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Harron K, Cavallaro F, van der Meulen J, Kennedy E, Gilbert R. Effects of the Family Nurse Partnership on all eligible mothers: a data linkage cohort study in England. PLoS One 2025; 20:e0320810. [PMID: 40179042 PMCID: PMC11967931 DOI: 10.1371/journal.pone.0320810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 02/24/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND An intensive programme of home visiting, the Family Nurse Partnership (FNP), is received by around one in four first-time adolescent mothers in selected areas in England. During home visits, nurses support mothers to make choices about healthy pregnancies, improving child development, and fulfilling their own aspirations and ambitions. Evidence is needed of the wider effects of the FNP, including for mothers not enrolled in the programme (who might experience unintended effects). We evaluated child and maternal outcomes for all eligible mothers giving birth before, during, and after the period in which FNP was active in local areas. METHODS We created a linked cohort of 237,185 eligible mothers, aged 13-19, who gave birth between April 2010 and March 2019, and who had a first antenatal booking appointment (or a date of 28 completed weeks of gestation, if missing) when FNP was active in their area. We used administrative hospital data to identify unplanned maternal/child hospitalisations up to 2 years after birth for children born and mothers delivering before, during and after FNP was active. Generalised linear models were used to adjust for background regional time trends, maternal characteristics, and clustering of outcomes within residential areas. RESULTS We found no evidence of differences in unplanned hospital admissions for children born during the FNP period (36.9% versus 36.0%, relative risk [RR] 1.01; 95% CI 0.99-1.02), or after FNP was active (37.1%, RR 1.0; 95% CI 0.95-1.06), compared with those born before FNP was active. There was no evidence of differences in child admissions for maltreatment/injury-related diagnoses or for maternal admissions for adversity-related diagnoses. CONCLUSION Child and maternal outcomes were similar before, during and after FNP active periods, suggesting that the FNP did not have a wider impact on outcomes in all eligible mothers, including those not participating in the FNP.
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Affiliation(s)
| | | | | | - Eilis Kennedy
- The Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom,
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Martins T, Down L, Samuels A, Lavu D, Hamilton W, Abel G, Neal RD. Understanding ethnic inequalities in cancer diagnostic intervals: a cohort study of patients presenting suspected cancer symptoms to GPs in England. Br J Gen Pract 2025:BJGP.2024.0518. [PMID: 39689922 PMCID: PMC11966531 DOI: 10.3399/bjgp.2024.0518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 12/09/2024] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND UK Asian and Black patients experience longer cancer diagnostic intervals - the period between initial symptomatic presentation in primary care and cancer diagnosis. AIM To determine whether the differences in diagnostic intervals are because of prolonged primary care, referral, or secondary care interval. DESIGN AND SETTING A cohort study was undertaken of 70 971 patients with seven cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, ovarian) diagnosed after symptom presentation in English primary care. METHOD Data on symptom presentation and diagnosis were extracted from cancer registry-linked primary care and secondary care data. Primary interval was defined as the period between first primary care presentation and secondary care referral, referral interval as the period between referral and first secondary care appointment, and secondary care interval as the period between the first secondary care appointment and diagnosis. Accelerated failure time models were used to investigate ethnic differences across all four intervals. RESULTS Across all sites, the median diagnostic interval was 46 days, ranging from 13 days for breast cancer to 116 days for lung cancer. It was 14% longer for Black patients (adjusted time ratio [ATR] 1.14, 95% confidence interval [CI] = 1.05 to 1.25) and 13% longer for Asian patients (ATR 1.13, 95% CI = 1.03 to 1.23) compared with White patients. Site-specific analyses showed that, for myeloma, lung, prostate, and colorectal cancer, the secondary care interval was longer in Asian and Black patients, who also had a longer primary care interval in breast and colorectal cancer. There was little evidence of ethnic differences in referral interval. CONCLUSION This study found evidence of ethnic differences in diagnostic intervals, with prolonged secondary care intervals for four common cancers and prolonged primary care intervals for two. Although these differences are relatively modest, they are unjustified and may indicate shortcomings in healthcare delivery that disproportionately affect ethnic minorities.
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Affiliation(s)
- Tanimola Martins
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter
| | - Liz Down
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter
| | - Alfred Samuels
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) Southwest Peninsula (PenARC), University of Exeter, Exeter
| | - Deepthi Lavu
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter
| | - William Hamilton
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter
| | - Gary Abel
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) Southwest Peninsula (PenARC), University of Exeter, Exeter
| | - Richard D Neal
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter
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Li Y, Kurinczuk JJ, Alderdice F, Quigley MA, Rivero-Arias O, Sanders J, Kenyon S, Siassakos D, Parekh N, De Almeida S, Carson C. Pre-pregnancy care in general practice in England: cross-sectional observational study using administrative routine health data. BMC Public Health 2025; 25:1101. [PMID: 40121446 PMCID: PMC11929985 DOI: 10.1186/s12889-025-21728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 01/31/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Optimising women's pre-pregnancy health is a policy priority for benefits spanning pregnancy and throughout the mother and baby's life. In the UK pre-pregnancy care (PPC) tends to be delivered in primary care, with the onus on women to seek services. We aimed to describe women's engagement with General Practice (GP) in the year preceding pregnancy, including specific PPC; to explore whether women with recognised risk factors for poor pregnancy outcomes receive targeted care. METHODS Data for women aged 18-48yrs and registered for ≥ 12 months with a GP on 01/01/2017, were drawn from English Clinical Practice Research Datalink (CPRD) GOLD, a source of electronic health record data. Demographic characteristics, lifestyle factors and health conditions were described. CPRD Pregnancy Register and linked hospital data were used to identify pregnancies in 2017/18 and to describe PPC in the year preceding pregnancy. RESULTS Of 193,578 women included, 14,326 had a confirmed pregnancy. 7.6% of the pregnant women had records indicating specific PPC in the preceding year, whilst 41.0% had records of health promotion (advice on nutrition, smoking, weight, alcohol and contraception). More women with pre-existing medical conditions received health promotion (46.0%-83.9% for various risk groups), although the levels of PPC remained low (4.7%-14.9%). CONCLUSIONS PPC was rarely recorded, likely reflecting low levels of consultation for, or discussion of, pregnancy planning. This represents a missed opportunity for maximising women's health, particularly in those with recognised risk factors for poor pregnancy, perinatal and longer-term outcomes.
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Affiliation(s)
- Yangmei Li
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Jennifer J Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Oliver Rivero-Arias
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dimitrios Siassakos
- EGA Institute for Women's Health, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Nikesh Parekh
- Public Health and Wellbeing, Royal Borough of Greenwich, London, UK
| | | | - Claire Carson
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Macaulay L, Saxton J, Ford T, Logan S, Harron K, Gilbert R, Zylbersztejn A. Health and education outcomes from adolescence to adulthood for young people with neurodisability and their peers: protocol for a population-based cohort study using linked hospital and education data from England. BMJ Open 2025; 15:e100276. [PMID: 40107698 PMCID: PMC11927417 DOI: 10.1136/bmjopen-2025-100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2025] Open
Abstract
INTRODUCTION Children and young people with neurodisability (conditions affecting the brain or nervous system, creating functional impairment, eg, autism, learning disabilities, epilepsy, cerebral palsy or attention-deficit/hyperactivity disorder) have more complex health and educational needs than their peers, contributing to higher healthcare use and special educational needs (SEN) provision. To guide policy and improve services, evidence is needed on how health and education support and outcomes change with age for adolescents with and without neurodisability. METHODS AND ANALYSIS Using the Education and Child Health Insights from Linked Data (ECHILD) database, which links health and education data across England, we will follow adolescents from the start of secondary school (Year 7) into early adulthood. We will classify children with and without neurodisability recorded in hospital and education records before Year 7, compare their sociodemographic characteristics and describe trends in health and educational outcomes throughout secondary school. We will estimate rates of planned and unplanned healthcare contacts by year of age (11-22 years old), and we will examine changes in trends before, during and after transition to adult healthcare. We will also estimate the proportion of adolescents with school-recorded SEN provision and rates of school absences and exclusions by year of age (11-15 years old) for the two groups. We will explore variation in outcomes by neurodisability subgroup and sociodemographic characteristics and contextualise the findings using existing interview and survey data from children, young people and parents/carers generated in the Health Outcomes of young People throughout Education (HOPE) research programme. ETHICS AND DISSEMINATION Ethics approval for analyses of the ECHILD database has been granted previously (20/EE/0180). Findings will be shared with academics, policymakers and stakeholders, and published in open-access journals. Code and metadata will be shared in the ECHILD GitHub repository.
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Affiliation(s)
- Louise Macaulay
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jennifer Saxton
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Stuart Logan
- NIHR Applied Research Collaboration for the Southwest, University of Exeter Medical School, Exeter, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ania Zylbersztejn
- Great Ormond Street Institute of Child Health, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Allen H, Hassell K, Rawlinson C, Pullen O, Campbell C, Jödicke AM, Català M, Prats-Uribe A, Dabrera G, Prieto-Alhambra D, Campos-Matos I. Development of the ECHOES national dataset: a resource for monitoring post-acute and long-term COVID-19 health outcomes in England. Front Public Health 2025; 13:1513508. [PMID: 40145004 PMCID: PMC11936881 DOI: 10.3389/fpubh.2025.1513508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 02/12/2025] [Indexed: 03/28/2025] Open
Abstract
Introduction Electronic health records can be used to understand the diverse presentation of post-acute and long-term health outcomes following COVID-19 infection. In England, the UK Health Security Agency, in collaboration with the University of Oxford, has created the Evaluation of post-acute COVID-19 Health Outcomes (ECHOES) dataset to monitor how an initial SARS-CoV-2 infection episode is associated with changes in the risk of health outcomes that are recorded in routinely collected health data. Methods The ECHOES dataset is a national-level dataset combining national-level surveillance, administrative, and healthcare data. Entity resolution and data linkage methods are used to create a cohort of individuals who have tested positive and negative for SARS-CoV-2 in England throughout the COVID-19 pandemic, alongside information on a range of health outcomes, including diagnosed clinical conditions, mortality, and risk factor information. Results The dataset contains comprehensive COVID-19 testing data and demographic, socio-economic, and health-related information for 44 million individuals who tested for SARS-CoV-2 between March 2020 and April 2022, representing 15,720,286 individuals who tested positive and 42,351,016 individuals who tested negative. Discussion With the application of epidemiological and statistical methods, this dataset allows a range of clinical outcomes to be investigated, including pre-specified health conditions and mortality. Furthermore, understanding potential determinants of health outcomes can be gained, including pre-existing health conditions, acute disease characteristics, SARS-CoV-2 vaccination status, and genomic variants.
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Affiliation(s)
- Hester Allen
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Health Data Sciences, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Katie Hassell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Christopher Rawlinson
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Owen Pullen
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Colin Campbell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Annika M. Jödicke
- Health Data Sciences, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Martí Català
- Health Data Sciences, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Albert Prats-Uribe
- Health Data Sciences, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Gavin Dabrera
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Daniel Prieto-Alhambra
- Health Data Sciences, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- Department of Medical Informatics, Erasmus Medical Centre University, Rotterdam, Netherlands
| | - Ines Campos-Matos
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
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Almilaji O, Sharples L, Aggarwal A, Cromwell D, Horgan K, Braun M, Arnott R, Nossiter J, Kuryba A, Lewin A, Rous B, Cowling T, Meulen JVD, Walker K. Value of hospital administrative data linked to national cancer registry records to identify metastatic disease at time of primary diagnosis in colorectal cancer patients: a study using national data in England. BMC Cancer 2025; 25:407. [PMID: 40050770 PMCID: PMC11887144 DOI: 10.1186/s12885-025-13777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 02/20/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Routinely collected data are increasingly being used for cancer research and health service evaluation. For both purposes, accurately identifying metastatic disease at diagnosis is essential. We developed an approach to identify metastatic disease at time of primary diagnosis according to national hospital administrative data (HAD) in patients identified with colorectal cancer (CRC) in the English national cancer registry (CR). METHODS A national cohort of CRC patients diagnosed between 2013 and 2018 in England identified in CR data were linked to HAD. Metastatic disease was assumed to be present at diagnosis according to HAD if at least one of a set of pre-specified diagnostic ICD-10 codes appeared in a record of a hospital admission between one month before and six months after CRC diagnosis date. RESULTS Of 186,236 patients, 40,421 (21.7%) had metastatic cancer according to HAD, 42,843 (23.0%) according to CR data, 49,827 (26.8%) according to either data source, and 33,437 (18.0%) according to both. Metastatic information was missing in CR data in 14,065 patients and 1,930 of these (13.7%) had metastatic cancer according to HAD. 1-year mortality was 59.3% (95%-CI: 58.8 - 59.8%) in patients with metastatic disease and 7.4% (7.2 - 7.5%) in patients without if HAD and CR data agreed. Mortality fell between these results if HAD and CR data disagreed. High mortality was seen in patients with missing metastatic data in the CR: 74.4% (72.4 - 76.3%) in patients with metastatic disease and 45.2% (44.3-46.1%) in patients without metastatic disease according to HAD. CONCLUSIONS HAD should be linked to CR data to provide more accurate information on metastatic CRC at diagnosis including sites of metastasis. Linkage to HAD increased the number of patients identified with metastatic CRC by 14%, compared to CR data alone. Patients with metastatic disease at diagnosis in either data source had mortality outcomes expected for patients with metastatic cancer. CRC patients with missing metastasis data in CR data are likely to have metastatic disease and linkage to HAD provides important prognostic information.
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Affiliation(s)
- Orouba Almilaji
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Linda Sharples
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ajay Aggarwal
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - David Cromwell
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Kieran Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St. James's University Hospital, Leeds, UK
| | | | - Robert Arnott
- Green Templeton College, University of Oxford, Oxford, UK
| | - Julie Nossiter
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Angela Kuryba
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Alexandra Lewin
- Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Brian Rous
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Cowling
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Jan Van Der Meulen
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Kate Walker
- Department of Health Service Research & Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
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Mazzella A, Amin-Chowdhury Z, Andrews A, Charlett A, Brown CS, Hope R, Chudasama D. Health inequalities in incidence of bacteraemias: a national surveillance and data linkage study, England, 2018 to 2022. Euro Surveill 2025; 30:2400312. [PMID: 40051395 PMCID: PMC11887031 DOI: 10.2807/1560-7917.es.2025.30.9.2400312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/26/2024] [Indexed: 03/09/2025] Open
Abstract
BackgroundHealth inequalities exist globally, but limited data exist on this topic for bacteraemia.AimIn this study we investigated health inequalities surrounding bacteraemia in England, to identify high-risk population groups and areas of intervention.MethodsWe retrospectively analysed English surveillance data between 2018 and 2022 for Escherichia coli, Klebsiella species, Pseudomonas aeruginosa, and both meticillin-sensitive and resistant Staphylococcus aureus (MSSA, MRSA) bacteraemia. Crude incidence rates stratified by index of multiple deprivation and ethnic groups were calculated; age-adjusted rate ratios were estimated using negative binomial regression models.ResultsWe identified 342,787 bacteraemia cases. Across all pathogens, as the level of deprivation rose, so did the age-adjusted bacteraemia incidence rate ratio. Compared with residents of the 20% least deprived areas of England, residents of the 20% most deprived areas had a 2.68-fold increased bacteraemia rate for MRSA (95% CI: 2.29-3.13) and 1.95-fold for E. coli (95% CI: 1.84-2.05), and 15% higher odds of dying within 30 days of any bacteraemia (95% CI: 1.13-1.19). After age adjustment, the incidence of all bacteraemia was higher in the Asian and Black groups compared with the White group: for MRSA, 79% higher in the Asian (95% CI: 1.51-2.10) and 59% higher in the Black (95% CI: 1.29-1.95) groups. The exception was MSSA, whose incidence was highest in the White group.ConclusionDisproportionately higher age-adjusted incidence of bacteraemia occurred in deprived areas and ethnic minorities. These disparities are likely multifactorial, possibly including socioeconomic, cultural, and systemic risk factors and different burden of comorbidities. Better understanding these factors can enable targeted interventions.
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Affiliation(s)
| | | | | | | | | | - Russell Hope
- UK Health Security Agency, London, United Kingdom
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Dafaalla M, Costa F, Jia H, Wijeysundera H, Rashid M, Graham MM, Wojakowski W, Chieffo A, Mintz GS, Mamas MA. Ischaemic and bleeding risk after ST-elevation myocardial infarction in patients with active cancer: a nationwide study. EUROPEAN HEART JOURNAL OPEN 2025; 5:oeaf012. [PMID: 40070878 PMCID: PMC11892560 DOI: 10.1093/ehjopen/oeaf012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 12/20/2024] [Accepted: 02/06/2025] [Indexed: 03/14/2025]
Abstract
Aims Treatment of patients with cancer presenting with ST-elevation myocardial infarction (STEMI) is complex given the increased risk of both thrombotic and major bleeding complications. Methods and results A nationally linked cohort of STEMI patients between January 2005 and March 2019 was obtained from the UK Myocardial Infarction National Audit Project and the UK National Hospital Episode Statistics Admitted Patient Care registries. The primary outcomes were major bleeding and re-infarction at 1 year following admission with STEMI. Major bleeding was defined as bleeding events that require hospital admission. Re-infarction was defined as acute MI according to the fourth Universal Definition of Myocardial Infarction. A total of 322 776 STEMI-indexed admissions were identified between January 2005 and March 2019. Of those, 7050 (2.2%) patients were diagnosed with active cancer. Cancer patients were older with more cardiovascular comorbidities. Cancer patients received invasive coronary angiography (62.2% vs. 72.7%, P < 0.001) and percutaneous coronary intervention (58.4% vs. 69.5%, P < 0.001) less often compared with patients without cancer and were less likely to be prescribed dual antiplatelet therapy (85% vs. 95.4%, P < 0.001). The incidence of major bleeding (6.5% vs. 3.5%, P < 0.001) and re-infarction (cancer 5.7%, no cancer 5.1%, P = 0.01) was higher in cancer patients at 1 year. After adjustment for differences in baseline covariates, a similar risk of re-infarction (sub-hazard ratios (SHR) 1.10, 95% CI 0.94-1.27) and a 50% increased risk of major bleeding (SHR 1.49, 95% CI 1.30-1.71) were observed in cancer patients. Conclusion Compared with non-cancer patients, cancer patients have a higher risk of major bleeding but not of re-infarction. Mitigating bleeding risk in STEMI patients with cancer is of paramount importance to improve outcomes.
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Affiliation(s)
- Mohamed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele Rd, Keele ST5 5BG, UK
| | - Francesco Costa
- Departamento de Medicina UMA, Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, Campus de Teatinos, 29010 Malaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Malaga, Spain
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Salvatore Pugliatti Square, 1 - 98122 Messina, Italy
| | - Haibo Jia
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, P. R. China
| | - Harindra Wijeysundera
- Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room A202, Toronto, ON M4N 3M5, Canada
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele Rd, Keele ST5 5BG, UK
| | - Michelle M Graham
- Mazankowski Alberta Heart Institute, University of Alberta, 11011-88 Avenue Edmonton, Alberta, Canada T6G 2G5
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Bankowa 12, 40-005 Katowice, Silesian Voivodeship, Poland
| | - Alaide Chieffo
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Olgettina Street, 58 - 20132 Milan, Italy
- Vita-Salute San Raffaele University, Olgettina Street, 58 - 20132 Milan, Italy
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele Rd, Keele ST5 5BG, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK
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9
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Bunting C, Clery A, McGrath-Lone L, Liu M, Kendall S, Bedford H, Cavallaro F, Saloniki EC, Harron K, Woodman J. How does health visiting in the first year of life vary by family characteristics? A longitudinal analysis of administrative data. J Public Health (Oxf) 2025; 47:82-89. [PMID: 39285663 DOI: 10.1093/pubmed/fdae259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 08/28/2024] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND The health visiting service in UK promotes the health and wellbeing of families with young children and comprises a universal offer (three mandated contacts between birth and 12 months) and additional contacts based on need. We aimed to understand how the level of health visiting support received varies by family characteristics. METHODS Using the Community Services Data Set linked to Hospital Episode Statistics, we identified 52 555 children in 10 local authorities with complete health visiting data for 12 months between April 2016 and March 2020. We analysed variation in health visiting contacts by deprivation, child ethnicity, maternal age, adversity and previous live births. RESULTS 41 340/52 555 children (79%) received the universal service; 63% received ≥1 additional contact and 25% received ≥3 additional contacts. The likelihood of receiving ≥3 additional contacts was greatest for children whose mothers had a history of hospital admissions relating to mental health, violence, self-harm or substance misuse (adjusted relative risk = 1.55, 95% confidence interval 1.26-1.92). CONCLUSIONS Most families received health visiting support in addition to the universal service. Policymakers and commissioners should consider how health visiting services can be expanded or targeted more effectively to ensure all families receive the support they need.
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Affiliation(s)
- C Bunting
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - A Clery
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - L McGrath-Lone
- Social Research Institute, University College London, London WC1H 0AA, UK
| | - M Liu
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - S Kendall
- Centre for Health Services Studies, University of Kent, Canterbury CT2 7NF, UK
| | - H Bedford
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - F Cavallaro
- Data Analytics Team, The Health Foundation, London EC4Y 8AP, UK
| | - E C Saloniki
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
- Research Partnership Team, National Institute for Health and Care Research Applied Research Collaboration North Thames, London W1T 7HA, UK
| | - K Harron
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - J Woodman
- Social Research Institute, University College London, London WC1H 0AA, UK
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10
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Shapiro SB, Yin H, Yu OHY, Rej S, Suissa S, Azoulay L. Glucagon-like peptide-1 receptor agonists and risk of suicidality among patients with type 2 diabetes: active comparator, new user cohort study. BMJ 2025; 388:e080679. [PMID: 40010803 DOI: 10.1136/bmj-2024-080679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2025]
Abstract
OBJECTIVE To determine whether the use of glucagon-like peptide-1 (GLP-1) receptor agonists is associated with an increased risk of suicidal ideation, self-harm, and suicide among patients with type 2 diabetes compared with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter-2 (SGLT-2) inhibitors. DESIGN Active comparator, new user cohort study. SETTING Primary care practices contributing data to the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics Admitted Patient Care and Office for National Statistics Death Registration databases. PARTICIPANTS Patients with type 2 diabetes. EXPOSURES Two cohorts were assembled, with the first composed of patients who started and continued on GLP-1 receptor agonists or DPP-4 inhibitors between 1 January 2007 and 31 December 2020 and the second composed of patients who started and continued on GLP-1 receptor agonists or SGLT-2 inhibitors between 1 January 1 2013 and 31 December 2020. Both cohorts were followed until 29 March 2021. MAIN OUTCOME MEASURES The primary outcome was suicidality, defined as a composite of suicidal ideation, self-harm, and suicide. Secondary outcomes were each of these events considered separately. Propensity score fine stratification weighted Cox proportional hazards models were fitted to estimate hazard ratios and 95% confidence intervals (CIs) to estimate the average treatment effect among the treated patients. RESULTS The first cohort included 36 082 GLP-1 receptor agonist users (median follow-up 1.3 years) and 234 028 DPP-4 inhibitor users (median follow-up 1.7 years). In crude analyses, GLP-1 receptor agonist use was associated with an increased incidence of suicidality compared with DPP-4 inhibitors (crude incidence rates 3.9 v 1.8 per 1000 person years, respectively; hazard ratio 2.08, 95% CI 1.83 to 2.36). This estimate decreased to a null value after confounding factors were accounted for (hazard ratio 1.02, 95% CI 0.85 to 1.23). The second cohort included 32 336 GLP-1 receptor agonist users (median follow-up 1.2 years) and 96 212 SGLT-2 inhibitor users (median follow-up 1.2 years). Similarly, GLP-1 receptor agonist use was associated with an increased risk of suicidality compared with SGLT-2 inhibitors in crude analyses (crude incidence rates 4.3 v 2.7 per 1000 person years; hazard ratio 1.60, 95% CI 1.37 to 1.87) but not after confounding factors were accounted for (0.91, 0.73 to 1.12). Similar findings were observed when suicidal ideation, self-harm, and suicide were analysed separately in both cohorts. CONCLUSIONS In this large cohort study, the use of GLP-1 receptor agonists was not associated with an increased risk of suicidality compared with the use of DPP-4 inhibitors or SGLT-2 inhibitors in patients with type 2 diabetes.
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Affiliation(s)
- Samantha B Shapiro
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Hui Yin
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Oriana Hoi Yun Yu
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Endocrinology, Jewish General Hospital, Montreal, QC, Canada
- Division of Endocrinology & Metabolism, McGill University, Montreal, QC, Canada
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Laurent Azoulay
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
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11
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Critchley JA, Limb ES, Khakharia A, Carey IM, Auld SC, De Wilde S, Harris T, Phillips LS, Cook DG, Rhee MK, Chaudhry UAR, Bowen L, Magee MJ. Tuberculosis and Increased Incidence of Cardiovascular Disease: Cohort Study Using United States and United Kingdom Health Records. Clin Infect Dis 2025; 80:271-279. [PMID: 39495677 PMCID: PMC11848252 DOI: 10.1093/cid/ciae538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 10/08/2024] [Accepted: 10/31/2024] [Indexed: 11/06/2024] Open
Abstract
BACKGROUND Limited evidence suggests elevated risks of cardiovascular disease (CVD) among people diagnosed with tuberculosis (TB) disease, though studies have not adjusted for preexisting CVD risk. We carried out a cohort study using 2 separate datasets, estimating CVD incidence in people with TB versus those without. METHODS Using data from the United States (Veterans Health Administration) and the United Kingdom (Clinical Practice Research Datalink) for 2000-2020, we matched adults with incident TB disease and no CVD history 2 years before TB diagnosis (US, n = 2121; UK, n = 15 820) with up to 10 people without TB on the basis of age, sex, race/ethnicity and healthcare practice. Participants were followed beginning 2 years before TB diagnosis and for 2 years subsequently. The acute period was defined as 3 months before/after TB diagnosis. TB, CVD, and covariates were identified from electronic routinely collected data (primary and secondary care; mortality). Poisson models estimated incident rate ratios for CVD events in people with TB compared to those without. RESULTS CVD incidence was consistently higher in people with TB, including during the baseline period (pre-TB) and particularly in the acute period: incident rate ratios were US, 3.5 (95% confidence interval, 2.7-4.4), and UK, 2.7 (2.2-3.3). Rate ratios remained high after adjusting for differences in preexisting CVD risk: US, 3.2 (2.2-4.4); UK, 1.6 (1.2-2.1). CONCLUSIONS Increased CVD incidence was observed in people with TB versus those without, especially within months of TB diagnosis, persistent after adjustment for differences in preexisting risk. Enhancing CVD screening and risk management may improve long-term outcomes in people with TB.
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Affiliation(s)
- Julia A Critchley
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Elizabeth S Limb
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Anjali Khakharia
- Clinical Studies Center, Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Iain M Carey
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Sara C Auld
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
- Departments of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stephen De Wilde
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Tess Harris
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Lawrence S Phillips
- Clinical Studies Center, Atlanta VA Health Care System, Decatur, Georgia, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Derek G Cook
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Mary K Rhee
- Clinical Studies Center, Atlanta VA Health Care System, Decatur, Georgia, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Umar A R Chaudhry
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Liza Bowen
- Population Health Research Institute, St George's School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom
| | - Matthew J Magee
- Departments of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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12
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Mullen L, Stables R. Validation of HES coding for the detection of major bleeding events: insights from the ROBOT-ACS study. BMC Med Res Methodol 2025; 25:42. [PMID: 39979827 PMCID: PMC11844057 DOI: 10.1186/s12874-025-02503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/11/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Increasingly research studies use HES (Hospital Episode Statistics) data to report clinical outcomes. No data exists on the performance of individual ICD-10 (International Classification of Diseases 10th Revision) diagnostic codes for identifying major bleeding events. Data from the ROBOT-ACS study provide a unique opportunity to assess this compared to conventionally adjudicated bleeding by standard definitions. METHODS A secondary analysis was performed on the 1172 HES records from ROBOT-ACS follow up data containing bleeding or anaemia codes. The 213 adjudicated major bleeds in ROBOT-ACS served as the gold standard comparator. Individual bleeding codes, and groups by type, were assessed for their positive predictive value (PPV). RESULTS The PPV of most codes for major bleeding were poor, generally < 50%. The best performing group of codes were relating to intracranial haemorrhage. 26 of 213 adjudicated bleeding events in ROBOT-ACS would be missed if anaemia codes were not considered. CONCLUSIONS The performance of diagnostic ICD-10 codes in HES, without further interrogation, for determining major bleeding events is poor. Whilst sensitivity is likely to be favourable, differentiating major bleeding is challenging. Options for using HES data to determine bleeding in cardiovascular studies would be either a hybrid approach, with HES screening followed by records review, or creating a new definition of significant bleeding using data more readily available in HES. TRIAL REGISTRATION ROBOT-ACS is registered on clinicaltrials.gov. Unique identifier: NCT02484924. Registered 30/6/2015.
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Affiliation(s)
- Liam Mullen
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
| | - Rod Stables
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
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13
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Allen I, Hassan H, Walburga Y, Huntley C, Loong L, Rahman T, Allen S, Garrett A, Torr B, Bacon A, Knott C, Jose S, Vernon S, Lüchtenborg M, Pethick J, Santaniello F, Goel S, Wang YW, Lavelle K, McRonald F, Eccles D, Morris E, Hardy S, Turnbull C, Tischkowitz M, Pharoah P, Antoniou AC. Second Primary Cancer Risks After Breast Cancer in BRCA1 and BRCA2 Pathogenic Variant Carriers. J Clin Oncol 2025; 43:651-661. [PMID: 39475295 PMCID: PMC7616773 DOI: 10.1200/jco.24.01146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/29/2024] [Accepted: 09/13/2024] [Indexed: 11/07/2024] Open
Abstract
PURPOSE Second primary cancer (SPC) risks after breast cancer (BC) in BRCA1/BRCA2 pathogenic variant (PV) carriers are uncertain. We estimated relative and absolute risks using a novel linkage of genetic testing data to population-scale National Disease Registration Service and Hospital Episode Statistics electronic health records. METHODS We followed 25,811 females and 480 males diagnosed with BC and tested for germline BRCA1/BRCA2 PVs in NHS Clinical Genetics centers in England between 1995 and 2019 until SPC diagnosis, death, migration, contralateral breast/ovarian surgery plus 1 year, or the 31st of December 2020. We estimated standardized incidence ratios (SIRs) using English population incidences, hazard ratios (HRs) comparing carriers to noncarriers using Cox regression, and Kaplan-Meier 10-year cumulative risks. RESULTS There were 1,840 BRCA1 and 1,750 BRCA2 female PV carriers. Compared with population incidences, BRCA1 carriers had elevated contralateral BC (CBC; SIR, 15.6 [95% CI, 11.8 to 20.2]), ovarian (SIR, 44.0 [95% CI, 31.4 to 59.9]), combined nonbreast/ovarian (SIR, 2.18 [95% CI, 1.59 to 2.92]), colorectal (SIR, 4.80 [95% CI, 2.62 to 8.05]), and endometrial (SIR, 2.92 [95% CI, 1.07 to 6.35]) SPC risks. BRCA2 carriers had elevated CBC (SIR, 7.70 [95% CI, 5.45 to 10.6]), ovarian (SIR, 16.8 [95% CI, 10.3 to 26.0]), pancreatic (SIR, 5.42 [95% CI, 2.09 to 12.5]), and combined nonbreast/ovarian (SIR, 1.68 [95% CI, 1.24 to 2.23]) SPC risks. Compared with females without BRCA1/BRCA2 PVs on testing, BRCA1 carriers had elevated CBC (HR, 3.60 [95% CI, 2.65 to 4.90]), ovarian (HR, 33.0 [95% CI, 19.1 to 57.1]), combined nonbreast/ovarian (HR, 1.45 [95% CI, 1.05 to 2.01]), and colorectal (HR, 2.93 [95% CI, 1.53 to 5.62]) SPC risks. BRCA2 carriers had elevated CBC (HR, 2.40 [95% CI, 1.70 to 3.40]), ovarian (HR, 12.0 [95% CI, 6.70 to 21.5]), and pancreatic (HR, 3.56 [95% CI, 1.34 to 9.48]) SPC risks. Ten-year cumulative CBC, ovarian, and combined nonbreast/ovarian cancer risks were 16%/6.3%/7.8% (BRCA1 carriers), 12%/3.0%/6.2% (BRCA2 carriers), and 3.6%/0.4%/4.9% (noncarriers). Male BRCA2 carriers had higher CBC (HR, 13.1 [95% CI, 1.19 to 146]) and prostate (HR, 5.61 [95% CI, 1.96 to 16.0]) SPC risks than noncarriers. CONCLUSION Survivors of BC carrying BRCA1 and BRCA2 PVs are at high SPC risk. They may benefit from enhanced surveillance and risk-reduction measures.
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Affiliation(s)
- Isaac Allen
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Hend Hassan
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Yvonne Walburga
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Catherine Huntley
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
| | - Lucy Loong
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
| | - Tameera Rahman
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Health Data Insight CIC, Cambridge, United Kingdom
| | - Sophie Allen
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
| | - Alice Garrett
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
- Department of Clinical Genetics, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Bethany Torr
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
| | - Andrew Bacon
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Craig Knott
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Health Data Insight CIC, Cambridge, United Kingdom
| | - Sophie Jose
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Health Data Insight CIC, Cambridge, United Kingdom
| | - Sally Vernon
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Margreet Lüchtenborg
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Centre for Cancer, Society and Public Health, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, c, London, United Kingdom
| | - Joanna Pethick
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Francesco Santaniello
- Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, Firenze, Italy
| | - Shilpi Goel
- National Disease Registration Service, National Health Service England, London, United Kingdom
- Health Data Insight CIC, Cambridge, United Kingdom
| | - Ying-Wen Wang
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Katrina Lavelle
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Fiona McRonald
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Diana Eccles
- Department of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Eva Morris
- Health Data Epidemiology Group, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Steven Hardy
- National Disease Registration Service, National Health Service England, London, United Kingdom
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, United Kingdom
| | - Marc Tischkowitz
- Department of Medical Genetics, Cambridge Biomedical Research Centre, National Institute for Health Research, University of Cambridge, Cambridge, United Kingdom
| | - Paul Pharoah
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Antonis C. Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
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14
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Shumway J, Ellis J, Stephens A, De Stavola BL, Gilbert R, Zylbersztejn A. Hospital-recorded chronic health conditions in children with and without Down syndrome in England: a national cohort of births from 2003 to 2019. Arch Dis Child 2025; 110:221-227. [PMID: 39477362 DOI: 10.1136/archdischild-2024-327532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 10/07/2024] [Indexed: 02/21/2025]
Abstract
OBJECTIVE The objective is to describe age-specific cumulative incidence for hospital-recorded indicators of chronic health conditions (CHCs) in children with Down syndrome (DS) compared with children without DS. DESIGN National birth cohort using hospital admission and death records. SETTING National Health Service (NHS)-funded hospitals in England. POPULATION Liveborn, singleton infants born in NHS-funded hospitals between 2003 and 2019. MAIN OUTCOME MEASURES Cumulative incidence of nine categories of hospital-recorded CHCs, multimorbidity and mortality. RESULTS We identified 10 621 infants with DS among 9 631 646 liveborn, singleton infants (0.11%). Among children with DS, the cumulative incidence for any indicated CHC was 90.1% by age 16, as compared with 21.2% of children without DS. By age 16, a third of children (33.1%) with DS had CHCs affecting four or more body systems; only 6.0% of children without DS had CHCs indicated in more than one body system. The most common CHCs in children with DS were severe congenital heart defects, indicated in 57.2% (0.8% in children without DS). The estimated HR for mortality up to age 16 comparing children with versus without DS was 15.26 (95% CI: 14.15, 16.45). CONCLUSIONS Children with DS had a higher cumulative incidence for CHCs in each body system category and subcategory, at all ages, than children without DS. Multimorbidity and mortality were higher among children with DS. Administrative data can be used to examine the health needs and healthcare use of children with DS throughout childhood and adolescence.
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Affiliation(s)
- Julia Shumway
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Jill Ellis
- East London NHS Foundation Trust, London, UK
| | - Alice Stephens
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Bianca Lucia De Stavola
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Ania Zylbersztejn
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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15
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Baranyi G, Harron K, Rajah N, Fitzsimons E. Self-reported psychological distress in childhood and mental health-related hospital attendance among young adults: a 12-year data linkage cohort study from England. Soc Psychiatry Psychiatr Epidemiol 2025:10.1007/s00127-025-02854-y. [PMID: 39966165 DOI: 10.1007/s00127-025-02854-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 02/07/2025] [Indexed: 02/20/2025]
Abstract
PURPOSE Investigating the relationship between self-reported mental health and secondary care utilisation can provide evidence on the link between population-level common mental conditions and clinical care; however, cohort studies with linked administrative data are rare. We explored the link between self-reported mental health in adolescence and mental health-related hospital attendance in young adulthood. METHODS Data from a nationally representative English cohort (Next Steps) were linked to NHS Hospital Episode Statistics. GHQ-12 assessed psychological distress in Next Steps at age 15; participants were followed up until their first mental health-related hospital presentations and outpatient treatments or were censored at the end of the study (age 27). Cox proportionate hazard models with survey weights estimated associations. RESULTS Out of 4058 young people, 19% reported high levels of distress at age 15. During the 12-year follow-up, 5.3%, 2.9% and 2.7% of the participants had at least one mental disorder, drug/alcohol misuse and self-harm presentation, respectively, and 4.2% had a mental health treatment in NHS hospitals. Higher GHQ-12 scores were associated with mental disorder presentations (HR = 1.10, 95% CI:1.04-1.16), and mental health treatments (HR = 1.14, 95% CI:1.08-1.20). Associations for hospital treatments were weaker for young people living in deprived areas, or if their main parent had lower education. CONCLUSION Adolescent psychological distress is associated with subsequent hospital attendance in young adulthood, but there might be treatment gaps in service utilisation among more disadvantaged individuals. Detecting youth with mental health difficulties may facilitate early intervention, improve life-course outcomes, and ultimately reduce secondary healthcare use.
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Affiliation(s)
- Gergő Baranyi
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, London, UK.
| | - Katie Harron
- Population, Policy & Practice Department, UCL GOS Institute of Child Health, University College London, London, UK
| | - Nasir Rajah
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, London, UK
| | - Emla Fitzsimons
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, London, UK
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Birnie K, Howe LD, Jones T, Madley-Dowd P, Martin FZ, Forbes H, Redaniel MT, Cornish R, Magnus MC, Davies NM, Tilling K, Hughes AD, Lawlor DA, Fraser A. Life course trajectories of maternal cardiovascular disease risk factors by obstetric history: a UK cohort study using electronic health records. BMC Med 2025; 23:91. [PMID: 39948598 PMCID: PMC11827161 DOI: 10.1186/s12916-025-03937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 02/07/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND Women who experience adverse pregnancy outcomes (APOs; gestational hypertension, preeclampsia (PE), gestational diabetes (GD), preterm birth (PTB), small or large for gestational age, miscarriage, multiple miscarriages, stillbirth, and offspring with major congenital anomalies) have increased risk of developing cardiovascular disease (CVD). We aimed to compare cardiometabolic health trajectories across the life course between women with and without APOs. METHODS We studied 187,186 women with a registered pregnancy in the UK Clinical Practice Research Datalink (CPRD) GOLD linked to Hospital Episode Statistics. Fractional polynomial multilevel models were used to compare trajectories of cardiometabolic risk factors (body mass index [BMI], blood pressure [BP], cholesterol, and glucose) between women with and without a history of APOs (individual APOs in any pregnancy and number of APOs). We explored two underlying time axes: (1) time relative to first pregnancy (from 10 years before first pregnancy to 15 years after) and (2) age. Models controlled for age at first pregnancy, residential area deprivation, non-singleton pregnancy, parity, smoking status, ethnicity, and medications use. RESULTS Women with a history of PE, gestational hypertension, or GD had higher BMI, BP, and glucose 10 years before first pregnancy compared to women without these APOs. These differences persisted 15 years post-first pregnancy. Women with a history of GD had a steeper post-partum rise in glucose. Women who experienced multiple (3 +) miscarriage, stillbirth, and/or medically indicated PTB had higher BP and BMI before and after pregnancy, with BP trajectories converging 15 years after first pregnancy. Women who experienced multiple APOs had the most adverse measurements across all cardiometabolic risk factors, with more unfavourable mean levels with each additional APO. There was little difference in cardiometabolic trajectories between women with and without a history of 1 or 2 miscarriages or congenital anomalies. CONCLUSIONS Women with APOs had adverse cardiometabolic profiles before first pregnancy, persisting up to 15 years post-pregnancy. Findings highlight the potential for targeted public health interventions to promote good cardiometabolic health in young adults transitioning from contraceptive use to planning pregnancies. APOs may identify young women who could benefit from monitoring CVD risk factors and interventions to improve cardiometabolic health.
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Affiliation(s)
- Kate Birnie
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK.
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
| | - Laura D Howe
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Timothy Jones
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Paul Madley-Dowd
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Florence Z Martin
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Harriet Forbes
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Faculty of Epidemiology and Population HealthandDepartment of Non-Communicable Disease EpidemiologySchool of Hygiene and Tropical Medicine, London, UK
| | - Maria Theresa Redaniel
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- National Cancer Registry Ireland, Cork, Ireland
| | - Rosie Cornish
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Neil M Davies
- Division of Psychiatry, University College London, London, UK
- Department of Statistical Sciences, University College London, London, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kate Tilling
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unitat the , University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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17
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Gouia I, Joulain F, Zhang Y, Morgan CL, Khan AH. Clinical Burden and Healthcare Resource Use of Asthma in Children in the UK. J Asthma Allergy 2025; 18:161-171. [PMID: 39931538 PMCID: PMC11809225 DOI: 10.2147/jaa.s452747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 09/10/2024] [Indexed: 02/13/2025] Open
Abstract
Background UK pediatric asthma prevalence is among the highest in Europe, and although the clinical and economic burden of asthma in UK adults is well described, childhood asthma data is lacking. We assessed the clinical and economic burden of asthma in children in the UK to better understand the impact of pediatric asthma. Methods This was a retrospective, case-matched, longitudinal analysis using the Clinical Practice Research Datalink GOLD database and linked patient-level data (Hospital Episode Statistics and Office for National Statistics datasets) of selected patient (aged 6-11 years) records in 2017. Severe exacerbation and re-exacerbation rates per patient-year (PPY), all-cause healthcare resource utilization (HCRU), and HCRU-related costs were assessed in asthma patients versus matched non-asthma controls, stratified by severity. Results Among 5950 patients, severe exacerbation rate was 0.06, 0.17 and 0.31 PPY for mild, moderate, and severe asthma, respectively. Incident rate of severe exacerbations were higher for moderate asthma (incident rate ratios [IRR; 95% CI] 2.87 [2.30-3.56], P<0.0001) and severe asthma (5.19 [4.20-6.41], P<0.0001) versus mild asthma. Risk of re-exacerbation was significantly increased for severe versus mild asthma (hazard ratio [95% CI]: 2.98 [1.90-4.65], P<0.001). All-cause HCRU (IRR [95% CI]) was higher in severe asthma patients versus controls (primary care: 3.81 [3.54-4.09], P<0.0001; inpatient admissions: 3.23 [2.31-4.62], P<0.0001]); total-cost ratios relative to controls for mild, moderate, and severe asthma were 1.58 (1.39-1.78, P<0.0001), 2.56 (1.97-3.33, P<0.0001), and 3.42 (2.54-4.61, P<0.0001), respectively. Asthma-related costs increased with severity (total-cost ratios: moderate versus mild, 1.68 [1.45-1.97], P<0.0001; severe versus mild, 2.67 [2.21-3.25], P<0.0001). Conclusion In children with asthma in the UK, increasing disease severity was associated with increased risk of severe exacerbations, re-exacerbations, and increased HCRU and costs.
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Affiliation(s)
- Imène Gouia
- HEVA (Health Economics and Value Assessment), Sanofi, Gentilly, France
| | - Florence Joulain
- HEVA (Health Economics and Value Assessment), Sanofi, Gentilly, France
| | - Yi Zhang
- Medical Affairs, Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | - Asif H Khan
- Global Medical, Sanofi, Bridgewater, NJ, USA
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18
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Ward JL, Vázquez-Vázquez A, Phillips K, Settle K, Pilvar H, Cornaglia F, Gibson F, Nicholls D, Roland D, Mathews G, Roberts H, Viner RM, Hudson LD. Admission to acute medical wards for mental health concerns among children and young people in England from 2012 to 2022: a cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2025; 9:112-120. [PMID: 39855751 DOI: 10.1016/s2352-4642(24)00333-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 12/03/2024] [Accepted: 12/03/2024] [Indexed: 01/27/2025]
Abstract
BACKGROUND There are challenges in providing high quality care for children and young people who are admitted to acute medical wards for mental health concerns. Although there is concern that these admissions are increasing, national data describing these patterns are scarce. We aimed to describe trends in these admissions in England over a 10-year period, and to identify factors associated with repeat admission and length of stay. METHODS In this cohort study we used data on all admissions to medical wards in England among children and young people aged 5-18 years from April 1, 2012, to March 31, 2022. We classified admissions for mental health concerns using the Global Burden of Disease Study cause hierarchy. We described national trends in admissions for mental health concerns over time by sex, age, ethnicity, and index of multiple deprivation quintile. We examined associations between sociodemographic and clinical factors and odds of the admission lasting more than 1 week, as well as hazard ratios of repeat admissions, using mixed-effects models. FINDINGS We identified 342 511 admissions for any cause in children and young people aged 5-18 years in 2021-22 in England, of which 39 925 (11·7%) were for mental health concerns. 21 337 (53·4%) admissions for mental health concerns were due to self-harm. Between 2012-13 and 2021-22, annual admissions for mental health concerns increased from 24 198 to 39 925 (65·0% increase), whereas all-cause admissions increased from 311 067 to 342 511 (10·1% increase). Increases were particularly steep in females aged 11-15 years, rising from 9091 to 19 349 (112·8% increase), and for eating disorders, rising from 478 to 2938 (514·6% increase). In 2021-22, 3130 (7·8%) admissions for mental health concerns lasted longer than 1 week, compared with 12 044 (3·5%) all-cause admissions. Of 239 541 children and young people who were admitted for mental health concerns between 2012-13 and 2021-22, 32 107 (13·4%) had a repeat admission within 6 months. The odds of long-stay admission and hazard ratios for being readmitted were significantly higher for children and young people aged 11-15 years, those who were female, those from less deprived areas, and those with eating disorders than among other groups. INTERPRETATION We found large increases in the number of children and young people admitted to acute medical wards for mental health concerns over a 10-year period. Further work is needed to understand factors driving these trends and how to improve care for children and young people with mental health concerns admitted to medical wards. FUNDING National Institute for Health and Care Research.
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Affiliation(s)
- Joseph L Ward
- University College London Great Ormond Street Institute of Child Health, London, UK.
| | | | - Kirsty Phillips
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Kate Settle
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | | | - Faith Gibson
- University of Surrey, Guildford, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK; SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
| | - Gabrielle Mathews
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Helen Roberts
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Russell M Viner
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Lee D Hudson
- University College London Great Ormond Street Institute of Child Health, London, UK
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19
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Ní Chobhthaigh S, Jay MA, Blackburn R. Emergency hospital admissions for stress-related presentations among secondary school-aged minoritised young people in England. Br J Psychiatry 2025; 226:63-71. [PMID: 39523214 PMCID: PMC7617073 DOI: 10.1192/bjp.2024.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
BACKGROUND Minoritised young people face a double burden of discrimination through increased risk of stress and differential treatment access. However, acute care pathways for minoritised young people with urgent mental health needs are poorly understood. AIMS To explore variation in stress-related presentations (SRPs) to acute hospitals across racial-ethnic groups in England. METHOD We examined rates, distribution, duration and types of SRPs across racial-ethnic groups in a retrospective cohort of 11- to 15-year-olds with one or more emergency hospital admissions between April 2014 and March 2020. SRPs were defined as emergency admissions for potentially psychosomatic symptoms, self-harm and internalising, externalising and thought disorders. RESULTS White British (8-38 per 1000 births) and Mixed White-Black (9-42 per 1000 births) young people had highest rates of SRPs, whereas Black African (5-14 per 1000 births), Indian (6-19 per 1000 births) and White other (4-19 per 1000 births) young people had the lowest rates of SRPs. The proportion of readmissions were highest for Pakistani (47.7%), White British (41.4%) and Mixed White-Black (41.3%) groups. Black Other (36.4%) and White Other (35.8%) groups had the lowest proportions of readmissions. The proportion of admission durations ≥3 days was higher for Black Other (16.6%), Bangladeshi (16.3%), Asian Other (15.9%) and Black Caribbean (15.8%) groups than their White British (11.9%) and Indian (11.8%) peers. The type of SRPs varied across racial-ethnic groups. CONCLUSIONS Patterns of SRP admissions systematically differed across racial-ethnic groups, indicative of inequitable triage, assessment and treatment processes. These findings highlight the need for implementation of race equality frameworks to address structural racism in healthcare pathways.
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20
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Syed S, Howe LD, Lacey RE, Deighton J, Qummer Ul Arfeen M, Feder G, Gilbert R. Adverse childhood experiences in firstborns and mental health risk and health-care use in siblings: a population-based birth cohort study of half a million children in England. Lancet Public Health 2025; 10:e111-e123. [PMID: 39909686 DOI: 10.1016/s2468-2667(24)00301-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 12/09/2024] [Accepted: 12/10/2024] [Indexed: 02/07/2025]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. We aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs. METHODS We derived a population-based birth cohort in England using linked electronic health records for first-time mothers (aged 14-55 years) with their children (born 2002-18). We followed up the cohort from 1 year before birth up to 18 years after birth across the Clinical Practice Research Datalink GOLD and Aurum databases (primary care), Hospital Episode Statistics (secondary care), and the Office of National Statistics (death registrations) between April 1, 2001, and March 31, 2020. We included six different ACE domains, including child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment, in the records of the mother or the firstborn in the first 1000 days. The primary outcome was the number of children (aged 5-18 years) with recorded mental health problems per mother. We used adjusted and weighted negative binomial regression models to estimate incidence rate ratios. FINDINGS Of 333 048 firstborns and their mothers, 123 573 (37·1%) had any ACEs between 1 year before and 2 years after birth, and 65 941 (19·8%) of all mothers had at least one child with a mental health problem between ages 5 years and 18 years (median follow-up 11·4 years [IQR 9·2-14·1]). Mothers with firstborns with ACEs had 1·71 (95% CI 1·68-1·73) times as many children in total with mental health problems (mean 29·8 children per 100 mothers, 29·4-30·1) compared with mothers without firstborns with ACEs (mean 17·4 children per 100 mothers, 17·3-17·6), translating into a mean difference of 12·3 (95% CI 11·9-12·7) additional children with mental health problems per 100 mothers. These mothers also had increased incidence rates of children with all-cause emergency admissions and mental health-related contacts. There was no significant difference in the risk of mental health problems between firstborn and later-born children. INTERPRETATION ACEs in firstborns during the first 1000 days were associated with increased mental health problems and health-care needs in multiple children in the same family. The findings highlight the importance of early identification of vulnerable first-time parents and firstborns and increased policy focus on sustained support beyond the first 1000 days to promote healthier long-term family outcomes. Future evaluations of interventions should include the health outcomes of multiple children within families. FUNDING NIHR Policy Research Programme.
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Affiliation(s)
- Shabeer Syed
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.
| | - Laura D Howe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca E Lacey
- Population Health Research Institute, St George's University of London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families and University College London, London, UK
| | | | - Gene Feder
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
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21
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Somathilake G, Ford E, Armes J, Moschoyiannis S, Collins M, Francsics P, Lemanska A. Evaluating the quality of prostate cancer diagnosis recording in CPRD GOLD and CPRD Aurum primary care databases for observational research: A study using linked English electronic health records. Cancer Epidemiol 2025; 94:102715. [PMID: 39616870 DOI: 10.1016/j.canep.2024.102715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 11/08/2024] [Accepted: 11/17/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Primary care data in the UK are widely used for cancer research, but the reliability of recording key events like diagnoses remains uncertain. Although data linkage can improve reliability, its costs, time requirements, and sample size constraints may discourage its use. We evaluated accuracy, completeness, and date concordance of prostate cancer (PCa) diagnosis recording in Clinical Practice Research Datalink (CPRD) GOLD and Aurum compared to linked Cancer Registry (CR) and Hospital Episode Statistics (HES) Admitted Patient Care (APC) in England. METHODS Incident PCa diagnoses (2000-2016) for males aged ≥46 at diagnosis who remained registered with their General Practitioner (GP) by age 65 and were recorded in at least one data source were analysed. Accuracy was the proportion of diagnoses recorded in GOLD or Aurum with a corresponding record in CR or HES. Completeness was the proportion of CR or HES diagnoses with a corresponding record in GOLD or Aurum. RESULTS The final cohorts for comparisons included 29,500 records for GOLD and 26,475 for Aurum. Compared to CR, GOLD was 86 % accurate and 65 % complete, while Aurum was 87 % accurate and 77 % complete. Compared to HES, GOLD was 76 % accurate and 60 % complete, and Aurum was 79 % accurate and 70 % complete. Concordance in diagnosis dates improved over time in both GOLD and Aurum, with 93 % of diagnoses recorded within a year compared to CR, and 66 % (GOLD) and 71 % (Aurum) compared to HES. Delays of 2-3 weeks in primary care diagnosis recording were observed compared to CR, whereas most diagnoses appeared at least 3 months earlier in primary care than in HES. CONCLUSIONS Aurum demonstrated better accuracy and completeness for PCa diagnosis recording than GOLD. However, linkage to HES or CR is recommended for improved case capture. Researchers should address the limitations of each data source to ensure research validity.
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Affiliation(s)
- Gayasha Somathilake
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, UK.
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, UK
| | - Sotiris Moschoyiannis
- Computer Science Research Centre, Faculty of Engineering and Physical Sciences, University of Surrey, UK
| | | | | | - Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, UK; Data Science, National Physical Laboratory, Teddington, UK
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22
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Matthews AH, Gray WK, Evans JP, Knight R, Evans JT, Lamb SE, Briggs T, Porteous A, Sabah SA, Alvand A, Price A, Toms AD. Higher hospital volume reduces early failure rates in single-stage revision TKR for infection: An analysis of the United Kingdom National Joint Registry and National Administrative Databases. Knee Surg Sports Traumatol Arthrosc 2025. [PMID: 39810729 DOI: 10.1002/ksa.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/18/2024] [Accepted: 12/22/2024] [Indexed: 01/16/2025]
Abstract
PURPOSE Revision knee replacement (RevKR) for infection is rare but increasing. It is hypothesised that higher hospital volume reduces adverse outcomes. The aim was to estimate the association of surgical unit volume with outcomes following first, single-stage RevKR for infection. METHODS This population-based cohort study merged data from the United Kingdom National Joint Registry, Hospital Episode Statistics, National Patient Reported Outcome Measures and the Civil Registrations of Death. Patients undergoing procedures between 1 January 2009 and 30 June 2019 were included. Early outcomes were chosen to reflect the quality of the surgical provision and included re-revision at 2 years, mortality, serious medical complications, length of stay and patient-reported outcome measures (PROMs). Adjusted fixed effect multivariable regression models were used to examine the association between surgical unit mean annual caseload and the risk of adverse outcomes. RESULTS A total of 1477 patients underwent first-time single-stage RevKRs for infection across 267 surgical units and 716 surgeons. Following adjustment for age, gender, American Society of Anaesthesiologists grade, surgeon volume, year of surgery and operation funder and modelling surgical unit volume with restricted cubic spline, a greater mean annual volume was associated with a lower risk of re-revision at 2 years. The odds of re-revision in hospitals performing fewer than or equal to 12 cases per year was 2.53 (95% confidence interval = 1.50-4.31) times more likely than hospitals performing three to four cases per month. Annual variation in surgical unit volume was not associated with mortality and serious medical complications within 90 days. Only 99 out of 1477 (7%) of patients had linked PROMs which precluded subsequent analysis. CONCLUSION Overall, higher volume surgical units had lower rates of early re-revision following the first RevKR for infection. We were unable to provide recommended specific volume thresholds for units; however, the probability of re-revision appears to be lowest in the highest volume units. LEVEL OF EVIDENCE Level III, retrospective cohort study of prospectively collected data.
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Affiliation(s)
- Alexander H Matthews
- Getting It Right First Time Programme, NHS England, London, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - William K Gray
- Getting It Right First Time Programme, NHS England, London, UK
| | - Jonathan P Evans
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Ruth Knight
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Jonathan T Evans
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Sarah E Lamb
- University of Exeter College of Life and Environmental Studies: University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Tim Briggs
- Getting It Right First Time Programme, NHS England, London, UK
- Royal National Orthopaedic Hospital, London, UK
| | | | - Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Royal National Orthopaedic Hospital, London, UK
- Nuffield Orthopaedic Centre, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Nuffield Orthopaedic Centre, Oxford, UK
| | - Andrew D Toms
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
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23
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Ibrahim B, Jardine JE, Lenguerrand E, Judge A, Khalil A, Draycott T, Iliodromiti S. Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study. BMJ Open 2025; 15:e090359. [PMID: 39788777 PMCID: PMC11751956 DOI: 10.1136/bmjopen-2024-090359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 12/05/2024] [Indexed: 01/12/2025] Open
Abstract
OBJECTIVE In the UK and worldwide, there are substantial ethnic inequalities in maternal and perinatal care and outcomes. We aim to assess the impact of the unprecedented change in care provision during the COVID-19 pandemic on inequalities in adverse maternity outcomes. DESIGN Retrospective cohort study using structured electronic health record data. SETTING English hospital trusts providing maternity care. PARTICIPANTS Women giving birth and babies born in the National Health Service (NHS) in England between 1 April 2018 and 31 March 2021, in three time groups: prepandemic, the first pandemic wave (26 March 2020 to 30 June 2020) and second pandemic wave (1 July 2020 to 31 March 2021). Self-reported ethnicity was grouped into White, South-Asian, Black, Mixed and Other. MAIN OUTCOME MEASURES Composite and component measures of maternal (emergency caesarean section, obstetric anal sphincter injury, hysterectomy, sepsis, anaesthetic complications and prolonged hospital stay) and perinatal (stillbirth, neonatal death, preterm birth, brain injury, small for gestational age and prolonged hospital stay). Poisson regression was used to compare relative risks between different ethnic groups. FINDINGS 1.54 million maternal and 1.43 million neonatal records were included. The overall incidence of adverse outcomes per 1000 births initially decreased maternal: from 308.0 (95% CI 307.0 to 309.0) to 291.0 (95% CI 311.4 to 314.9) (p<0.001); perinatal: from 133.0 (95% CI 132.3 to 133.7) to 111.9 (95% CI 110.1 to 113.7) (p<0.001)), but then increased in the second pandemic period (maternal: 313.2 (95% CI 311.4 to 314.9) (p<0.001); perinatal 118.9 (95% CI 117.7 to 120.0) (p<0.001)). The risk of adverse outcomes was higher in women and babies from all ethnic minority groups compared with White women in both pandemic periods. Black and South-Asian women and babies were approximately 25% more likely to sustain adverse outcomes. While similar overall changes in adverse outcomes were seen in all groups, existing inequalities were sustained throughout the pandemic periods. INTERPRETATION Existing inequalities in adverse maternal and perinatal/neonatal outcomes were maintained, not tempered, during the pandemic, despite substantial changes to maternity services and care. Further research on possible interventions to reduce inequality is needed.
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Affiliation(s)
| | | | - Erik Lenguerrand
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Asma Khalil
- Fetal Medicine Unit, NHS Foundation Trust and Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Tim Draycott
- Department of Women's Health, North Bristol NHS Trust, Westbury on Trym, UK
- Department of Obstetrics and Gynaecology, University of Bristol School of Clinical Science, Bristol, UK
| | - Stamatina Iliodromiti
- Centre for Primary Care and Public Health, Queen Mary University of London Wolfson Institute of Preventive Medicine, London, UK
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24
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Lugo‐Palacios DG, Bidulka P, O’Neill S, Carroll O, Basu A, Adler A, DíazOrdaz K, Briggs A, Grieve R. Going beyond randomised controlled trials to assess treatment effect heterogeneity across target populations. HEALTH ECONOMICS 2025; 34:85-104. [PMID: 39327529 PMCID: PMC11631826 DOI: 10.1002/hec.4903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 08/07/2024] [Accepted: 09/02/2024] [Indexed: 09/28/2024]
Abstract
Methods have been developed for transporting evidence from randomised controlled trials (RCTs) to target populations. However, these approaches allow only for differences in characteristics observed in the RCT and real-world data (overt heterogeneity). These approaches do not recognise heterogeneity of treatment effects (HTE) according to unmeasured characteristics (essential heterogeneity). We use a target trial design and apply a local instrumental variable (LIV) approach to electronic health records from the Clinical Practice Research Datalink, and examine both forms of heterogeneity in assessing the comparative effectiveness of two second-line treatments for type 2 diabetes mellitus. We first estimate individualised estimates of HTE across the entire target population defined by applying eligibility criteria from national guidelines (n = 13,240) within an overall target trial framework. We define a subpopulation who meet a published RCT's eligibility criteria ('RCT-eligible', n = 6497), and a subpopulation who do not ('RCT-ineligible', n = 6743). We compare average treatment effects for pre-specified subgroups within the RCT-eligible subpopulation, the RCT-ineligible subpopulation, and within the overall target population. We find differences across these subpopulations in the magnitude of subgroup-level treatment effects, but that the direction of estimated effects is stable. Our results highlight that LIV methods can provide useful evidence about treatment effect heterogeneity including for those subpopulations excluded from RCTs.
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Affiliation(s)
- David G. Lugo‐Palacios
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Patrick Bidulka
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Stephen O’Neill
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Orlagh Carroll
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Anirban Basu
- The Comparative Health Outcomes, Policy & Economics (CHOICE) InstituteUniversity of Washington School of PharmacySeattleWashingtonUSA
| | - Amanda Adler
- Diabetes Trials UnitThe Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordOCDEM Building Churchill HospitalHeadingtonUK
| | - Karla DíazOrdaz
- Department of Statistical ScienceUniversity College LondonLondonUK
| | - Andrew Briggs
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Richard Grieve
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
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Mansi ET, Rentsch CT, Bourne RS, Jeffery A, Guthrie B, Lone NI. Benzodiazepine and z-drug prescribing in critical care survivors and the risk of rehospitalisation or death due to falls/trauma and due to any cause: a retrospective matched cohort study using the UK Clinical Practice Research Datalink. Intensive Care Med 2025; 51:125-136. [PMID: 39774867 DOI: 10.1007/s00134-024-07762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 12/10/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population. METHODS Retrospective cohort study of 28,678 adult critical care survivors hospitalised in 2010 and 2018: 4844 prescribed benzodiazepines or z-drugs, matched to 23,834 unexposed survivors using UK Clinical Practice Research Datalink linked datasets. Multivariable stratified Cox regression was used to estimate the adjusted hazards ratio (adjHR) with 95% confidence intervals (CI) of community benzodiazepine/z-drug prescribing and falls/trauma-related events, as well as all-cause 30-day rehospitalisation or death. We performed subgroup analyses on patients without pre-critical care admission prescription of benzodiazepines/z-drugs ('treatment-naïve'), and sensitivity analyses excluding patients receiving palliative care after discharge. RESULTS Prescription of benzodiazepines or z-drugs showed no conclusive evidence of increased risk of falls/trauma-related events in the whole cohort (adjHR 1.27; 95%CI 0.76-2.14) or in treatment-naïve individuals (adjHR 1.79; 95%CI 0.61-5.26), because estimates lacked precision due to low event rates. For all-cause rehospitalisation or death, benzodiazepines/z-drugs were associated with increased risk (whole cohort adjHR 1.24, 95%CI 1.14-1.36; treatment-naïve adjHR 1.66, 95%CI 1.49-1.86). However, after excluding patients treated for palliative care, the association persisted only in treatment-naïve individuals (whole cohort adjHR 1.08, 95%CI 0.98-1.19; treatment-naïve adjHR 1.42, 95%CI1.25-1.62). CONCLUSIONS Community benzodiazepine and z-drug prescribing was associated with increased risk of all-cause, but not falls/trauma-related, rehospitalisations and deaths in critical care survivors who had not been prescribed these before hospitalisation. Clinicians should balance the possible benefits with the likely harms of prescribing these drugs in this potentially vulnerable patient group.
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Affiliation(s)
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, USA
| | - Richard S Bourne
- Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (PSRC), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Annie Jeffery
- Division of Psychiatry, Epidemiology and Applied Clinical Research Department, University College London, London, UK
| | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
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Bonar K, Boudiaf N, Zaremba P, Tarancón T, Zhou J, Jacob S. Disease burden, healthcare resource utilisation, and treatment patterns in patients with newly diagnosed myasthenia gravis in England: A retrospective cohort study. J Neuromuscul Dis 2025; 12:22143602241308194. [PMID: 39973446 DOI: 10.1177/22143602241308194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
BACKGROUND Myasthenia gravis (MG), a chronic and unpredictable autoimmune disease, is associated with multiple comorbidities and high disease burden. OBJECTIVE To assess the disease burden, healthcare resource utilisation (HCRU), and treatment patterns of patients with newly diagnosed MG in England. METHODS Data from Clinical Practice Research Datalink GP practices linked to the Hospital Episode Statistics database were used. Eligible patients had ≥1 diagnostic code for MG, with the first MG diagnostic code recorded between 01 January 2010 and 31 December 2019. Non-MG controls were selected if they had no recorded MG diagnosis and ≥12 months of data. Controls were matched for age, sex and GP practice in a maximum ratio of 5:1. RESULTS Mean follow-up duration was 2.8 and 3.1 years for the MG and non-MG cohorts, respectively. In the MG cohort, 56% of patients were male, with a mean age of 67 years at baseline. Incidence rates of all comorbidities assessed during follow-up were higher in the MG cohort than in controls. Almost two-thirds of MG patients experienced ≥1 myasthenic exacerbation during follow-up; incidence rates (95% confidence interval) of MG exacerbations and crises were 50.0 (44.7-55.9) and 1.3 (0.8-2.0) per 100 person-years, respectively. Visits to non-neurology specialists and outpatient clinics were the most common instances of HCRU overall, each being more frequent in the MG cohort than for controls. In the first year of follow-up, acetylcholinesterase inhibitors (AChEIs) and corticosteroids were used by 56.0% and 50.2% of MG patients, respectively; the use of AChEIs declined thereafter. CONCLUSIONS Despite treatment, there is a high disease burden for patients with newly diagnosed MG in England, with high rates of MG exacerbation and HCRU use. Thus, there is a need for targeted treatments with sustained efficacy and improved safety to adequately manage MG symptoms and reduce MG-related disease burden.
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Affiliation(s)
| | | | | | | | | | - Saiju Jacob
- Department of Neurology and Centre for Rare Diseases, Institute of Immunology and Immunotherapy, University Hospitals Birmingham and University of Birmingham, Birmingham, UK
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27
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Luney MS, Chalitsios CV, Lindsay W, Sanders RD, McKeever TM, Moppett IK. Adverse outcomes after surgery after a cerebrovascular accident or acute coronary syndrome: a retrospective observational cohort study. Br J Anaesth 2025; 134:63-71. [PMID: 39384506 PMCID: PMC11718364 DOI: 10.1016/j.bja.2024.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/23/2024] [Accepted: 08/15/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Delaying surgery after a major cardiovascular event might reduce adverse postoperative outcomes. The time interval represents a potentially modifiable risk factor but is not well studied. METHODS This was a longitudinal retrospective population-based cohort study, linking data from Hospital Episode Statistics for NHS England and the Myocardial Ischaemia National Audit Project. Adults undergoing noncardiac, non-neurologic surgery in 2007-2018 were included. The time interval between a preoperative cardiovascular event and surgery was the main exposure. The outcomes of interest were acute coronary syndrome (ACS), acute myocardial infarction (AMI), cerebrovascular accident (CVA) within 1 year of surgery, unplanned readmission (at 30 days and 1 year), and prolonged length of stay. Multivariable logistic regression models with restricted cubic splines were used to estimate adjusted odds ratios (aORs; age, sex, socioeconomic deprivation, and comorbidities). RESULTS In total, 877 430 people had a previous cardiovascular event and 20 582 717 were without an event. CVA, ACS, and AMI in the year after elective surgery were more frequent after prior cardiovascular events (adjusted hazard ratio 2.12, 95% confidence interval [CI] 2.08-2.16). Prolonged hospital stay (aOR 1.36, 95% CI 1.35-1.38) and 30-day (aOR 1.28, 95% CI 1.25-1.30) and 1-yr (aOR 1.60, 95% CI 1.58-1.62) unplanned readmission were more common after major operations in those with a prior cardiovascular event. After adjusting for the time interval between preoperative events until surgery, elective operations within 37 months were associated with an increased risk of postoperative ACS or AMI. The risk of postoperative stroke plateaued after a 20-month interval until surgery, irrespective of surgical urgency. CONCLUSIONS These observational data suggest increased adverse outcomes after a recent cardiovascular event can occur for up to 37 months after a major cardiovascular event.
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Affiliation(s)
- Matthew S Luney
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, University of Nottingham, Nottingham, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christos V Chalitsios
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - William Lindsay
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, University of Nottingham, Nottingham, UK; Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert D Sanders
- Speciality of Anaesthetics, Central Clinical School & NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Tricia M McKeever
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Iain K Moppett
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, University of Nottingham, Nottingham, UK; Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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28
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Persson R, Hagberg KW, Pranschke E, Vasilakis-Scaramozza C, Jick S. Treatment for osteoporosis and risk of osteonecrosis of the jaw among female patients in the United Kingdom Clinical Practice Research Datalink. Osteoporos Int 2025; 36:47-60. [PMID: 39400702 DOI: 10.1007/s00198-024-07262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/16/2024] [Indexed: 10/15/2024]
Abstract
Osteonecrosis of the jaw (ONJ) is an adverse effect of antiresorptives. Among female patients treated for osteoporosis, ONJ risk was threefold higher after 2-3 years of treatment and eightfold after 10 years compared with past use. Absolute risks remained low (~ 0.05% after 5 years) and diminished after discontinuation. PURPOSE Osteonecrosis of the jaw (ONJ) is a rare adverse effect of antiresorptive drug use; however, the magnitude of risk in osteoporosis patients has not been clearly described. METHODS We conducted a cohort study among cancer-free female patients aged 40-89 with, or at risk for, osteoporosis in United Kingdom Clinical Practice Research Datalink (CPRD) Aurum. We followed patients from first osteoporosis treatment until first of osteonecrosis diagnosis, age 90, record end, or other prespecified censoring event, and accumulated person-time by osteoporosis treatment. ONJ cases were selected from CPRD Aurum and linked Hospital Episode Statistics data using an algorithm and manual review. We estimated incidence rates (IR) of ONJ by current treatment type and post discontinuation. We conducted a nested case-control analysis to further describe risk by cumulative dose and duration of antiresorptive therapies. RESULTS Among 467,654 eligible patients, there were 208 ONJ cases. IR among patients currently treated with antiresorptives (primarily alendronate) was 1.2 (95% confidence interval [CI] 1.0-1.4) per 10,000 person-years. Compared with past use of antiresorptives, odds ratios of ONJ were 3.0 (95% CI 1.5-5.7) after 2-3 years of treatment and 8.1 (95% CI 4.4-15) after 10 years. However, absolute risks remained low (~ 0.05% after 5 years and ~ 0.18% after 10 years) and elevated risks diminished to near zero within 6 to 9 months of discontinuation. CONCLUSION Risk of ONJ increased after 2-3 years of treatment with antiresorptives; however, the absolute risk was low and returned to baseline shortly after treatment discontinuation.
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Affiliation(s)
- Rebecca Persson
- BCDSP, Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
| | | | - Emma Pranschke
- BCDSP, Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
| | | | - Susan Jick
- BCDSP, Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Richards-Belle A, Launders N, Hardoon S, Richards A, Man KK, Davies NM, Bramon E, Hayes JF, Osborn DP. Comparative cardiometabolic safety and effectiveness of aripiprazole in people with severe mental illness: A target trial emulation. PLoS Med 2025; 22:e1004520. [PMID: 39847591 PMCID: PMC11778676 DOI: 10.1371/journal.pmed.1004520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 01/29/2025] [Accepted: 01/07/2025] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND There is limited and conflicting evidence on the comparative cardiometabolic safety and effectiveness of aripiprazole in the management of severe mental illness. We investigated the hypothesis that aripiprazole has a favourable cardiometabolic profile, but similar effectiveness when compared to olanzapine, quetiapine, and risperidone. METHODS AND FINDINGS We conducted an observational emulation of a head-to-head trial of aripiprazole versus olanzapine, quetiapine, and risperidone in UK primary care using data from the Clinical Practice Research Datalink. We included adults diagnosed with severe mental illness (i.e., bipolar disorder, schizophrenia, and other non-organic psychoses) who were prescribed a new antipsychotic between 2005 and 2017, with a 2-year follow-up to 2019. The primary outcome was total cholesterol at 1 year (cardiometabolic safety). The main secondary outcome was psychiatric hospitalisation (effectiveness). Other outcomes included body weight, blood pressure, all-cause discontinuation, and mortality. Analyses adjusted for baseline confounders, including sociodemographics, diagnoses, concomitant medications, and cardiometabolic parameters. We included 26,537 patients (aripiprazole, n = 3,573, olanzapine, n = 8,554, quetiapine, n = 8,289, risperidone, n = 6,121). Median (IQR) age was 53 (42-67) years, 55.4% were female, 82.3% White, and 18.0% were diagnosed with schizophrenia. Patients prescribed aripiprazole had similar total cholesterol levels after 1 year to those prescribed olanzapine (adjusted mean difference [aMD], -0.03, 95% CI, -0.09 to 0.02, p = 0.261), quetiapine (aMD, -0.03, 95% CI, -0.09 to 0.03, p = 0.324), and risperidone (aMD, -0.01, 95% CI, -0.08 to 0.05, p = 0.707). However, there was evidence that patients prescribed aripiprazole had better outcomes on other cardiometabolic parameters, such as body weight and blood pressure, especially compared to olanzapine. After additional adjustment for prior hospitalisation, patients prescribed aripiprazole had similar rates of psychiatric hospitalisation as those prescribed olanzapine (adjusted hazard ratio [aHR], 0.91, 95% CI, 0.82 to 1.01, p = 0.078), quetiapine (aHR, 0.94, 95% CI, 0.85 to 1.04, p = 0.230), or risperidone (aHR, 1.01, 95% CI, 0.91 to 1.12, p = 0.854). CONCLUSIONS Data from our large, powered, diverse, real-world target trial emulation sample, followed over 2 years, suggest that adults diagnosed with severe mental illness prescribed aripiprazole have similar total cholesterol 1 year after first prescription compared to those prescribed olanzapine, quetiapine, and risperidone. However, patients prescribed aripiprazole had better outcomes on some other cardiometabolic parameters, and there was little evidence of differences in effectiveness. Our findings inform a common clinical dilemma and contribute to the evidence base for real-world clinical decision-making on antipsychotic choice for patients diagnosed with severe mental illness.
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Affiliation(s)
| | - Naomi Launders
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sarah Hardoon
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Kenneth K.C. Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
| | - Neil M. Davies
- Division of Psychiatry, University College London, London, United Kingdom
- Department of Statistical Sciences, University College London, London, United Kingdom
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elvira Bramon
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Joseph F. Hayes
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - David P.J. Osborn
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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30
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Birmpili P, Li Q, Johal AS, Atkins E, Waton S, Pherwani AD, Williams R, Chetter I, Boyle JR, Cromwell DA. Delays to Revascularisation and Outcomes of Non-Elective Admissions for Chronic Limb Threatening Ischaemia: a UK Population Based Cohort Study. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)01395-9. [PMID: 39725308 DOI: 10.1016/j.ejvs.2024.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 12/10/2024] [Accepted: 12/19/2024] [Indexed: 12/28/2024]
Abstract
OBJECTIVE Major amputation and death are significant outcomes after lower limb revascularisation for chronic limb threatening ischaemia (CLTI), but there is limited evidence on their association with the timing of revascularisation. The aim of this study was to examine the relationship between time from non-elective admission to revascularisation and one year outcomes for patients with CLTI. METHODS This was an observational, population based cohort study of patients aged ≥ 50 years with CLTI admitted non-electively for infrainguinal revascularisation procedures in English National Health Service hospitals from January 2017 to December 2019 recorded in the Hospital Episode Statistics database. Outcomes were death and ipsilateral major amputation rate at one year. Logistic regression models were fitted to explore the relationship between time to revascularisation and death, adjusted for patient and admission factors. For major amputation, multinomial logistic regression models were used to account for the competing risk of death. RESULTS A total of 10 183 patients (median age 75 years) were included in the analysis, of which 67.1% (n = 6 831) were male and 57.6% had diabetes. In patients with tissue loss, the unadjusted one year mortality rate was 30.0% (95% confidence interval [CI] 28.9 - 31.0%), and for every one day increase in time from admission to revascularisation, the adjusted odds of one year death increased by 3% (odds ratio 1.03, 95% CI 1.02 - 1.04). In the absence of tissue loss, the unadjusted one year mortality rate was 19.9% (95% CI 18.4 - 21.4%) and there was no evidence of an association with time to revascularisation. There was also no statistically significant association between the time to revascularisation and risk of ipsilateral major amputation at one year irrespective of tissue loss. CONCLUSION Patients undergoing infrainguinal revascularisation during non-elective admissions for CLTI have high one year major amputation and mortality rates. Longer time from admission to revascularisation was independently associated with a higher mortality rate in patients with tissue loss, but not in those without.
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Affiliation(s)
- Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, University of Hull, Hull, UK.
| | - Qiuju Li
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Amundeep S Johal
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Eleanor Atkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Hull York Medical School, University of Hull, Hull, UK
| | - Sam Waton
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arun D Pherwani
- Keele University School of Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Robin Williams
- Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ian Chetter
- Hull York Medical School, University of Hull, Hull, UK; Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust and Department of Surgery, University of Cambridge, Cambridge, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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31
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White B, Zakkak N, Renzi C, Rafiq M, Gonzalez-Izquierdo A, Denaxas S, Nicholson BD, Lyratzopoulos G, Barclay ME. Underlying disease risk among patients with fatigue: a population-based cohort study in primary care. Br J Gen Pract 2024:BJGP.2024.0093. [PMID: 39084871 PMCID: PMC11653409 DOI: 10.3399/bjgp.2024.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Presenting to primary care with fatigue is associated with a wide range of conditions, including cancer, although their relative likelihood is unknown. AIM To quantify associations between new-onset fatigue presentation and subsequent diagnosis of various diseases, including cancer. DESIGN AND SETTING A cohort study of patients presenting in English primary care with new-onset fatigue during 2007-2017 (the fatigue group) compared with patients who presented without fatigue (the non-fatigue group), using Clinical Practice Research Datalink data linked to hospital episodes and national cancer registration data. METHOD The excess short-term incidence of 237 diseases in patients who presented with fatigue compared with those who did not present with fatigue is described. Disease-specific 12-month risk by sex was modelled and the age-adjusted risk calculated. RESULTS The study included 304 914 people in the fatigue group and 423 671 in the non-fatigue group. In total, 127 of 237 diseases studied were more common in men who presented with fatigue than in men who did not, and 151 were more common in women who presented with fatigue. Diseases that were most strongly associated with fatigue included: depression; respiratory tract infections; insomnia and sleep disturbances; and hypo/hyperthyroidism (women only). By age 80 years, cancer was the third most common disease and had the fourth highest absolute excess risk in men who presented with fatigue (fatigue group: 7.01%, 95% confidence interval [CI] = 6.54 to 7.51; non-fatigue group: 3.36%, 95% CI = 3.08 to 3.67; absolute excess risk 3.65%). In women, cancer remained relatively infrequent; by age 80 years it had the thirteenth highest excess risk in patients who presented with fatigue. CONCLUSION This study ranked the likelihood of possible diagnoses in patients who presented with fatigue, to inform diagnostic guidelines and doctors' decisions. Age-specific findings support recommendations to prioritise cancer investigation in older men (aged ≥70 years) with fatigue, but not in women at any age, based solely on the presence of fatigue.
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Affiliation(s)
- Becky White
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Nadine Zakkak
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London; Cancer Intelligence, Cancer Research UK, London, UK
| | - Cristina Renzi
- ECHO Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK; associate professor, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Meena Rafiq
- ECHO Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK; Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Arturo Gonzalez-Izquierdo
- Centre for Health Data Science, Institute of Applied Health Research, University of Birmingham, Birmingham; Institute of Health Informatics (IHI), University College London, London, UK
| | - Spiros Denaxas
- IHI, University College London, London; British Heart Foundation Data Science Centre, London, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Matthew E Barclay
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK
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32
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Scott IC, Daud N, Bailey J, Twohig H, Hider SL, Mallen CD, Jordan KP, Muller S. Gabapentinoid use and the risk of fractures in patients with inflammatory arthritis: nested case-control study in the Clinical Practice Research Datalink Aurum. BMC Med 2024; 22:575. [PMID: 39663522 PMCID: PMC11636031 DOI: 10.1186/s12916-024-03774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 11/14/2024] [Indexed: 12/13/2024] Open
Abstract
BACKGROUND Gabapentinoids are increasingly prescribed in inflammatory arthritis (IA), despite no trial evidence for efficacy at managing pain in this population. Observational studies in non-IA populations suggest gabapentinoids are associated with fractures but are limited by methodological heterogeneity/potential residual confounding. Patients with IA generally have an increased risk of fracture so may be particularly vulnerable. We examined the relationship between fractures and gabapentinoids in patients with IA who had all been prescribed a gabapentinoid at some point (to minimise confounding by indication). METHODS Our matched case-control study used linked national data from English primary care (Clinical Practice Research Datalink Aurum) and Hospital Episode Statistics. A cohort was constructed of adults with IA, contributing data 01/01/2004-31/03/2021, and ever prescribed oral gabapentinoids. Cases with an incident fracture post-cohort inclusion were ascertained and 1:5 risk set-matched (on age/gender/gabapentinoid type) with controls. Gabapentinoid prescription exposure was categorised as follows: (a) current (overlapping with fracture date); (b) recent (ending 1-60 days pre-fracture); and (c) remote (ending > 60 days pre-fracture). Conditional logistic regression models determined ORs with 95% CIs for fractures with current or recent vs. remote gabapentinoid use, adjusting for confounders. RESULTS A total of 2485 cases (mean age 63.0 years; 79.4% female) and 12,244 controls (mean age 62.7 years; 79.6% female) were included. Of cases: 1512 received gabapentin, 910 pregabalin, and 63 both drugs; 65.6% were remote, 5.5% recent, and 28.9% current users. In adjusted models, current gabapentinoid use had an increased risk of fracture (OR vs. remote: 1.36 [95% CI 1.22, 1.51]). Similar associations were seen with gabapentin (OR 1.38 [1.19, 1.60]) and pregabalin (OR 1.40 [1.18, 1.66]). Similar or higher levels of association were seen for all gabapentin/pregabalin doses except moderate/very high dose gabapentin. Associations were strongest in those starting gabapentinoids more recently. CONCLUSIONS Our study suggests a modest association between current gabapentinoid use and fractures in patients with IA, after accounting for measured and time-invariant unmeasured confounding. Whilst other unmeasured confounding remains possible, given the absence of evidence for gabapentinoid efficacy in patients with IA who are particularly vulnerable to fractures, this highlights a need for efforts to deliver safer gabapentinoid prescribing in this population.
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Affiliation(s)
- Ian C Scott
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK.
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK.
| | - Noor Daud
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - James Bailey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Helen Twohig
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Samantha L Hider
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK
| | - Kelvin P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Faitna P, Harwood R, Kenny SE, Viner RM, Aylin PP, Hargreaves DS, Bottle A. The Impact of COVID-19 on Acute Surgeries in England Among the Under-25s: A Retrospective Study of 61,360 Appendicitis and 15,850 Testicular Torsion Admissions. J Pediatr Surg 2024; 59:161694. [PMID: 39261187 DOI: 10.1016/j.jpedsurg.2024.161694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Little is known about how COVID-19 impacted acute surgical activity for children and young people (CYP) across England. Appendicitis and testicular torsion are common surgical conditions where treatment delays can lead to avoidable complications. We undertook a retrospective national cohort study. PRIMARY AIM To describe monthly acute surgical activity in CYP during the COVID-19 pandemic. Secondary aim: To investigate evidence of delayed diagnosis and adverse outcomes, describing variations by age and socioeconomic deprivation. METHODS Acute hospital admissions with appendicitis or testicular pain for those under 18 were extracted using Hospital Episode Statistics. Interrupted time series modelling, Mann-Whitney and Pearson's Chi-Squared tests compared the first 14 pandemic months with the previous five years. Results were stratified by age (0-4s, 5-9s and 10-17s) and appendicitis type (all, simple and complex). RESULTS Admissions for appendicitis and testicular torsion fell significantly early in the COVID-19 pandemic. The proportion of children with complex appendicitis also increased during this time. Orchidectomy rates rose in April 2020 for the 0-4s (+15.6% (95% CI 7.9-23.3)) and 10-17s (+11.5% (4.9-18.2)), but when the pre-pandemic period was compared with the pandemic period as a whole, there were no overall statistically significant differences in orchidectomy rates between the study periods. Overall, there was a statistically significant rise in the orchidopexy rate during the pandemic period for the 10-17s when compared with the pre-pandemic period (Pre-pandemic: 17.0% vs Pandemic: 20.9%, p < 0.0001). CONCLUSION A consistent reduction in activity, with short-lived periods of delayed presentations during COVID-19 pandemic peaks, occurred without persisting overall increased complication rates. These results provide useful national context for smaller sized studies that reported complications due to delays in surgery. Future research could examine how reduced activity impacted other healthcare settings and treatment pathways. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Puji Faitna
- School of Public Health, Imperial College London, London, UK.
| | - Rachel Harwood
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Simon E Kenny
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK; NHS England and NHS Improvement, London, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Institute Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Paul P Aylin
- School of Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- School of Public Health, Imperial College London, London, UK; Mohn Centre for Children's Health and Wellbeing, Imperial College London, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
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34
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Hamoodi Z, Shapiro J, Sayers A, Whitehouse MR, Watts AC, Abbott J, Abbott S, Adebayo O, Ahmad K, Ahrens P, Akinfala M, Al-Hadithy N, Al-Najjar M, Amirfeyz R, Ankarath S, Ashton F, Aulton K, Auplish S, Austin J, Ayeko S, Azhar R, Bahia R, Baines S, Baldomir M, Barai S, Barkham B, Barrett E, Batten T, Bavan L, Baxter J, Beaumont S, Bentley J, Bhabra G, Bhat M, Bhatt A, Bhingraj M, Bhutta A, Bingham S, Blastland J, Boardman D, Boateng M, Bojarska K, Boksh K, Booker S, Borreshi S, Bould M, Boulton L, Brannan L, Breidaka Z, Brereton R, Brinsden M, Brooker J, Brookes S, Broux C, Brown E, Browne J, Bryant R, Buchanan J, Buck L, Burnett K, Burrows M, Burt J, Burton D, Butt U, Campaner B, Candal-Couto J, Carvell H, Chakravarthy J, Chatterji S, Chaudhury S, Chauhan GS, Chojnowski A, Cittambalam J, Clark D, Gosia Clarke M, Clarke B, Clelland A, Cochrane R, Colbridge K, Cook H, Cooper B, Correa E, Craven J, Crawford J, Curtis S, Cuthbert R, Dainton J, Dale L, Davies S, Davis J, Davis V, Dean B, Dehler T, Dennis S, Der Tavitian J, Desai A, Dhillon SS, Dias R, Dickinson G, Dirckx M, Dixon O, Docker C, Dodenhoff R, Domos P, Draviaraj K, Drew S, Duff C, Duffin S, Durham P, Earnshaw K, Edakalathur J, Edwards M, Elahi Z, Else S, Emara M, Eng K, Esfandiari A, Esler C, Evans J, Everall A, Eyre-Brook A, Farhan-Alanie M, Federer S, Ferdinandus S, Finch M, Fischer J, Flood C, Forde C, Forder J, Fowler L, Franklin M, Gacaferi H, Gamble D, Garg S, Gill V, Ginley J, Glancey E, Glanville G, Gmati A, Goddard K, Goel J, Goldsmith C, Gooding B, Goodwin F, Goring B, Goude W, Guyver P, Haines S, Haque A, Hardley T, Haritonow S, Harnett L, Harris J, Harris M, Harrison J, Hauffe I, Hawken A, Hawkes D, Hay S, Haywood M, Hedge S, Hickey S, Hickinson A, Higgs D, Hill R, Hill S, Hind J, Hitchcock M, Holdcroft T, Holdcroft E, Holliday A, Hudson S, Hughes H, Imtiaz R, Iqbal S, Jabr Y, Jackson C, Jameson J, Jayme O, Jennings A, Jenvey C, Jewitt E, Jimenez A, Joby J, Jones A, Jones N, Jovanovic J, Kabala V, Kang N, Kausor G, Kaynes S, Keane C, Keen L, Kelly G, Kent M, Kent J, Kerr C, Kerr J, King C, Kinnair A, Kinsley G, Konarski A, Kord J, Kumar H, Kumar S, Lafferty R, Lancaster P, Levitt W, Lewin A, Li Y, Liew I, Yizhe Lim M, Lipscombe S, Lynch E, MacInnes S, Madden P, Maddocks N, Mahajan R, Mahoney R, Malik S, Mannan S, Maris A, Markey M, Martin C, Martin R, Masunda S, Mazis G, Mcauliffe AM, McBride T, McGowan A, Mckeown N, McLauchlan G, McNally D, Melton J, Miller J, Millyard C, Mitchell C, Mohamed F, Mohamed A, Charlotte Montgomery H, Munn D, Mutimer J, Nanda R, Neen D, Newton L, Newton A, Nicholl A, Nightingale J, Ogden E, Orton P, Oswald L, Page K, Paius M, Papanna M, Patel N, Paul C, Peach C, Pegg D, Penfold S, Phillips E, Pickering G, Plakogiannis C, Platt J, Pole C, Potter R, Povall K, Pradhan R, Prasad G, Price K, Pride J, Prins A, Qazzaz L, Radhakrishnan A, Ramesh A, Rashid A, Rashid A, Rasidovic D, Ratford E, Rayner J, Rhee J, Rice-Evans M, Ricketts M, Roach D, Waters ER, Robinson S, Robinson P, Rodgers S, Rogers E, Rooney A, Rossouw D, Roy B, Sadiqi M, Sagmeister M, Samy D, Sanders P, Sanderson K, Sandher D, Sargazi N, Saunders M, Saunders N, Savage K, Sawalha S, Schouw M, Scott G, Selzer G, Sepesiova L, Shah S, Shahane S, Shaw G, Shrestha S, Shutt J, Siddiqui N, Sidharthan S, Simons A, Simpson V, Sinclair P, Siney P, Singh J, Singh B, Singh H, Sinha A, Smith C, Smith C, Smith K, Somanchi B, Soufan M, Southgate C, Southgate J, Spearpoint N, Stainer R, Stevens R, Stimler B, Stone A, Suter D, Talbot C, Tareef T, Theivendran K, Thomas B, Thomas W, Thompson A, Thompson J, Thornhill E, Titchener A, Townley M, Tozer T, Truman J, Truss A, Turner R, Van Rensburg L, Venugopal V, Vollans S, Waller L, Walsh A, Waraich A, Wei N, James White W, Wilkinson M, Williams D, Williams P, Williams N, Wilson S, Wood D, Yadu S, Yarashi T, Zeolla J, Zreik NH, Ollivere B. The National Joint Registry Data Quality Audit of elbow arthroplasty. Bone Joint J 2024; 106-B:1461-1468. [PMID: 39618239 DOI: 10.1302/0301-620x.106b12.bjj-2023-1372.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
Aims The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow. Methods It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them. Results Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties. Conclusion The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.
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Affiliation(s)
- Zaid Hamoodi
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - Joanne Shapiro
- National Joint Registry, London, UK
- NEC Software Solutions, Hemel Hempstead, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | | | - Sarah Abbott
- Epsom and St Helier University Hospitals NHS Trust, Sutton, UK
| | - Oliver Adebayo
- Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Kashif Ahmad
- Mid Cheshire Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Rouin Amirfeyz
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sudhi Ankarath
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Fiona Ashton
- Northumbria Healthcare NHS Foundation Trust, London, UK
| | | | - Sunil Auplish
- York and Scarborough Teaching Hospital NHS Foundation Trust, North Yorkshire, UK
| | - Jane Austin
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Segun Ayeko
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Raja Azhar
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Rish Bahia
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Steven Baines
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Goole, UK
| | - Marisol Baldomir
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Sneha Barai
- North West Anglia NHS Foundation Trust, London, UK
| | | | - Emily Barrett
- Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | | | | | | | | | - James Bentley
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gev Bhabra
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mahendar Bhat
- South Warwickshire NHS Foundation Trust, South Warwickshire, UK
| | - Ankit Bhatt
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Aqeel Bhutta
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | | | - Jenny Blastland
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Goole, UK
| | - David Boardman
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | | | - Khalis Boksh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Simon Booker
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Michael Bould
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lesley Boulton
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Linda Brannan
- University Hospitals Dorset NHS Foundation Trust, London, UK
| | - Zarina Breidaka
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | | | - Mark Brinsden
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Joanne Brooker
- University Hospitals Sussex NHS Foundation Trust, London, UK
| | - Sabine Brookes
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Cheryl Broux
- Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Elke Brown
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Jacqueline Browne
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Lisa Buck
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Melanie Burrows
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Jill Burt
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - David Burton
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Usman Butt
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | | | | | - Hannah Carvell
- University Hospitals Dorset NHS Foundation Trust, London, UK
| | | | | | | | | | - Adrian Chojnowski
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - David Clark
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Ben Clarke
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK
| | - Andrew Clelland
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Roz Cochrane
- York and Scarborough Teaching Hospital NHS Foundation Trust, North Yorkshire, UK
- York and Scarborough Teaching Hospital NHS Foundation Trust, North Yorkshire, UK
| | | | | | | | | | - Joanna Craven
- Mid Cheshire Hospitals NHS Foundation Trust, London, UK
| | | | - Sherri Curtis
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK
| | - Rory Cuthbert
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Lisa Dale
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sammy Davies
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, UK
| | - Joanne Davis
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Vicky Davis
- Epsom and St Helier University Hospitals NHS Trust, Sutton, UK
| | - Ben Dean
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Tom Dehler
- South Tyneside and Sunderland NHS Foundation Trust, South Tyneside, UK
| | - Sonu Dennis
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Aravind Desai
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Goole, UK
| | | | - Richard Dias
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Margo Dirckx
- Epsom and St Helier University Hospitals NHS Trust, Sutton, UK
| | - Oliver Dixon
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | - Peter Domos
- Royal Free London NHS Foundation Trust, London, UK
| | | | - Steven Drew
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Caroline Duff
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Sarah Duffin
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | - Jefin Edakalathur
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, UK
| | - Michelle Edwards
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | - Zain Elahi
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Moustafa Emara
- South Warwickshire NHS Foundation Trust, South Warwickshire, UK
| | - Khemerin Eng
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | | | - Colin Esler
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jon Evans
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | | | | | | | - Simon Federer
- University Hospitals Sussex NHS Foundation Trust, London, UK
| | | | - Marie Finch
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | | | | | | | - Justin Forder
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Lisa Fowler
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Marieta Franklin
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - David Gamble
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sunil Garg
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Vicki Gill
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Jean Ginley
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Emma Glancey
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Gemma Glanville
- United Lincolnshire Hospitals NHS Trust, Gonerby Hill Foot, UK
| | - Aimen Gmati
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Karen Goddard
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jay Goel
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Carly Goldsmith
- United Lincolnshire Hospitals NHS Trust, Gonerby Hill Foot, UK
| | - Ben Gooding
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fiona Goodwin
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, UK
| | | | - Will Goude
- Walsall Healthcare NHS Trust, Walsall, UK
| | - Paul Guyver
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Aziz Haque
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Thomas Hardley
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Susan Haritonow
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Louise Harnett
- South Tyneside and Sunderland NHS Foundation Trust, South Tyneside, UK
| | - Joanna Harris
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Margaret Harris
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | - Jane Harrison
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Isabelle Hauffe
- University Hospitals Sussex NHS Foundation Trust, London, UK
| | - Archie Hawken
- Torbay South Devon NHS Foundation Trust, Torquay, UK
| | - Dave Hawkes
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stuart Hay
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, UK
| | - Mia Haywood
- Chesterfield Royal Hospital NHS Foundation Trust, Calow, UK
| | - Siddhant Hedge
- South Warwickshire NHS Foundation Trust, South Warwickshire, UK
| | - Susan Hickey
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Anne Hickinson
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Goole, UK
| | - Deborah Higgs
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Richard Hill
- University Hospitals Sussex NHS Foundation Trust, London, UK
| | - Sharyn Hill
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - Jamie Hind
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Terry Holdcroft
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | | | - Ann Holliday
- Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - Siobhan Hudson
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hazel Hughes
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Rabia Imtiaz
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | | | - Yamen Jabr
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | | | - Jackie Jameson
- University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK
| | - Odette Jayme
- Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Andrew Jennings
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Cara Jenvey
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | | | - Andreea Jimenez
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - John Joby
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK
| | - Adrian Jones
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Vanessa Kabala
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Niel Kang
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gulnaz Kausor
- South Warwickshire NHS Foundation Trust, South Warwickshire, UK
| | - Sarah Kaynes
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Conal Keane
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Lauren Keen
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Gaynor Kelly
- York and Scarborough Teaching Hospital NHS Foundation Trust, North Yorkshire, UK
| | - Matthew Kent
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jonathan Kent
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Carla Kerr
- North Cumbria Integrated Care NHS Foundation Trust, Lancaster, UK
| | - Julie Kerr
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Christina King
- North Cumbria Integrated Care NHS Foundation Trust, Lancaster, UK
| | | | - Gemma Kinsley
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Jacqueline Kord
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Hari Kumar
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | - Sachin Kumar
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, UK
| | - Rebecca Lafferty
- Wrightington Wigan and Leigh NHS Foundation Trust, Wrightington, UK
| | | | - William Levitt
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | | | | | - Martin Yizhe Lim
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | | | | | - Scott MacInnes
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | - Paula Madden
- Wrightington Wigan and Leigh NHS Foundation Trust, Wrightington, UK
| | | | | | - Rachel Mahoney
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sheraz Malik
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Syed Mannan
- North Cumbria Integrated Care NHS Foundation Trust, Lancaster, UK
| | | | - Michael Markey
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | | | - Rebecca Martin
- North Cumbria Integrated Care NHS Foundation Trust, Lancaster, UK
| | - Stanley Masunda
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - George Mazis
- Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | | | - Tim McBride
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Amy McGowan
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Nicolee Mckeown
- University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK
| | | | - Debbie McNally
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joel Melton
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jane Miller
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Claire Mitchell
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Foad Mohamed
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Darren Munn
- Torbay South Devon NHS Foundation Trust, Torquay, UK
| | - John Mutimer
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Rajesh Nanda
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Daniel Neen
- Dartford and Gravesham NHS Trust, Dartford, UK
| | - Lynne Newton
- Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Ashley Newton
- Wrightington Wigan and Leigh NHS Foundation Trust, Wrightington, UK
| | - Aly Nicholl
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | | | - Emma Ogden
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Peter Orton
- Stockport NHS Foundation Trust, Stockport, UK
| | - Lynda Oswald
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - Kelly Page
- Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Maria Paius
- University Hospitals Dorset NHS Foundation Trust, London, UK
| | - Madhavan Papanna
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | - Neelam Patel
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Claudia Paul
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Chris Peach
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Derek Pegg
- Mid Cheshire Hospitals NHS Foundation Trust, London, UK
| | - Sue Penfold
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Eleanore Phillips
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | - Julie Platt
- Wrightington Wigan and Leigh NHS Foundation Trust, Wrightington, UK
| | - Craig Pole
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Richard Potter
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, UK
| | - Kate Povall
- Dartford and Gravesham NHS Trust, Dartford, UK
| | | | - Ganesh Prasad
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Karen Price
- South Warwickshire NHS Foundation Trust, South Warwickshire, UK
| | - Julie Pride
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Afnan Prins
- South Warwickshire NHS Foundation Trust, South Warwickshire, UK
| | - Layth Qazzaz
- Mid and South Essex NHS Foundation Trust, Basildon, UK
| | | | | | - Adil Rashid
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, South Yorkshire, UK
| | - Abbas Rashid
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Damir Rasidovic
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Emily Ratford
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Jan Rayner
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jae Rhee
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | | | | | | | - Eve R Waters
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon Robinson
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | | | - Samantha Rodgers
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emma Rogers
- University Hospitals Dorset NHS Foundation Trust, London, UK
| | - Aaron Rooney
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Dan Rossouw
- Royal Free London NHS Foundation Trust, London, UK
| | - Bibhas Roy
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Maseh Sadiqi
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - David Samy
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | | | | | | | - Nastaran Sargazi
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mark Saunders
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Nicky Saunders
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Kim Savage
- Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Seif Sawalha
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | | | | | | | | | - Sohan Shah
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Grant Shaw
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - John Shutt
- County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | | | | | - Adrian Simons
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Vera Simpson
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Paul Siney
- Wrightington Wigan and Leigh NHS Foundation Trust, Wrightington, UK
| | | | | | | | - Apurv Sinha
- Chesterfield Royal Hospital NHS Foundation Trust, Calow, UK
| | - Callum Smith
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Christopher Smith
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Kerry Smith
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Brinda Somanchi
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | | | | | | | | | | | | | - Andrew Stone
- University Hospitals Sussex NHS Foundation Trust, London, UK
| | | | - Charlie Talbot
- Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Tareq Tareef
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | - William Thomas
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Andrew Thompson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Tina Tozer
- The Hillingdon Hospital NHS Foundation Trust, Uxbridge, UK
| | - Jennie Truman
- York and Scarborough Teaching Hospital NHS Foundation Trust, North Yorkshire, UK
| | - Adam Truss
- East Cheshire NHS Trust, Macclesfield, UK
| | - Rob Turner
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Lee Van Rensburg
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Sam Vollans
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Louise Waller
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Anna Walsh
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Aleena Waraich
- St Helens and Knowsley Hospitals NHS Trust, St. Helens, UK
| | - Nicholas Wei
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | | | | | | | | | - Nicola Williams
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Stephanie Wilson
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, UK
| | - David Wood
- Chesterfield Royal Hospital NHS Foundation Trust, Calow, UK
| | - Shirley Yadu
- North West Anglia NHS Foundation Trust, London, UK
| | - Tejas Yarashi
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Nasri H Zreik
- St Helens and Knowsley Hospitals NHS Trust, St. Helens, UK
| | - Ben Ollivere
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Mansi ET, Rentsch CT, Bourne RS, Guthrie B, Lone NI. Patient Characteristics and Practice Variation Associated With New Community Prescription of Benzodiazepine and z-Drug Hypnotics After Critical Illness: A Retrospective Cohort Study Using the UK Clinical Practice Research Datalink. Pharmacoepidemiol Drug Saf 2024; 33:e70056. [PMID: 39603606 PMCID: PMC11602247 DOI: 10.1002/pds.70056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 10/01/2024] [Accepted: 10/25/2024] [Indexed: 11/29/2024]
Abstract
PURPOSE Survivors of critical illness are often affected by new or worsened mental health conditions and sleep disorders. We examined the incidence, practice variation and factors associated with new benzodiazepine and z-drug community prescriptions among critical illness survivors. METHODS A retrospective cohort study using the UK Clinical Practice Research Datalink data included 52 846 adult critical care survivors hospitalised in 2010 and 2018 who were not prescribed benzodiazepines or z-drugs before hospitalisation. We performed multilevel multivariable logistic regression to assess patient factors associated with new (any prescription within 90 days) and with new-and-persistent (2+ prescriptions within 180 days) benzodiazepine or z-drug prescribing, and to evaluate variation by primary care practice. RESULTS 5.2% (2769/52846) of treatment-naïve survivors (95% CI 5.1-5.4) were prescribed a benzodiazepine or z-drug, and 2.5% (1311/52846) had new-and-persistent prescribing. A history of insomnia (adjusted OR 1.96; 95% CI 1.74-2.21), anxiety or depression (adjusted OR 1.40; 95% CI 1.28-1.53) and recent prescription opioid use (adjusted OR 1.47; 95% CI 1.34-1.61) were associated with new community prescription. Sex was not associated with new prescriptions and older patients were less likely to receive a prescription. 2.6% of the variation in new prescribing and 4.1% of the variation in new-and-persistent prescribing were attributable to the prescribing practice. CONCLUSIONS One in twenty critical illness survivors receive a new community benzodiazepine or z-drug prescription. Further research is needed to understand where in the patient care pathway initiation occurs and the risk of adverse events in survivors of recent critical illness.
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Affiliation(s)
| | - Christopher T. Rentsch
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Department of Internal MedicineYale School of MedicineNew HavenUSA
| | - Richard S. Bourne
- Department of Pharmacy and Critical CareSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
- Division of Pharmacy and OptometrySchool of Health Sciences, Faculty of Biology, Medicine and Health, the University of ManchesterManchesterUK
| | - Bruce Guthrie
- Usher InstituteUniversity of EdinburghEdinburghUK
- Advanced Care Research Centre, University of EdinburghEdinburghUK
| | - Nazir I. Lone
- Usher InstituteUniversity of EdinburghEdinburghUK
- University Department of Anaesthesia, Critical Care, and Pain MedicineSchool of Clinical Sciences, University of EdinburghEdinburghUK
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Avenoso D, Davidson JA, Larvin H, Brewer HR, Rice CT, Ecsy K, Sil A, Skinner L, Hudson RDA. Healthcare Resource Utilization and Associated Costs in Patients With Chronic Graft-Versus-Host Disease Post-Allogeneic Hematopoietic Stem Cell Transplantation in England. Transplant Cell Ther 2024; 30:1207.e1-1207.e11. [PMID: 39389467 DOI: 10.1016/j.jtct.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/27/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024]
Abstract
Limited evidence suggests chronic graft-versus-host disease (cGvHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) increases healthcare resource utilization (HCRU) and costs. However, this burden has not been well characterized in England. This study assesses secondary care HCRU and costs for patients following allo HSCT in England with cGvHD and patients who did not develop graft-versus-host disease (GvHD). Further stratification was performed among patients who did or did not subsequently receive high-cost therapies for the treatment of cGvHD. This descriptive, retrospective cohort study used Hospital Episode Statistics (HES) data from April 2017 to March 2022. HES data captures information on reimbursed diagnoses and procedures from all National Health Service (NHS) secondary care admissions and attendances in England. High-cost drugs as defined by NHS England are recorded in HES, these drugs and other procedures including plasma exchange, were used to identify patients with cGvHD who were in receipt of high-cost therapies. HCRU and costs were described for patients with cGvHD following allo-HSCT (n = 721) and were matched with patients with no evidence of GvHD following allo-HSCT (n = 718). HCRU and costs were also described for the subset of patients with cGvHD (n = 198) following receipt of high-cost therapies and patients with cGvHD prior to or without such therapies (n = 523). A higher proportion of patients with cGvHD had at least one inpatient or intensive care unit (ICU) admission or emergency care attendance than patients without GvHD (inpatient: 74.6% versus 66.6%; emergency care: 39.3% versus 30.5%; ICU: 7.4% versus 4.7%; respectively); whilst the proportion of patients with an outpatient attendance were similar for both groups (outpatient: 80.3% versus 84.1%; respectively). The cost across all secondary care settings was higher for patients with cGvHD than patients without GvHD, with a mean cost of inpatient admissions of £17,339 per patient-year for those with cGvHD versus £8548 per patient-year in patients without GvHD. A higher proportion of patients who received high-cost therapies for the treatment of cGvHD had at least one secondary care admission or attendance, than patients who did not (inpatient: 85.4% versus 66.4%; ICU: 7.1% versus 5.4%; outpatient: 87.9% versus 76.7%; emergency care: 44.4% versus 36.5%; respectively). Patients who were treated with high-cost therapies for the treatment of cGvHD had a greater mean number (14.6 versus 8.2 per patient-year, respectively) for all-cause inpatient admissions after treatment than patients who did not. In all secondary care settings, the total cost per patient-year was higher for patients who received high-cost therapies for the treatment of cGvHD, than for those who did not. Patients who were treated with high-cost therapies for the treatment of cGvHD had a greater mean cost (£21,137 versus £15,956 per patient-year, respectively) for all-cause inpatient admissions than patients who did not. This study demonstrates that cGvHD and the use of associated high-cost therapies impacts healthcare activity and costs across various secondary care settings in England more than patients without GvHD and patients with cGvHD who received no high-cost therapies.
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Affiliation(s)
- Daniele Avenoso
- Department of Haematological Medicine, King's College Hospital, London, UK.
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Mellor J, Jones O, Ward T. The Impact of Healthcare Pressures on the COVID-19 Hospitalisation Fatality Risk in England. J Epidemiol Glob Health 2024; 14:1579-1590. [PMID: 39378019 PMCID: PMC11652468 DOI: 10.1007/s44197-024-00310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 09/24/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND As the impact of the SARS-CoV-2 pandemic extends into 2023 and beyond, the treatment and outcomes of infected patients continues to evolve. Unlike earlier in the pandemic there are now further infectious disease pressures placed on hospitals, which influence patient care and triage decisions. METHODS The manuscript uses individual patient records linked with associated hospital management information of system pressure characteristics to attribute COVID-19 hospitalisation fatality risks (HFR) to patients and hospitals, using generalised additive mixed effects models. RESULTS Between 01 September 2022 and 09 October 2023, the COVID-19 hospitalisation fatality risk in England was estimated as 12.71% (95% confidence interval (CI) 12.53%, 12.88%). Staff absences had an adjusted odds ratio of 1.038 (95% CI 1.017, 1.060) associated with the HFR when accounting for patient and hospital characteristics. INTERPRETATION This observational research presents evidence that a range of local hospital effects can have a meaningful impact on the risk of death from COVID-19 once hospitalised and should be accounted for when reporting estimates. We show that both the patient case mix and hospital pressures impact estimates of patient outcomes.
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Affiliation(s)
- Jonathon Mellor
- UK Health Security Agency, 10 South Colonnade, Poplar, London, UK.
| | - Owen Jones
- UK Health Security Agency, 10 South Colonnade, Poplar, London, UK
| | - Thomas Ward
- UK Health Security Agency, 10 South Colonnade, Poplar, London, UK
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Plumb L, Steenkamp R, Hamilton AJ, Maxwell H, Inward CD, Marks SD, Nitsch D. The spectrum of co-existing disease in children with established kidney failure using registry and linked electronic health record data. Pediatr Nephrol 2024; 39:3521-3531. [PMID: 39112637 PMCID: PMC11511698 DOI: 10.1007/s00467-024-06470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Children with established kidney failure may have additional medical conditions influencing kidney care and outcomes. This cross-sectional study aimed to examine the prevalence of co-existing diseases captured in the electronic hospital record compared to UK Renal Registry (UKRR) data and differences in coding. METHODS The study population comprised children aged < 18 years receiving kidney replacement therapy (KRT) in England and Wales on 31/12/2016. Comorbidity data at KRT start was examined in the hospital record and compared to UKRR data. Agreement was assessed by the kappa statistic. Associations between patient and clinical factors and likelihood of coding were examined using multivariable logistic regression. RESULTS A total of 869 children (62.5% male) had data linkage for inclusion. UKRR records generally reported a higher prevalence of co-existing disease than electronic health records; congenital, non-kidney disease was most commonly reported across both datasets. The highest sensitivity in the hospital record was seen for congenital heart disease (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.51, 0.78) and malignancy (OR 0.63, 95% CI 0.41, 0.85). At best, moderate agreement (kappa ≥ 0.41) was seen between the datasets. Factors associated with higher odds of coding in hospital records included age, while kidney disease and a higher number of comorbidities were associated with lower odds of coding. CONCLUSIONS Health records generally under-reported co-existing disease compared to registry data with fair-moderate agreement between datasets. Electronic health records offer a non-selective overview of co-existing disease facilitating audit and research, but registry processes are still required to capture paediatric-specific variables pertinent to kidney disease.
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Affiliation(s)
- Lucy Plumb
- UK Renal Registry, UK Kidney Association, Brandon House Building 20A1, Filton 20, Filton, Bristol, BS34 7RR, UK.
- Population Health Sciences, University of Bristol Medical School, Bristol, UK.
| | - Retha Steenkamp
- UK Renal Registry, UK Kidney Association, Brandon House Building 20A1, Filton 20, Filton, Bristol, BS34 7RR, UK
| | | | - Heather Maxwell
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, UK
| | - Carol D Inward
- Department of Paediatric Nephrology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Brandon House Building 20A1, Filton 20, Filton, Bristol, BS34 7RR, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Mahmoudpour SH, Knott C, Kearney M, Russo L, Verpillat P. Factors associated with receipt of systemic anticancer treatment for locally advanced or metastatic urothelial carcinoma in England: a population-based study. Urol Oncol 2024; 42:451.e11-451.e18. [PMID: 39069443 DOI: 10.1016/j.urolonc.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/06/2024] [Accepted: 07/07/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Systemic anticancer therapy for locally advanced or metastatic urothelial carcinoma (la/mUC) is associated with efficacy benefits, including longer overall survival (OS), but many patients remain untreated. This observational, real-world, national study aimed to investigate factors associated with receiving systemic anticancer therapy for la/mUC in England. PATIENTS AND METHODS Adults diagnosed with la/mUC between 2013 and 2019 were identified in the National Cancer Registration Dataset and followed until March 2021. Healthcare and comorbidity data were obtained from Hospital Episode Statistics Admitted Patient Care and Outpatient datasets. Treatment data were obtained from the Systemic Anti-Cancer Therapy dataset. Factors associated with treatment were identified using multivariable logistic regression. OS from la/mUC diagnosis was estimated using Kaplan-Meier methodology. RESULTS Of 16,610 patients diagnosed with la/mUC, 5,191 (31%) received systemic anticancer therapy; 4,700 (91%) received platinum-based chemotherapy. Only 18% of patients were cisplatin ineligible. Patients were significantly less likely to receive treatment if they were female, cisplatin ineligible, older, or diagnosed before 2018; had laUC, an Eastern Cooperative Oncology Group performance status >1, or greater comorbidity; or resided outside London or in income-deprived areas. Median OS (95% CI) from diagnosis in treated vs. untreated patients was 19.9 (19.4-20.6) vs. 5.8 (5.6-6.0) months, respectively. Limitations include retrospective analysis of data not initially collected for research purposes. CONCLUSION From 2013 to 2019, ≈70% of patients with la/mUC in England were untreated, which is high given the availability of effective treatments. Reasons for undertreatment should be addressed. Given the evolving treatment landscape, analysis of more recent data would be informative. MICROABSTRACT This study investigated systemic anticancer treatment for patients diagnosed with advanced urothelial carcinoma in England between 2013 and 2019. Of 16,610 patients, 31% received treatment. Various factors were associated with not receiving treatment, including female sex, older age, worse performance status, greater comorbidity, and resident in income-deprived areas. Median overall survival in treated vs. untreated patients was 19.9 vs. 5.8 months.
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Affiliation(s)
| | - Craig Knott
- Health Data Insight CIC, Fulbourn, United Kingdom; NHS Digital, Leeds, United Kingdom
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40
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Purkayastha M, Sutcliffe A, Brison DR, Nelson SM, Lawlor D, Roberts SA. Perinatal health in a cohort of children conceived after assisted reproduction in the UK: a population-based record-linkage study. BMJ Open 2024; 14:e091910. [PMID: 39532353 PMCID: PMC11555099 DOI: 10.1136/bmjopen-2024-091910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVE To compare the risk of hospitalisation for conditions originating in the perinatal period between children conceived via assisted reproductive technology and those that are naturally conceived, differentiating by treatment type. STUDY DESIGN, SETTING AND PARTICIPANTS Population-based record-linkage study of children born after assisted reproduction in the UK between 2002 and 2009 (n=44 618), their naturally conceived siblings (n=8462) and matched naturally conceived population (n=89 072) controls linked to their hospital inpatient records up to 31 March 2016. PRIMARY AND SECONDARY OUTCOME MEASURES Robust estimates of the overall and cause-specific risk of hospital admission for adverse perinatal events and the comparison of outcomes by type of treatment. RESULTS Over the study period, 17 132 (38.40%) children conceived via assisted reproduction and 30 306 (34.02%) and 1738 (20.54%) naturally conceived population and sibling controls, respectively, were admitted to the hospital for severe perinatal events. Compared with the population controls, singletons (Risk ratio (95% CI 1.30 (1.26, 1.34))) and twins (1.01 (0.99, 1.03)) conceived via assisted reproduction exhibited a higher risk of hospitalisation for any adverse perinatal event. However, no such increase was observed in the within-sibling analysis (0.97 (0.84, 1.12)). Similar patterns were seen for diagnoses related to length of gestation and fetal growth (vs population controls: 1.37 (1.29, 1.46); vs siblings: 1.17 (0.86, 1.60)); birth trauma (vs population controls: 1.23 (1.04, 1.44); vs siblings: 0.78 (0.47, 1.30)); respiratory and cardiovascular disorders (vs population controls: 1.28 (1.20, 1.38); vs siblings: 0.72 (0.53, 0.98)); infections (vs population controls: 1.30 (1.06, 1.59); vs siblings: 0,68 (0.24, 1.90)) and several other conditions. Associations were similar when comparing in vitro fertilisation to intracytoplasmic sperm injection and were higher when comparing fresh to frozen embryo transfers. CONCLUSION Children conceived via assisted reproduction showed modest increases in the risk of hospitalisations for severe perinatal events when compared with population controls, although these findings were attenuated in the sibling analyses. The imprecision of within-sibling analyses highlights the need for larger studies to explore potential causal effects.
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Affiliation(s)
| | | | - Daniel R Brison
- Division of Developmental Biology & Medicine, The University of Manchester, Manchester, UK
| | - Scott M Nelson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Deborah Lawlor
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Stephen A Roberts
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
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Lewer D, Brown M, Burns A, Eastwood N, Gittins R, Holland A, Hope V, Ko A, Lewthwaite P, Morris AM, Noctor A, Preston A, Scott J, Smith E, Sweeney S, Tilouche N, Wickremsinhe M, Harris M. Improving hospital-based opioid substitution therapy (iHOST): protocol for a mixed-methods evaluation. NIHR OPEN RESEARCH 2024; 4:10. [PMID: 39568556 PMCID: PMC11576563 DOI: 10.3310/nihropenres.13534.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/05/2024] [Indexed: 11/22/2024]
Abstract
Background Opioid substitution therapy (also known as 'opioid agonist therapy' or 'medication treatment of opioid use disorder') is associated with improved health and social outcomes for people who use heroin and other illicit opioids. It is typically managed in the community and is not always continued when people are admitted to hospital. This causes opioid withdrawal, patient-directed discharge, and increased costs. We are establishing a project called iHOST (improving hospital opioid substitution therapy) to address these problems. This is an applied health research project in which we will develop and evaluate an intervention that aims to improve opioid substitution therapy in three acute hospitals in England. The intervention was developed in collaboration with stakeholders including people who use opioids, hospital staff, and other professionals who work with this group. It includes five components: (1) a card that patients can use to help hospital clinicians confirm their opioid substitution therapy, (2) a helpline for patients and staff, (3) an online training module for staff, (4) a clinical guideline for managing opioid withdrawal in hospital, and (5) 'champion' roles at each hospital. Methods We will do a mixed-methods study including a quasi-experimental quantitative study and a qualitative process evaluation. The primary outcomes for the quantitative study are patient-directed discharge and emergency readmission within 28 days. We will do a difference-in-difference analysis comparing changes in these outcomes for patients at iHOST sites with changes for patients at control hospitals. The process evaluation will use in-depth interviews, focus groups, and site observations with people who use opioids and staff. We will assess acceptability of the intervention, barriers and facilitators to implementation, and contextual factors impacting outcomes. Impact We anticipate that iHOST will improve care for hospital patients who use illicit opioids and/or are receiving community-based opioid substitution therapy. Depending on the results, we will promote the intervention at hospitals across the UK. Dissemination, including through publication, will inform hospital-based services for people who use drugs both in the UK and other countries.
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Affiliation(s)
- Dan Lewer
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England, BD9 6RJ, UK
- University College London, London, England, WC1E 6AE, UK
| | - Michael Brown
- University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
- Exchange Supplies, Dorchester, DT1 1RD, UK
| | - Adam Burns
- Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | | | | | - Adam Holland
- University of Bristol, Bristol, England, BS8 1QU, UK
| | - Vivian Hope
- Liverpool John Moores University, Liverpool, England, L2 2QP, UK
| | - Aubrey Ko
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | - Ann-Marie Morris
- University Hospital of the North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Adrian Noctor
- University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | | | - Jenny Scott
- University of Bristol, Bristol, England, BS8 1QU, UK
| | - Erica Smith
- University Hospital of the North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Sedona Sweeney
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Nerissa Tilouche
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | - Magdalena Harris
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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Han L, Mayne E, Dodkins J, Sullivan R, Cook A, Parry M, Nossiter J, Cowling TE, Tree A, Clarke N, van der Meulen J, Aggarwal A. Is Centralisation of Cancer Services Associated With Under-Treatment of Patients With High-Risk Prostate Cancer?-A National Population-Based Study. Cancer Med 2024; 13:e70403. [PMID: 39526482 PMCID: PMC11551782 DOI: 10.1002/cam4.70403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/17/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Centralising prostate cancer surgical and radiotherapy services, requires some patients to travel longer to access treatment, but its impact on actual treatment utilisation and outcomes is unknown. METHODS Using national cancer registry records linked to administrative hospital data, we identified all patients with high risk and locally advanced prostate cancer diagnosed between 1 April 2019 and 31 March 2020 in the English National Health Service (n = 15,971). Estimated travel times from the patient residential areas to the nearest hospital providing surgery or radiotherapy were estimated for journeys by car and by public transport. Multivariable logistic regression was used to model relationships between travel time and receipt of care with adjustment for patient characteristics. RESULTS 10,693 (67%) men received radical surgery or radiotherapy (RT) within 12 months of diagnosis. Average travel time to the nearest hospital providing prostatectomy or RT was 23.2 min by private car and 58.2 min by public transport. We found no association between travel time, either by car or public transport and the likelihood of receiving curative treatment. Patients living in the most socially deprived areas, those aged over 70, those with two or more comorbidities, and those of black ethnic origin, were less likely to receive curative treatment (p& =& 0.001 for all associations). CONCLUSIONS The current configuration of national prostate cancer services is not associated with the likelihood of receiving curative treatment. Further increases in capacity will unlikely improve utilisation rates beyond addressing sociodemographic barriers.
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Affiliation(s)
- Lu Han
- Faculty of Public Health and PolicyThe London School of Hygiene and Tropical MedicineLondonUK
| | - Emily Mayne
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Joanna Dodkins
- Faculty of Public Health and PolicyThe London School of Hygiene and Tropical MedicineLondonUK
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | | | - Adrian Cook
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Matthew Parry
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of UrologyUniversity College LondonLondonUK
| | - Julie Nossiter
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Thomas E. Cowling
- Faculty of Public Health and PolicyThe London School of Hygiene and Tropical MedicineLondonUK
| | - Alison Tree
- Department of RadiotherapyThe Royal Marsden HospitalLondonUK
| | - Noel Clarke
- Department of UrologyThe Christie NHS TrustLondonUK
| | - Jan van der Meulen
- Faculty of Public Health and PolicyThe London School of Hygiene and Tropical MedicineLondonUK
| | - Ajay Aggarwal
- Faculty of Public Health and PolicyThe London School of Hygiene and Tropical MedicineLondonUK
- Department of OncologyGuy's & St Thomas' NHS TrustLondonUK
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Fife K, Pearson C, Knott CS, Greaves A, Stewart GD. Variability in Kidney Cancer Treatment and Survival in England: Results of a National Cohort Study. Clin Oncol (R Coll Radiol) 2024; 36:e429-e438. [PMID: 39242248 DOI: 10.1016/j.clon.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/22/2024] [Accepted: 08/01/2024] [Indexed: 09/09/2024]
Abstract
AIMS To establish whether there are geographic differences in treatments and outcomes for patients with kidney cancer (KC) in England which could potentially be improved by the creation of national guidelines. MATERIALS AND METHODS A multidisciplinary group convened by the charity Kidney Cancer UK developed Quality Performance Indicators (QPIs) for the treatment of KC. Adherence to these QPIs was reported for all patients with a histological diagnosis of KC diagnosed in England between 2017 and 2018. Utilising data extracted from national datasets, logistic and linear probability models were used to estimate geographic variation in the delivery of surgery and systemic anti-cancer therapy at Cancer Alliance and NHS trust levels. Results were adjusted for a priori confounders, including age at diagnosis, area deprivation of residence, and Charlson Comorbidity Index. Differences in overall survival are reported. RESULTS The cohort comprised 18,640 tumours in 18,421 patients. Of tumours diagnosed, median patient age was 68 (interquartile range 58-77) years and 63.4% were in males. When stratified by Cancer Alliance, the proportions of T1a/T1b/N0/M0 KC that had radical nephrectomy (RN), nephron sparing surgery or ablation ranged from 53.3% (95% CI [48.7, 57.8]) to 80.3% (95% CI [73.0, 86.0]). For stage T1b-3 cancers, the proportion that received RN ranged from 65.6% (95% CI [60.3, 70.5]) to 77.3% (95% CI [72.1, 81.7]). Patients with M0 (n = 12,365) and M1 KC (n = 3312) at diagnosis had 24-month survival of 87.5% and 25.1%, respectively. Of patients diagnosed with M1 KC, 50.3% received systemic anti-cancer therapy, ranging from 39.7% (95% CI [33.7, 46.1]) to 70.7% (95% CI [59.6, 79.8]) between Cancer Alliances. The six-month survival of these patients was 77.4% compared to 27.6% for those that did not receive SACT. CONCLUSION These major geographical differences in surgical and systemic therapy practice have led to national guideline development.
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Affiliation(s)
- K Fife
- Oncology Dept, Box 193, Cambridge University Hospitals NHSFT, Hills Road, Cambridge, CB2 0QQ, UK; CRUK Cambridge Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - C Pearson
- Health Data Insight CIC, Cambridge, CB21 5XE, UK; National Disease Registration Service, NHS England, London, UK
| | - C S Knott
- Health Data Insight CIC, Cambridge, CB21 5XE, UK; National Disease Registration Service, NHS England, London, UK
| | - A Greaves
- Kidney Cancer UK, Creation House, Suite D, Unit 1D, Merrow Business Park, Guildford, Surrey, GU4 7WA, UK
| | - G D Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; CRUK Cambridge Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Moler-Zapata S, Hutchings A, Grieve R, Hinchliffe R, Smart N, Moonesinghe SR, Bellingan G, Vohra R, Moug S, O’Neill S. An Approach for Combining Clinical Judgment with Machine Learning to Inform Medical Decision Making: Analysis of Nonemergency Surgery Strategies for Acute Appendicitis in Patients with Multiple Long-Term Conditions. Med Decis Making 2024; 44:944-960. [PMID: 39440442 PMCID: PMC11542320 DOI: 10.1177/0272989x241289336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 08/07/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Machine learning (ML) methods can identify complex patterns of treatment effect heterogeneity. However, before ML can help to personalize decision making, transparent approaches must be developed that draw on clinical judgment. We develop an approach that combines clinical judgment with ML to generate appropriate comparative effectiveness evidence for informing decision making. METHODS We motivate this approach in evaluating the effectiveness of nonemergency surgery (NES) strategies, such as antibiotic therapy, for people with acute appendicitis who have multiple long-term conditions (MLTCs) compared with emergency surgery (ES). Our 4-stage approach 1) draws on clinical judgment about which patient characteristics and morbidities modify the relative effectiveness of NES; 2) selects additional covariates from a high-dimensional covariate space (P > 500) by applying an ML approach, least absolute shrinkage and selection operator (LASSO), to large-scale administrative data (N = 24,312); 3) generates estimates of comparative effectiveness for relevant subgroups; and 4) presents evidence in a suitable form for decision making. RESULTS This approach provides useful evidence for clinically relevant subgroups. We found that overall NES strategies led to increases in the mean number of days alive and out-of-hospital compared with ES, but estimates differed across subgroups, ranging from 21.2 (95% confidence interval: 1.8 to 40.5) for patients with chronic heart failure and chronic kidney disease to -10.4 (-29.8 to 9.1) for patients with cancer and hypertension. Our interactive tool for visualizing ML output allows for findings to be customized according to the specific needs of the clinical decision maker. CONCLUSIONS This principled approach of combining clinical judgment with an ML approach can improve trust, relevance, and usefulness of the evidence generated for clinical decision making. HIGHLIGHTS Machine learning (ML) methods have many potential applications in medical decision making, but the lack of model interpretability and usability constitutes an important barrier for the wider adoption of ML evidence in practice.We develop a 4-stage approach for integrating clinical judgment into the way an ML approach is used to estimate and report comparative effectiveness.We illustrate the approach in undertaking an evaluation of nonemergency surgery (NES) strategies for acute appendicitis in patients with multiple long-term conditions and find that NES strategies lead to better outcomes compared with emergency surgery and that the effects differ across subgroups.We develop an interactive tool for visualizing the results of this study that allows findings to be customized according to the user's preferences.
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Affiliation(s)
- S. Moler-Zapata
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - A. Hutchings
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - R. Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - R. Hinchliffe
- Bristol Surgical Trials Centre, University of Bristol, Bristol, UK
| | - N. Smart
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - S. R. Moonesinghe
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, NHS foundation Trust, London, UK
| | - G. Bellingan
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, NHS foundation Trust, London, UK
| | - R. Vohra
- Trent Oesophago-Gastric Unit, City Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S. Moug
- Department of Colorectal Surgery, Royal Alexandra Hospital, Paisley, UK
| | - S. O’Neill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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45
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Berglund M, Gonzalez-Izquierdo A, Denaxas S, Lethebe BC, Sajobi TT, Engbers JDT, Wiebe S, Josephson CB. Excess health care use is significantly and persistently reduced following diagnosis of late-onset epilepsy. Epilepsia 2024; 65:3350-3361. [PMID: 39302250 DOI: 10.1111/epi.18105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE The incidence of late-onset epilepsy (LOE) is rising, and these patients may use an excess of health care resources. This study aimed to measure pre-/post-diagnostic health care use (HCU) for patients with LOE compared to controls. METHODS This was an observational open cohort study covering years 1998-2019 using UK population-based linked primary care (Clinical Practice Research Datalink [CPRD]) and hospital (HES) electronic health records. The participants included patients with incident LOE enrolled in CPRD and 1:10 age-, sex-, and general practice-matched controls. The exposure was incident LOE (diagnosed at age ≥65) using a 5-year washout. The main outcome was all HCU (primary care [PC], accident and emergency [A&E], admitted patient and outpatient care) using inverse proportional weighting to PC use and HCU by setting. An interrupted time-series analysis was used to examine pre-/post-diagnostic HCU between patients with LOE and controls over 4 years either side of diagnosis/matching date. An adjusted mixed-effects negative binomial regression was used for post-diagnosis HCU interactions. RESULTS Of 2 569 874 people ≥65 years of age, 1048 (4%) developed incident LOE. Mean weighted total HCU increased by 32 visits per patient-year (95% confidence interval [95% CI]: 13-50, p = .003) until LOE diagnosis, and then dropped by a mean of 60 visits per patient-year (95% CI: -81 to -40). There was an acute rise and fall over the 1-2 years immediately pre-/post-diagnosis. Incident HCU remained higher for LOE compared to controls post-diagnosis (adjusted incidence rate ratio: 1.72; 95% CI: 1.65-1.70; p < .001), including A&E, outpatient, and admitted care. SIGNIFICANCE Health care use demonstrates an acute on chronic rise over the 4 years before diagnosis of LOE. To what extent the partial reversal of the acute pre-diagnosis rise, and the mediators of the accelerated increase compared to controls are attributed to epilepsy, comorbid and bidirectional disease states, or a combination of both warrants further exploration.
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Affiliation(s)
| | - Arturo Gonzalez-Izquierdo
- UCL Institute of Health Informatics, London, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research (HDR) UK, London, UK
| | - Spiros Denaxas
- UCL Institute of Health Informatics, London, UK
- Health Data Research (HDR) UK, London, UK
- Alan Turing Institute, London, UK
| | - B Cord Lethebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Samuel Wiebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
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Gannon MR, Dodwell D, Miller K, Medina J, Clements K, Horgan K, Park MH, Cromwell DA. Survival following adjuvant trastuzumab-based treatment among older patients with HER2-positive early invasive breast cancer: A national population-based cohort study using routine data. Eur J Cancer 2024; 211:114309. [PMID: 39293345 DOI: 10.1016/j.ejca.2024.114309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/06/2024] [Accepted: 08/22/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Randomised controlled trials (RCTs) reported adjuvant trastuzumab-based treatment improved overall survival (OS) among patients with HER2-positive early invasive breast cancer (EIBC). Few RCTs included older patients or those with comorbidity/frailty. This study aimed to determine whether the effect of adjuvant trastuzumab-based treatment on survival outcomes varies by patient age and fitness, using national data from routine care. METHODS Women (50+ years) newly-diagnosed with HER2-positive EIBC between 2014 and 2019 were identified from England Cancer Registry data. Registration records were linked to Systemic Anti-Cancer Therapy data for treatment details and ONS death register for mortality details. A propensity score analysis employing the inverse probability of treatment weighting method was used to balance the patient variables across treatment groups. Cox models were used to evaluate whether the effect of treatment on OS was associated with patient age and fitness; competing risks regression models were used for breast cancer-specific survival (BCSS). RESULTS 5238 women initiated adjuvant trastuzumab-based treatment. Median follow-up was 56.7 months. Comparison with 3421 women who did not receive adjuvant trastuzumab highlighted differences at diagnosis in relation to age, fitness, grade, nodal involvement, surgery type and use of radiotherapy. Weighted survival analysis found trastuzumab was associated with improved OS (hazard ratio HR 0.56, 95 %CI: 0.45-0.70) and improved BCSS (subHR 0.62, 95 %CI: 0.47-0.82). We found no evidence of a difference in effect by age or patient fitness for either outcome. CONCLUSION In this national dataset, adjuvant trastuzumab was associated with improvements in survival, with an OS effect size similar to RCT evidence. The effect size was not found to vary by patient age or fitness. Chronological age and fitness alone should not be barriers to receipt of effective adjuvant targeted treatment.
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Affiliation(s)
- Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Katie Miller
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen Clements
- National Cancer Registration and Analysis Service, NHS England, 5th Floor, 23 Stephenson Street, Birmingham, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Min Hae Park
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Jones T, McNair A, McLeod H, Morley J, Rooshenas L, Hollingworth W. Identifying potentially low value surgical care: A national ecological study in England. J Health Serv Res Policy 2024; 29:223-229. [PMID: 38725100 PMCID: PMC11346124 DOI: 10.1177/13558196241252053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
OBJECTIVES High variation in clinical practice may indicate uncertainty and potentially low-value care. Methods to identify low value care are often not well defined or transparent and can be time intensive. In this paper we explore the usefulness of variation analysis of routinely-collected data about surgical procedures in England to identify potentially low-value surgical care. METHODS This is a national ecological study using Hospital Episode Statistics linked to mid-year population estimates and indices of multiple deprivation in England, 2014/15-2018/19. We identified the top 5% of surgical procedures in terms of growth in standardised procedure rates for 2014/15 to 2018/19 and variation in procedure rates between clinical commissioning groups as measured by the systematic component of variance (SCV). A targeted literature review was conducted to explore the evidence for each of the identified techniques. Procedures without evidence of cost-effectiveness were viewed as of potentially low value. RESULTS We identified six surgical procedures that had a high growth rate of 37% or more over 5 years, and four with higher geographical variation (SCV >1.6). There was evidence for two of the 10 procedures that surgery was more cost-effective than non-surgical treatment albeit with uncertainty around optimal surgical technique. The evidence base for eight procedures was less clear cut, with uncertainty around clinical- and/or cost-effectiveness. These were: deep brain stimulation; removing the prostate; surgical spine procedures; a procedure to alleviate pain in the spine; surgery for dislocated joints due to trauma and associated surgery for traumatic fractures; hip joint replacement with cemented pelvic component or cemented femoral component; and shoulder joint replacement. CONCLUSIONS This study demonstrates that variation analysis could be regularly used to identify potentially low-value procedures. This can provide important insights into optimising services and the potential de-adoption of costly interventions and treatments that do not benefit patients and the health system more widely. Early identification of potentially low value care can inform prioritisation of clinical trials to generate evidence on effectiveness and cost-effectiveness before treatments become established in clinical practice.
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Affiliation(s)
- Tim Jones
- Research Fellow, The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Research Fellow, Bristol Medical School, University of Bristol, Bristol, UK
| | - Angus McNair
- Associate Professor in Colorectal Surgery, Bristol Medical School, University of Bristol, Bristol, UK
- Consultant, North Bristol NHS Trust, Bristol, UK
| | - Hugh McLeod
- Senior Lecturer, NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Senior Lecturer, Bristol Medical School, University of Bristol, Bristol, UK
| | - Josie Morley
- PhD Student, NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- PhD Student, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- Associate Professor, Bristol Medical School, University of Bristol, Bristol, UK
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Lewis KM, Burns R, Cortina-Borja M, Heilmann A, Macfarlane A, Nath S, Salway SM, Saxena S, Villarroel-Williams N, Viner R, Hardelid P. Parental migration, socioeconomic deprivation and hospital admissions in preschool children in England: national birth cohort study, 2008 to 2014. BMC Med 2024; 22:416. [PMID: 39334300 PMCID: PMC11438240 DOI: 10.1186/s12916-024-03619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND A third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group. METHODS Birth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group. RESULTS Overall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4-171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1-156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4-188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42-1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia. CONCLUSIONS Overall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health.
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Affiliation(s)
- Kate M Lewis
- Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Rachel Burns
- Institute of Health Informatics, University College London, London, UK
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Selina Nath
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sarah M Salway
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | | | - Russell Viner
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Pia Hardelid
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Maharani A, Sinclair DR, Clegg A, Hanratty B, Nazroo J, Tampubolon G, Todd C, Wittenberg R, O’Neill TW, Matthews FE. The association between frailty, care receipt and unmet need for care with the risk of hospital admissions. PLoS One 2024; 19:e0306858. [PMID: 39331671 PMCID: PMC11432830 DOI: 10.1371/journal.pone.0306858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/25/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Frailty is characterised by a decline in physical, cognitive, energy, and health reserves and is linked to greater functional dependency and higher social care utilisation. However, the relationship between receiving care, or receiving insufficient care among older people with different frailty status and the risk of unplanned admission to hospital for any cause, or the risk of falls and fractures remains unclear. METHODS AND FINDINGS This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6-8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalisation due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. CONCLUSIONS Care receipt increases the risk of hospitalisation substantially, suggesting this is a group worthy of prevention intervention focus.
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Affiliation(s)
- Asri Maharani
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - David R. Sinclair
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Barbara Hanratty
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - James Nazroo
- Cathie Marsh Institute for Social Research, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester, United Kingdom
| | - Gindo Tampubolon
- Global Development Institute, University of Manchester, Manchester, United Kingdom
| | - Chris Todd
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Raphael Wittenberg
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Terence W. O’Neill
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Fiona E. Matthews
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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50
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Graham S, Walker JL, Andrews N, Nitsch D, Parker EPK, McDonald H. Identifying markers of health-seeking behaviour and healthcare access in UK electronic health records. BMJ Open 2024; 14:e081781. [PMID: 39327051 PMCID: PMC11429345 DOI: 10.1136/bmjopen-2023-081781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 08/18/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVE To assess the feasibility of identifying markers of health-seeking behaviour and healthcare access in UK electronic health records (EHR), for identifying populations at risk of poor health outcomes and adjusting for confounding in epidemiological studies. DESIGN Cross-sectional observational study using the Clinical Practice Research Datalink Aurum prelinked to Hospital Episode Statistics. SETTING Individual-level routine clinical data from 13 million patients across general practices (GPs) and secondary data in England. PARTICIPANTS Individuals aged ≥66 years on 1 September 2019. MAIN OUTCOME MEASURES We used the Theory of Planned Behaviour (TPB) model and the literature to iteratively develop criteria for markers selection. Based on this we selected 15 markers: those that represented uptake of public health interventions, markers of active healthcare access/use and markers of lack of access/underuse. We calculated the prevalence of each marker using relevant lookback periods prior to the index date (1 September 2019) and compared with national estimates. We assessed the correlation coefficients (phi) between markers with inferred hierarchical clustering. RESULTS We included 1 991 284 individuals (mean age: 75.9 and 54.0% women). The prevalence of markers ranged from <0.1% (low-value prescriptions) to 92.6% (GP visits), and most were in line with national estimates; for example, 73.3% for influenza vaccination in the 2018/2019 season, compared with 72.4% in national estimates. Screening markers, for example, abdominal aortic aneurysm screening were under-recorded even in age-eligible groups (54.3% in 65-69 years old vs 76.1% in national estimates in men). Overall, marker correlations were low (<0.5) and clustered into groups according to underlying determinants from the TPB model. CONCLUSION Overall, markers of health-seeking behaviour and healthcare access can be identified in UK EHRs. The generally low correlations between different markers of health-seeking behaviour and healthcare access suggest a range of variables are needed to capture different determinants of healthcare use.
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Affiliation(s)
- Sophie Graham
- London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Jemma L Walker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- UK Health Security Agency, London, UK
| | | | - Dorothea Nitsch
- London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
- UK Renal Registry, Bristol, UK
- Renal Unit, Royal Free London NHS Foundation Trust, Hertfordshire, UK
| | - Edward P K Parker
- London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
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