING AND PARTICIPANTS We interviewed consecutive patients admitted to nine Scottish hospitals over 23 months. Information was obtained, via questionnaire, on age, sex, smoking status, postcode of residence and admission serum cotinine concentration was measured. Follow-up data were obtained from routine hospital admission and death databases. RESULTS Of the 5815 participants, 1261 were never-smokers. Within 30 days, 50 (4%) had died and 35 (3%) had a non-fatal myocardial infarction. All-cause deaths increased from 10 (2.1%) in those with cotinine < or =0.1 ng/ml to 22 (7.5%) in those with cotinine >0.9 ng/ml (chi(2) test for trend p<0.001). This persisted after adjustment for potential confounders (cotinine >0.9 ng/ml: adjusted OR 4.80, 95% CI 1.95 to 11.83, p = 0.003). The same dose response was observed for cardiovascular deaths and death or myocardial infarction. CONCLUSIONS Secondhand smoke exposure is associated with worse early prognosis following acute coronary syndrome. Non-smokers need to be protected from the harmful effects of secondhand smoke.
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Affiliation(s)
- J P Pell
- Section of Public Health, University of Glasgow, UK.
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35
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Fischbacher CM, Bhopal R, Steiner M, Morris AD, Chalmers J. Is there equity of service delivery and intermediate outcomes in South Asians with type 2 diabetes? Analysis of DARTS database and summary of UK publications. J Public Health (Oxf) 2009; 31:239-49. [PMID: 19196794 DOI: 10.1093/pubmed/fdp003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There are doubts whether diabetes care is equitable across UK ethnic groups. We examined processes and outcomes in South Asians with diabetes and reviewed the UK literature. METHODS We used name search methods to identify South Asians in a regional diabetes database. We compared prevalence rates, processes and outcomes of care between November 2003 and December 2004. We used standard literature search techniques. RESULTS The prevalence of diabetes in South Asians was 3-4 times higher than non-South Asians. South Asians were 1.11 times (95% confidence interval 1.06, 1.16) more likely to have a structured review. South Asian women were 1.10 times more likely to have a record of body mass index (95% CI 1.04, 1.16). HbA1c levels were 1.03 times higher (95% CI 1.00, 1.06) among South Asians, retinopathy 1.36 times more common (95% CI 1.03, 1.78) and hypertension 0.71 times as common (95% CI 0.58, 0.87). CONCLUSIONS We found evidence of equity in many aspects of diabetes care for South Asians in Tayside. The finding of higher HbA1c and more retinopathy among South Asians needs explanation and a service response. These findings from a region with a small non-White population largely support the recent findings from other parts of the UK.
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Affiliation(s)
- C M Fischbacher
- Information Services Division, NHS National Services Scotland, Edinburgh EH12 9EB, UK.
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36
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Goyder E, Wild S, Fischbacher C, Carlisle J, Peters J. Evaluating the impact of a national pilot screening programme for type 2 diabetes in deprived areas of England. Fam Pract 2008; 25:370-5. [PMID: 18765406 DOI: 10.1093/fampra/cmn054] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A pilot programme designed to systematically screen for type 2 diabetes was introduced in 24 general practices in England selected for their high levels of socio-economic deprivation and multi-ethnic populations. OBJECTIVE To evaluate the impact of screening on the prevalence of type 2 diabetes. METHODS A prospective audit of screening activity in pilot practices and comparison of the change in prevalence of diabetes in pilot and comparison practices were conducted. RESULTS Of 41,400 individuals invited for screening from a population of 165,828 in pilot practices, 25,356 (61%) were screened. Three hundred and fifty-eight (0.22%) new cases of diabetes were detected among those screened. Only 69% of those with a positive screening test had diagnostic testing recorded and only 19% had a record of an oral glucose tolerance test. The absolute increase in the prevalence of diagnosed diabetes was 0.53% in pilot practices and 0.42% in comparison practices. CONCLUSIONS The 'real world' nature of the programme and dependence on routine data collection systems makes results more difficult to interpret but also enabled problems with implementation, not evident from previous research, to be identified. It is likely that the low diagnostic yield was largely due to a high level of ad hoc screening activity outside the pilot protocol and inadequate access to diagnostic testing after a positive screening test. In particular, implementation of screening for diabetes in primary care should not be undertaken without robust assessment of the resources required for diagnostic testing and follow-up and adequate clinical audit.
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Affiliation(s)
- E Goyder
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Abstract
AIM To create a standardized systematic quality assurance system for diabetes care throughout Scotland. METHODS Each of 15 National Health Service (NHS) boards have submitted core diabetes data for a nationally agreed data specification on an annual basis since 2001. These data are collated to produce an annual national report. We describe the iterative progress of the work in obtaining and analysing this information. The setting was Scotland, with a population of 5 million. RESULTS In Scotland in 2006, 196,801 people (3.9% of the population) were reported as having diabetes compared with 105,777 in 2001. In 2006 the prevalence of reported diabetes varied from 3.5 to 4.4% in different NHS board areas, reflecting variation in completeness of local registers as well as different demographic patterns. The completeness of recording of many clinical parameters has also increased. (2002 data n = 103,755: diagnosis date 77%, HbA(1c), blood pressure and cholesterol within 15 months 71, 67 and 60%, respectively, increasing to 98, 87, 89 and 85% by 2006, n = 196,801.) A national information management and technology solution (Scottish Collaborative Information-Diabetes Care), involving automatic daily collection of data from routinely used systems both in primary and secondary care, is now used to co-ordinate the collection of data in all NHS board areas. CONCLUSIONS We have used routine data to estimate the prevalence of reported diabetes in Scotland, UK. This iterative approach to quality improvement has taken 6 years to achieve a baseline measure of care. There is potential to analyse these data further for a better understanding of the epidemiology of diabetes in Scotland. The national diabetes information technology system will contribute to this process.
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Affiliation(s)
- J A McKnight
- University of Edinburgh, Western General Hospital, Edinburgh, UK.
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Simpson CR, Anandan C, Fischbacher C, Lefevre K, Sheikh A. Will Systematized Nomenclature of Medicine-Clinical Terms improve our understanding of the disease burden posed by allergic disorders? Clin Exp Allergy 2007; 37:1586-93. [PMID: 17883425 DOI: 10.1111/j.1365-2222.2007.02830.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Analysis of data collected through the use of high-quality computerized systems is vital if we are to understand the health burden from allergic disease. Coding systems currently used, such as the World Health Organization's International Classification of Diseases and the Read system, have however been criticized as being unduly restrictive and hence inadequate for the detailed coding of allergic problems. Greater granularity of coding can be achieved by using the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) system, which will be adopted by several countries including the United States and United Kingdom. Before the introduction of SNOMED-CT, it is important that several issues are resolved, including ensuring that adequate mapping occurs from existing systems, that the SNOMED-CT is trialled before general implementation, and that training is provided for users new to coding as part of their clinical practice. Of particular importance is that the allergy fraternity bring to light any gaps in allergy coding through the creation of a working group to advise the newly formed International Healthcare Terminology Standards Development Organisation. There is also a role for allergy experts, working in conjunction with government agencies and professional bodies, to determine a recommended set of codes, which will obviate some of the inevitable challenges raised by a very fluid coding structure for those wishing to undertake secondary analysis of health care datasets.
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Affiliation(s)
- C R Simpson
- Department of General Practice and Primary Care, Primary Care Clinical Informatics Unit, The University of Aberdeen, Scotland, UK
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Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R. Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003. J Public Health (Oxf) 2007; 29:191-8. [PMID: 17456532 DOI: 10.1093/pubmed/fdm010] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Differences in mortality by country of birth in England and Wales in people under 70 years of age have been demonstrated previously. Changes in age distribution of migrants and in migration patterns have occurred subsequently. METHODS All-cause and circulatory disease mortality for people aged 20 years and over in England and Wales by country of birth were examined using population data from the 2001 Census and mortality data for 2001-2003. Indirect standardization was used to estimate sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) in comparison to mortality for England and Wales as a whole. RESULTS SMRs for all-cause mortality were statistically significantly higher than the national average for people born in Ireland, Scotland, East Africa and West Africa and lower for people born in China and Hong Kong. SMRs for circulatory disease were highest among people born in Bangladesh and lowest among people born in China and Hong Kong. Patterns of ischaemic heart disease and cerebrovascular disease mortality differed by country of birth. CONCLUSIONS Mortality, particularly due to ischaemic heart disease and stroke, differs markedly by country of birth in all age groups including the > or =70-year-old group.
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Affiliation(s)
- S H Wild
- Public Health Sciences, University of Edinburgh, Teviot Place EH8 9AG, UK.
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Anandan C, Simpson CR, Fischbacher C, Sheikh A. Exploiting the potential of routine data to better understand the disease burden posed by allergic disorders. Clin Exp Allergy 2007; 36:866-71. [PMID: 16839400 DOI: 10.1111/j.1365-2222.2006.02520.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Department of Health and Scottish Executive are currently undertaking independent reviews of allergy services in England (and Wales) and Scotland. Each review will assess the disease burden posed by allergic problems, involving secondary analyses of routine National Health Service (NHS) datasets. Major suggestions for re-structuring and/or re-focusing the NHS efforts to better deal with allergic disease are anticipated. The UK has some of the best datasets of routine health data in the world, but despite their strengths, they have important limitations. These include gaps in data collection, particularly in relation to monitoring of Accident & Emergency and out-patient consultations, and in-patient prescribing, thereby resulting in considerable under-estimates of hospital workload. The current gaps in service monitoring are likely to under-estimate the burden and workload associated with allergic problems, particularly in secondary care. One major limitation of existing data sources is the general inability to link individual patient level data between different datasets. By unlocking this potential there are very considerable potential gains to be made. Data linkage techniques currently being developed in the UK offer exciting new possibilities of looking across the primary-, secondary- and tertiary-care interfaces and also assessing short-and long-term social and educational outcomes in relation to allergic disorders. The current reviews of allergy services being undertaken need to be cognisant of these inherent limitations of existing data sources and would do well to recommend strategic initiatives that could enhance the availability, accessibility and quality of these datasets. Ideally, this should include investment in central data repositories staffed by teams with the necessary technical and statistical expertise, which would also take responsibility for progressing data linkage capabilities.
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Affiliation(s)
- C Anandan
- Division of Community Health Sciences: General Practice Section, University of Edinburgh, Edinburgh, UK.
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Oldroyd JC, Yallop J, Fischbacher C, Bhopal R, Chamley J, Ayis S, Alberti KGMM, Unwin NC. Transient and persistent impaired glucose tolerance and progression to diabetes in South Asians and Europeans: new, large studies are a priority. Diabet Med 2007; 24:98-9. [PMID: 17227332 DOI: 10.1111/j.1464-5491.2007.02007.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wild SH, Fischbacher CM, Brock A, Griffiths C, Bhopal R. Erratum: Mortality from all cancers and lung, colorectal, breast and prostate cancer by country of birth in England and Wales, 2001–2003. Br J Cancer 2006. [PMCID: PMC2360656 DOI: 10.1038/sj.bjc.6603263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Brindle P, May M, Gill P, Cappuccio F, D'Agostino R, Fischbacher C, Ebrahim S. Primary prevention of cardiovascular disease: a web-based risk score for seven British black and minority ethnic groups. Heart 2006; 92:1595-602. [PMID: 16762981 PMCID: PMC1861244 DOI: 10.1136/hrt.2006.092346] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To recalibrate an existing Framingham risk score to produce a web-based tool for estimating the 10-year risk of coronary heart disease (CHD) and cardiovascular disease (CVD) in seven British black and minority ethnic groups. DESIGN Risk prediction models were recalibrated against survey data on ethnic group risk factors and disease prevalence compared with the general population. Ethnic- and sex-specific 10-year risks of CHD and CVD, at the means of the risk factors for each ethnic group, were calculated from the product of the incidence rate in the general population and the prevalence ratios for each ethnic group. SETTING Two community-based surveys. PARTICIPANTS 3778 men and 4544 women, aged 35-54, from the Health Surveys for England 1998 and 1999 and the Wandsworth Heart and Stroke Study. MAIN OUTCOME MEASURES 10-year risk of CHD and CVD. RESULTS 10-year risk of CHD and CVD for non-smoking people aged 50 years with a systolic blood pressure of 130 mm Hg and a total cholesterol to high density lipoprotein cholesterol ratio of 4.2 was highest in men for those of Pakistani and Bangladeshi origin (CVD risk 12.6% and 12.8%, respectively). CHD risk in men with the same risk factor values was lowest in Caribbeans (2.8%) and CVD risk was lowest in Chinese (5.4%). Women of Pakistani origin were at highest risk and Chinese women at lowest risk for both outcomes with CVD risks of 6.6% and 1.2%, respectively. A web-based risk calculator (ETHRISK) allows 10-year risks to be estimated in routine primary care settings for relevant risk factor and ethnic group combinations. CONCLUSIONS In the absence of cohort studies in the UK that include significant numbers of black and minority ethnic groups, this risk score provides a pragmatic solution to including people from diverse ethnic backgrounds in the primary prevention of CVD.
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Affiliation(s)
- P Brindle
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
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Wild SH, Fischbacher CM, Brock A, Griffiths C, Bhopal R. Mortality from all cancers and lung, colorectal, breast and prostate cancer by country of birth in England and Wales, 2001-2003. Br J Cancer 2006; 94:1079-85. [PMID: 16523198 PMCID: PMC2361230 DOI: 10.1038/sj.bjc.6603031] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 02/01/2006] [Accepted: 02/06/2006] [Indexed: 11/08/2022] Open
Abstract
Mortality from all cancers combined and major cancers among men and women aged 20 years and over was compared by country of birth with that of the whole of England and Wales as the reference group. Population data from the 2001 Census and mortality data for 2001-2003 were used to estimate standardised mortality ratios. Data on approximately 399 000 cancer deaths were available, with at least 400 cancer deaths in each of the smaller populations. Statistically significant differences from the reference group included: higher mortality from all cancers combined, lung and colorectal cancer among people born in Scotland and Ireland, lower mortality for all cancers combined, lung, breast and prostate cancer among people born in Bangladesh (except for lung cancer in men), India, Pakistan or China/Hong Kong, lower lung cancer mortality among people born in West Africa or the West Indies, higher breast cancer mortality among women born in West Africa and higher prostate cancer mortality among men born in West Africa or the West Indies. These data may be relevant to causal hypotheses and in relation to health care and cancer prevention.
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Affiliation(s)
- S H Wild
- Public Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, Scotland.
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Abstract
BACKGROUND Moderate physical activity is protective against coronary heart disease (CHD) and diabetes, both important public health problems among UK South Asian (Indian, Pakistani and Bangladeshi) ethnic groups. We assessed the evidence that physical activity is lower in South Asian groups than in the general population. METHODS We carried out a systematic literature review of studies describing levels of physical activity and fitness in UK South Asians using MEDLINE, EMBASE, the Cochrane databases, hand searching of relevant journals and review of reference lists. RESULTS We identified 12 studies in adults and five in children. Various methods were used to assess physical activity and fitness, but all the studies reported lower levels among South Asian groups. The differences were substantial, particularly among women and older people. For example, the Health Survey for England found that Indian, Pakistani and Bangladeshi men were 14, 30 and 45 per cent less likely than the general population to meet current guidelines for physical activity. Limited information was provided about translation and adaptation of questionnaires. CONCLUSION Levels of physical activity were lower in all South Asian groups than the general population and patterns of activity differed. No studies used validated measures. Insufficient attention has been paid to issues of cross-cultural equivalence. With these caveats, low levels of physical activity among UK South Asian ethnic groups may contribute to their increased risk of diabetes and CHD. Closer attention to validity, translation and adaptation is necessary to monitor changes and assess the effectiveness of interventions to increase physical activity.
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Affiliation(s)
- C M Fischbacher
- Public Health Sciences, University of Edinburgh, Edinburgh EH8 9AG.
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Fischbacher CM, Blackwell CC, Bhopal R, Ingram R, Unwin NC, White M. Serological evidence of Helicobacter pylori infection in UK South Asian and European populations: implications for gastric cancer and coronary heart disease. J Infect 2004; 48:168-74. [PMID: 14720493 DOI: 10.1016/s0163-4453(03)00127-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To describe the prevalence of serological evidence of infection with Helicobacter pylori among people of South Asian and European ethnic origins and to assess its association with prevalent coronary heart disease (CHD). METHODS We used a quantitative method to compare IgG antibodies to H. pylori in a population sample of 300 South Asians and 302 Europeans in Newcastle upon Tyne, UK. RESULTS For men and women, respectively, H. pylori IgG (95% confidence interval) was 16.7 microg/ml (13.9, 20.2) and 11.3 (9.4, 13.5) among Europeans and 11.6 (9.8, 13.7) and 14.3 (12.1, 16.9) among South Asians. Levels were higher in older participants and in those of lower socioeconomic status. The ratio of geometric mean IgG, (95% confidence interval) adjusted for age, sex and socioeconomic status, in those with and without CHD was 1.02 (0.49, 2.11) among Europeans and 1.79 (1.01, 3.17) among South Asians. Antibodies against staphylococcal enterotoxins A and B were higher among South Asians than Europeans. CONCLUSIONS The prevalence of H. pylori infection among UK South Asians does not reflect that of their countries of origin, nor their lower prevalence of gastric cancer. The association with CHD in South Asians requires corroboration in other studies.
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Affiliation(s)
- C M Fischbacher
- Department of Public Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK.
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Hayes L, White M, Unwin N, Bhopal R, Fischbacher C. Reply. J Public Health (Oxf) 2003. [DOI: 10.1093/pubmed/fdg074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fischbacher CM, Bhopal R, Blackwell CC, Ingram R, Unwin NC, White M, Alberti KGMM. IgG is higher in South Asians than Europeans: does infection contribute to ethnic variation in cardiovascular disease? Arterioscler Thromb Vasc Biol 2003; 23:703-4. [PMID: 12692011 DOI: 10.1161/01.atv.0000060449.70345.8e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fischbacher CM, Bhopal R, Rutter MK, Unwin NC, Marshall SM, White M, Alberti KGMM. Microalbuminuria is more frequent in South Asian than in European origin populations: a comparative study in Newcastle, UK. Diabet Med 2003; 20:31-6. [PMID: 12519317 DOI: 10.1046/j.1464-5491.2003.00822.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS We aimed to compare levels of urinary albumin excretion and the prevalence of microalbuminuria in UK South Asians and Europeans. Microalbuminuria predicts cardiovascular disease in European origin populations, but evidence from the general population of South Asians is lacking. Coronary heart disease (CHD) mortality is 40-50% higher in UK South Asians compared with the whole population, for reasons that are incompletely understood. METHODS Microalbuminuria was measured using the albumin-creatinine ratio in an age- and sex-stratified random sample of 1509 adults from European (n = 825), Indian (n = 259), Pakistani (n = 305) and Bangladeshi (n = 120) ethnic groups. RESULTS Levels of urinary albumin excretion were substantially higher in South Asians (geometric mean albumin creatinine ratio (95% confidence interval) 0.83 (0.75, 0.91)) than in Europeans (0.55 (0.51, 0.60)). Microalbuminuria was associated with older age, hypertension and diabetes, but independently of these risk factors urinary albumin excretion was higher in South Asians than Europeans. CONCLUSIONS Urinary albumin excretion is higher and microalbuminuria more frequent in UK South Asians compared with the majority ethnic population. Microalbuminuria may be relevant to the causal pathways leading to the excess of cardiovascular mortality and possibly renal failure in UK South Asians.
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Affiliation(s)
- C M Fischbacher
- Department of Epidemiology and Public Health, The Medical School, University of Newcastle-upon-Tyne, Newcastle, UK.
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