Use of Personal Child Health Records in the UK: Findings From the Millenium Cohort Study

Abstract Context Recent studies have suggested that a higher body mass index (BMI) and serum urate levels were associated with a lower risk of developing dementia. However, these reverse relationships remain controversial, and whether serum urate and BMI confound each other is not well established. Objectives To investigate the independent associations of BMI and urate, as well as their interaction with the risk of developing dementia. Design and Settings We analyzed a cohort of 502 528 individuals derived from the UK Biobank that included people aged 37–73 years for whom BMI and urate were recorded between 2006 and 2010. Dementia was ascertained at follow-up using electronic health records. Results During a median of 8.1 years of follow-up, a total of 2138 participants developed dementia. People who were underweight had an increased risk of dementia (hazard ratio [HR] = 1.91, 95% confidence interval [CI]: 1.24–2.97) compared with people of a healthy weight. However, the risk of dementia continued to fall as weight increased, as those who were overweight and obese were 19% (HR = 0.81, 95%: 0.73–0.90) and 22% (HR = 0.78, 95% CI: 0.68–0.88) were less likely to develop dementia than people of a healthy weight. People in the highest quintile of urate were also associated with a 25% (HR = 0.75, 95% CI: 0.64–0.87) reduction in the risk of developing dementia compared with those who were in the lowest quintile. There was a significant multiplicative interaction between BMI and urate in relation to dementia (P for interaction = 0.004), and obesity strengthens the protective effect of serum urate on the risk of dementia. Conclusion Both BMI and urate are independent predictors of dementia, and there are inverse monotonic and dose-response associations of BMI and urate with dementia.

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Are children with clinical obesity at increased risk of inpatient hospital admissions? An analysis using linked electronic health records in the UK millennium cohort study

Pediatric Obesity ◽

10.1111/ijpo.12505 ◽

2019 ◽

Vol 14 (6) ◽

pp. e12505 ◽

Cited By ~ 1

Author(s):

Lucy J. Griffiths ◽

Mario Cortina‐Borja ◽

Amrita Bandyopadhyay ◽

Karen Tingay ◽

Bianca L. De Stavola ◽

...

Keyword(s):

Cohort Study ◽

Electronic Health Records ◽

Hospital Admissions ◽

Millennium Cohort Study ◽

Health Records ◽

Inpatient Hospital ◽

Increased Risk ◽

Electronic Health ◽

Uk Millennium Cohort Study ◽

The Uk

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Changing Epidemiology of Bariatric Surgery in the UK: Cohort Study Using Primary Care Electronic Health Records

Obesity Surgery ◽

10.1007/s11695-015-2032-9 ◽

2016 ◽

Vol 26 (8) ◽

pp. 1900-1905 ◽

Cited By ~ 13

Author(s):

Helen P. Booth ◽

◽

Omar Khan ◽

Alison Fildes ◽

A. Toby Prevost ◽

...

Keyword(s):

Bariatric Surgery ◽

Primary Care ◽

Cohort Study ◽

Electronic Health Records ◽

Health Records ◽

Electronic Health ◽

The Uk

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Validity of UK electronic health records to study migrant health: a population-based cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.768 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

N Pathak ◽

P Patel ◽

R Mathur ◽

R Burns ◽

A Gonzalez-Izquierdo ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Electronic Health Records ◽

Barriers To Care ◽

Population Based ◽

Health Records ◽

Migration Status ◽

English Speaking ◽

International Migrants ◽

The Uk

Abstract Background An estimated 14.3% (9.4 million people) of people living in the UK in 2019 were international migrants. Despite this, little is known about how migrants access and use healthcare services. To use electronic healthcare records (EHRs) to study migration health, a valid migration phenotype is necessary: a transparent reproducible algorithm using clinical terminology codes to determine migration status. We have previously described the validity of a migration phenotype in CALIBER data using the Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR. This study further evaluates the phenotype by examining certainty of migration status. Methods This is a population-based cohort study of individuals in CPRD Gold (1997-2018) with a Read term indicating migration to the UK. We describe completeness of recording of migration over time: percentage of individuals recorded as migrants. We also describe cohort size based on certainty of migration status: “definite” (country of birth or visa status terms), “probable” (non-English first/main language terms), and “possible” (non-UK origin terms). Results Overall, 2.5% (403,768/16,071,111) of CPRD had ≥1 of 434 terms indicating migration to the UK. The percentage of recorded migrants per year increased from 0.2% (4,417/2,210,551) in 1997 to 3.64% (100,626/2,761,397) in 2018, following a similar trend to national migration data. 44.27% (178,749/403,768) were “definite” migrants and 53.68% (216,731/403,768) were “probable” migrants. Only 2.05%(8,288/16,071,111) were “possible” migrants. Conclusions We have created a large cohort of international migrants in the UK and certainty of migration status is high. This cohort can be used to study migration health in UK primary care EHR. The large contribution of language terms make this phenotype particularly suitable for understanding healthcare access and use by non-English speaking migrants who may face additional barriers to care. Key messages We have developed a way to study migration health in UK primary care electronic health records. Our method is particularly useful to study healthcare for non-English speaking migrants who may face additional barriers to care.

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Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003829 ◽

2021 ◽

Vol 18 (11) ◽

pp. e1003829

Author(s):

Meghna Jani ◽

Nadyne Girard ◽

David W. Bates ◽

David L. Buckeridge ◽

Therese Sheppard ◽

...

Keyword(s):

Cohort Study ◽

North America ◽

Cancer Pain ◽

Population Based ◽

Opioid Epidemic ◽

Prescribing Practices ◽

Multicenter Cohort Study ◽

Health Records ◽

Opioid Prescribing ◽

The Uk

Background The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries. In addition, we evaluated differences in the type, strength, and starting dose of medication and whether these characteristics changed over time. Methods and findings We conducted a retrospective multicenter cohort study of adults who are new users of opioids without prior cancer. Electronic health records and administrative health records from Boston (United States), Quebec and Alberta (Canada), United Kingdom, and Taiwan were used to identify patients between 2006 and 2015. Standard dosages in morphine milligram equivalents (MMEs) were calculated according to The Centers for Disease Control and Prevention. Age- and sex-standardized opioid prescribing rates were calculated for each jurisdiction. Of the 2,542,890 patients included, 44,690 were from Boston (US), 1,420,136 Alberta, 26,871 Quebec (Canada), 1,012,939 UK, and 38,254 Taiwan. The highest standardized opioid prescribing rates in 2014 were observed in Alberta at 66/1,000 persons compared to 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively. The median MME/day (IQR) at initiation was highest in Boston at 38 (20 to 45); followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11). Oxycodone was the first prescribed opioid in 65% of patients in the US cohort compared to 14% in Quebec, 4% in Alberta, 0.1% in the UK, and none in Taiwan. One of the limitations was that data were not available from all centers for the entirety of the 10-year period. Conclusions In this study, we observed substantial differences in opioid prescribing practices for non-cancer pain between jurisdictions. The preference to start patients on higher MME/day and more potent opioids in North America may be a contributing cause to the opioid epidemic.

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