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Strafford H, Lacey AS, Hollinghurst J, Akbari A, Watkins A, Paterson J, Jennings D, Lyons RA, Powell HR, Kerr MP, Chin RW, Pickrell WO. COVID-19 vaccination uptake in people with epilepsy in wales. Seizure 2023; 108:49-52. [PMID: 37080124 PMCID: PMC10076248 DOI: 10.1016/j.seizure.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE People with epilepsy (PWE) are at increased risk of severe COVID-19. Assessing COVID-19 vaccine uptake is therefore important. We compared COVID-19 vaccination uptake for PWE in Wales with a matched control cohort. METHODS We performed a retrospective, population, cohort study using linked, anonymised, Welsh electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank (Welsh population=3.1 million).We identified PWE in Wales between 1st March 2020 and 31st December 2021 and created a control cohort using exact 5:1 matching (sex, age and socioeconomic status). We recorded 1st, 2nd and booster COVID-19 vaccinations. RESULTS There were 25,404 adults with epilepsy (127,020 controls). 23,454 (92.3%) had a first vaccination, 22,826 (89.9%) a second, and 17,797 (70.1%) a booster. Comparative figures for controls were: 112,334 (87.8%), 109,057 (85.2%) and 79,980 (62.4%).PWE had higher vaccination rates in all age, sex and socioeconomic subgroups apart from booster uptake in older subgroups. Vaccination rates were higher in older subgroups, women and less deprived areas for both cohorts. People with intellectual disability and epilepsy had higher vaccination rates when compared with controls with intellectual disability. CONCLUSIONS COVID-19 vaccination uptake for PWE in Wales was higher than that for a matched control group.
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Affiliation(s)
- H Strafford
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK.
| | - A S Lacey
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - J Hollinghurst
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - A Akbari
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - A Watkins
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - J Paterson
- Epilepsy Action, New Anstey House, Gate Way Drive, Yeadon, Leeds, England, UK
| | - D Jennings
- Epilepsy Action, New Anstey House, Gate Way Drive, Yeadon, Leeds, England, UK
| | - R A Lyons
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - H R Powell
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK; Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales, UK
| | - M P Kerr
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, Wales, UK
| | - R W Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and Department of Child Life and Health, The University of Edinburgh, Scotland, UK; Royal Hospital for Children and Young People, Edinburgh, Scotland, UK
| | - W O Pickrell
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK; Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales, UK
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Emmerson C, Hollinghurst J, North L, Fry R, Akbari A, Humphreys C, Gravenor MB, Lyons RA. The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence. Age Ageing 2022; 51:afac250. [PMID: 36469089 PMCID: PMC9721242 DOI: 10.1093/ageing/afac250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND dementia may increase care home residents' risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors. METHODS we created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 31 December 2020. Risk factors were analysed using multi-level logistic regression to model the likelihood of SARS-CoV-2 infection and mortality. RESULTS the cohort included 9,571 individuals in 673 homes. Dementia was diagnosed in 5,647 individuals (59%); 1,488 (15.5%) individuals tested positive for SARS-CoV-2. We estimated the effects of age, dementia, frailty, care home size, proportion of residents with dementia, nursing and dementia services, communal space and region. The final model included the proportion of residents with dementia (OR for positive test 4.54 (95% CIs 1.55-13.27) where 75% of residents had dementia compared to no residents with dementia) and frailty (OR 1.29 (95% CIs 1.05-1.59) for severe frailty compared with no frailty). Analysis suggested 76% of the variation was due to setting rather than individual factors. Additional analysis suggested severe frailty and proportion of residents with dementia was associated with all-cause mortality, as was dementia diagnosis. Mortality analyses were challenging to interpret. DISCUSSION whilst individual frailty increased the risk of COVID-19 infection, dementia was a risk factor at care home but not individual level. These findings suggest whole-setting interventions, particularly in homes with high proportions of residents with dementia and including those with low/no individual risk factors may reduce the impact of COVID-19.
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Affiliation(s)
| | - Joseph Hollinghurst
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - Laura North
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - Richard Fry
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - Ashley Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | | | - Mike B Gravenor
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
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Ritchie L, Harrison SL, Penson PE, Akbari A, Torabi F, Hollinghurst J, Harris D, Oke OB, Akpan A, Halcox JP, Rodgers SE, Lip GYH, Lane DA. Factors associated with prescription of oral anticoagulation for atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prescription of oral anticoagulants (OAC) is paramount for stroke prevention in people with atrial fibrillation (AF), but treatment decisions in older care home residents are complicated by frailty, multi-morbidity and heightened stroke and bleeding risk. There is a paucity of data on factors influencing the decision to prescribe OAC in this high-risk population who are under-represented in research studies.
Purpose
To explore the factors associated with OAC prescription for care home residents aged ≥65 years with AF.
Methods
Nationwide retrospective cohort study of people aged ≥65 years entering a care home in Wales between 1 January 2003 and 31 December 2018, using anonymised individual-level electronic health record and administrative data sources available within the Secure Anonymised Information Linkage Databank. Unadjusted and adjusted logistic regression models were used to explore the association between resident characteristics and OAC prescription or non-prescription.
Results
Between 2003 and 2018, 14,493 people with AF aged ≥65 years became new residents in care homes in Wales and 7,057 (48.7%) were prescribed OAC (32.7% in 2003 compared to 72.7% in 2018), Figure 1. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per one year age increase [95% confidence interval, 0.95 to 0.96] and aOR 0.91 [0.84 to 0.98], respectively). Conversely, prior venous thromboembolism (aOR 4.06 [3.17 to 5.20]), advancing frailty (mild: aOR 4.61 [3.95 to 5.38]; moderate: aOR 6.69 [5.74 to 7.80]; severe: aOR 8.42 [7.16 to 9.90]) and year of care home entry in the post-non-vitamin K antagonist oral anticoagulant (NOAC) era from 2011 onwards (aOR 1.91 [1.76 to 2.06]) were associated with higher odds of OAC prescription, Figure 2.
Conclusions
The proportion of care home residents prescribed OAC therapy has increased over time with the introduction of NOACs in 2011, but OAC prescription rates are still sub-optimal. Although there is an expected rise in OAC prescribing for increasingly frail people, further work is needed to investigate the interaction with deprivation and other socio-economic and demographic factors to assess potential inequalities in prescribing across these groups. Targeted educational tools for clinicians are needed to address barriers to OAC prescription for AF, such as older age and separate indications for antiplatelet therapy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Ritchie
- University of Liverpool , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool , Liverpool , United Kingdom
| | - P E Penson
- Liverpool John Moores University , Liverpool , United Kingdom
| | - A Akbari
- Swansea University , Swansea , United Kingdom
| | - F Torabi
- Swansea University , Swansea , United Kingdom
| | | | - D Harris
- Swansea University , Swansea , United Kingdom
| | - O B Oke
- University of Liverpool , Liverpool , United Kingdom
| | - A Akpan
- University of Liverpool , Liverpool , United Kingdom
| | - J P Halcox
- Swansea University , Swansea , United Kingdom
| | - S E Rodgers
- University of Liverpool , Liverpool , United Kingdom
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool , Liverpool , United Kingdom
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Ritchie LA, Harrison SL, Penson PE, Akbari A, Torabi F, Hollinghurst J, Harris D, Oke OB, Akpan A, Halcox JP, Rodgers SE, Lip GYH, Lane DA. Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Older care home residents are a high-risk group of people with atrial fibrillation (AF) who are under-represented in clinical trials. Improved understanding of AF epidemiology and management in this population is paramount for health and social care organisations to strategically plan services.
Purpose
To determine the trends in AF prevalence and compare adverse health outcomes in older care home residents aged ≥65 years with AF compared to those without AF.
Methods
Retrospective cohort study of people entering a care home between 2003–2018 using nationwide, population-scale anonymised health and administrative data, provisioned from the Secure Anonymised Information Linkage (1 January 2000–31st December 2018). Direct standardisation was used to calculate AF prevalence by year of care entry (2010–2018). Cox regression analyses were used to estimate the risk of adverse health outcomes.
Results
Between 2003 and 2018, 86,602 people aged ≥65 years became new residents in care homes in Wales. Residents with AF (n=14,493) had a significantly higher risk (adjusted hazard ratio [aHR], 95% confidence interval [CI]) of cardiovascular (aHR 1.27 [1.17 to 1.37], p<0.001) and all-cause mortality (aHR 1.14 [1.11 to 1.17], p<0.001), Figure 1. The risk (sub-distribution hazard ratio [sHR], 95% CI) of ischaemic stroke (adjusted sHR 1.55 [1.36 to 1.76], p<0.001) and cardiovascular hospitalisation (adjusted sHR 1.28 [1.22 to 1.34], p<0.001) was also higher in residents with AF, even when mortality was considered a competing event, Figure 1. There was no significant change in age- and sex-standardised prevalence of AF between 2010 and 2018, 16.79% (95% CI 15.85 to 17.94) and 17.02% (95% CI 16.05 to 17.98), respectively (absolute change 2010–2018: 0.06% [95% CI: −1.38 to 1.50], p=0.93), Figure 2.
Conclusions
This study demonstrates unique data on the epidemiology of AF and associated outcomes in older care home residents. Whilst the prevalence of AF remained stable between 2010–2018, residents with AF had significantly higher risk of adverse health events. Treatment of AF in accordance with guidelines is critical in this population to optimise management and reduce adverse health outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L A Ritchie
- University of Liverpool , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool , Liverpool , United Kingdom
| | - P E Penson
- Liverpool John Moores University , Liverpool , United Kingdom
| | - A Akbari
- Swansea University , Swansea , United Kingdom
| | - F Torabi
- Swansea University , Swansea , United Kingdom
| | | | - D Harris
- Swansea University , Swansea , United Kingdom
| | - O B Oke
- University of Liverpool , Liverpool , United Kingdom
| | - A Akpan
- University of Liverpool , Liverpool , United Kingdom
| | - J P Halcox
- Swansea University , Swansea , United Kingdom
| | - S E Rodgers
- University of Liverpool , Liverpool , United Kingdom
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool , Liverpool , United Kingdom
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Daniels H, Lacey AS, Akbari A, Fonferko-Shadrach B, Hollinghurst J, Rees MI, Sawhney IMS, Powell HR, Kerr MP, Owen Pickrell W. 146 Epilepsy, deprivation and mortality in Wales 2005–2017. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPublic Health England have recently reported that deaths associated with epilepsy are increasing and are associated with increased deprivation. We investigated comparable Welsh mortality trends and associations between epilepsy mortality and deprivation.MethodWe used routinely-collected health data within the Secure Anonymised Information Linkage (SAIL) Databank. We recorded deaths associated with epilepsy (DAE), epilepsy recorded on death certificates, and deaths in people with epilepsy (DPWE), people with diagnoses of epilepsy and epilepsy prescriptions before death. We compared death rates in different deprivation deciles adjusting for epilepsy prevalence.ResultsDuring 2005–2017 (41million patient-years) there were 2116 DAE and 7821 DPWE. DAE and DPWE increased from 4.3/100,000/yr and 17.2/100,000/yr in 2005–2007 to 5.7/100,000/yr and 20.9/100,000/yr in 2015–2017. The age-standardised mortality rates (ASMR) in 2006–2008 for DAE and DPWE were 5.3/100,000/yr and 20/100,000/yr respectively, in 2015–2017 they were 5.8/100,000/yr and 20/100,000/yr. DAE were not significantly associated with deprivation when adjusted for epilepsy prevalence.ConclusionWhen adjusting for age, deaths associated wtih epilepsy and deaths in people with epilepsy did not increase significantly in Wales between 2005–2007 and 2015–2017. The association between dep- rivation and deaths associated with epilepsy appears to be explained by higher epilepsy prevalence in areas of higher deprivation.w.o.pickrell@swansea.ac.uk
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Pugh RJ, Bailey R, Szakmany T, Al Sallakh M, Hollinghurst J, Akbari A, Griffiths R, Battle C, Thorpe C, Subbe CP, Lyons RA. Long-term trends in critical care admissions in Wales. Anaesthesia 2021; 76:1316-1325. [PMID: 33934335 PMCID: PMC10138728 DOI: 10.1111/anae.15466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
As national populations age, demands on critical care services are expected to increase. In many healthcare settings, longitudinal trends indicate rising numbers and proportions of patients admitted to ICU who are older; elsewhere, including some parts of the UK, a decrease has raised concerns with regard to rationing according to age. Our aim was to investigate admission trends in Wales, where critical care capacity has not risen in the last decade. We used the Secure Anonymised Information Linkage Databank to identify and characterise critical care admissions in patients aged ≥ 18 years from 1 January 2008 to 31 December 2017. We categorised 85,629 ICU admissions as youngest (18-64 years), older (65-79 years) and oldest (≥ 80 years). The oldest group accounted for 15% of admissions, the older age group 39% and the youngest group 46%. Relative to the national population, the incidence of admission rates per 10,000 population in the oldest group decreased significantly over the study period from 91.5/10,000 in 2008 to 77.5/10,000 (a relative decrease of 15%), and among the older group from 89.2/10,000 in 2008 to 75.3/10,000 in 2017 (a relative decrease of 16%). We observed significant decreases in admissions with high comorbidity (modified Charlson comorbidity index); increases in the proportion of older patients admitted who were considered 'fit' rather than frail (electronic frailty index); and decreases in admissions with a medical diagnosis. In contrast to other healthcare settings, capacity constraints and surgical imperatives appear to have contributed to a relative exclusion of older patients presenting with acute medical illness.
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Affiliation(s)
- R J Pugh
- Department of Anaesthetics, Glan Clwyd Hospital, Bodelwyddan, UK
| | - R Bailey
- Public Health Medicine, Swansea University, Swansea, UK
| | - T Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - M Al Sallakh
- Public Health Medicine, Swansea University, Swansea, UK
| | | | - A Akbari
- Public Health Medicine, Swansea University, Swansea, UK
| | - R Griffiths
- Public Health Medicine, Swansea University, Swansea, UK
| | - C Battle
- Ed Major Critical Care Unit, Morriston Hospital, Swansea, UK
| | - C Thorpe
- Department of Anaesthetics, Ysbyty Gwynedd, Bangor, UK
| | - C P Subbe
- Acute and Critical Care Medicine, School of Medical Sciences, Bangor University, Bangor, UK
| | - R A Lyons
- Public Health Medicine, Swansea University, Swansea, UK
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Lyons J, Akbari A, Torabi F, Davies GI, North L, Griffiths R, Bailey R, Hollinghurst J, Fry R, Turner SL, Thompson D, Rafferty J, Mizen A, Orton C, Thompson S, Au-Yeung L, Cross L, Gravenor MB, Brophy S, Lucini B, John A, Szakmany T, Davies J, Davies C, Thomas DR, Williams C, Emmerson C, Cottrell S, Connor TR, Taylor C, Pugh RJ, Diggle P, John G, Scourfield S, Hunt J, Cunningham AM, Helliwell K, Lyons R. Understanding and responding to COVID-19 in Wales: protocol for a privacy-protecting data platform for enhanced epidemiology and evaluation of interventions. BMJ Open 2020; 10:e043010. [PMID: 33087383 PMCID: PMC7580065 DOI: 10.1136/bmjopen-2020-043010] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The emergence of the novel respiratory SARS-CoV-2 and subsequent COVID-19 pandemic have required rapid assimilation of population-level data to understand and control the spread of infection in the general and vulnerable populations. Rapid analyses are needed to inform policy development and target interventions to at-risk groups to prevent serious health outcomes. We aim to provide an accessible research platform to determine demographic, socioeconomic and clinical risk factors for infection, morbidity and mortality of COVID-19, to measure the impact of COVID-19 on healthcare utilisation and long-term health, and to enable the evaluation of natural experiments of policy interventions. METHODS AND ANALYSIS Two privacy-protecting population-level cohorts have been created and derived from multisourced demographic and healthcare data. The C20 cohort consists of 3.2 million people in Wales on the 1 January 2020 with follow-up until 31 May 2020. The complete cohort dataset will be updated monthly with some individual datasets available daily. The C16 cohort consists of 3 million people in Wales on the 1 January 2016 with follow-up to 31 December 2019. C16 is designed as a counterfactual cohort to provide contextual comparative population data on disease, health service utilisation and mortality. Study outcomes will: (a) characterise the epidemiology of COVID-19, (b) assess socioeconomic and demographic influences on infection and outcomes, (c) measure the impact of COVID-19 on short -term and longer-term population outcomes and (d) undertake studies on the transmission and spatial spread of infection. ETHICS AND DISSEMINATION The Secure Anonymised Information Linkage-independent Information Governance Review Panel has approved this study. The study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.
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Affiliation(s)
- Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Gareth I Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Laura North
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Samantha L Turner
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Daniel Thompson
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - James Rafferty
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Amy Mizen
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Chris Orton
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Simon Thompson
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Lee Au-Yeung
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Lynsey Cross
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Mike B Gravenor
- Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Sinead Brophy
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Biagio Lucini
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Tamas Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
- Aneurin Bevan University Health Board, Newport, UK
| | | | | | | | | | | | | | - Thomas R Connor
- School of Biosciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Chris Taylor
- School of Social Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Richard J Pugh
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - Peter Diggle
- Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
- Epidemiology and Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Gareth John
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | | | - Joe Hunt
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | | | | | - Ronan Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
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