The burden of mental ill health associated with childhood maltreatment in the UK, using The Health Improvement Network database: a population-based retrospective cohort study

BackgroundFaecal calprotectin (FC) testing to detect inflammatory bowel disease (IBD) was recommended for use in UK general practice in 2013. The actual use of FC testing following the national recommendations is unknown.AimTo characterise the use of FC testing for IBD in UK general practice.Design and settingA retrospective cohort study of routine electronic patient records from The Health Improvement Network database from UK general practice.MethodThe study included 6 965 853 adult patients (aged ≥18 years), between 2006 and 2016. FC test uptake, the patients tested, and patient management following testing were characterised.ResultsA total of 17 027 patients had 19 840 FC tests recorded. The mean age of tested patients was 44.2 years. The first FC tests were documented in 2009. FC test use was still increasing in 2016. By 2016, 66.8% (n = 493/738) of practices had started FC testing. About one-fifth (20.7%, n = 1253/6051) of tests were carried out in patients aged ≥60 years. Only 7.8% (n = 473/6051) of the FC test records were preceded by symptoms eligible for FC testing. Only 3.1% (n = 1720/55 477) of patients with eligible symptoms have received FC testing since the national recommendations were published. There was only a small number of patients with symptoms, FC test, and a IBD diagnosis. In total, 71.3% (n = 1416/1987) of patients with a positive and 47.7% (n = 1337/2805) with a negative FC test were referred or further investigated.ConclusionUptake of FC testing in clinical practice has been slow and inconsistent. The indication of non-compliance with national recommendations may suggest that these recommendations lack applicability to the general practice context.

Download Full-text

Incidence and risk of celiac disease after type 1 diabetes: A population‐based cohort study using the health improvement network database

Pediatric Diabetes ◽

10.1111/pedi.12770 ◽

2018 ◽

Vol 19 (8) ◽

pp. 1422-1428 ◽

Cited By ~ 3

Author(s):

Mary Ellen Vajravelu ◽

Ron Keren ◽

David R. Weber ◽

Ritu Verma ◽

Diva D. De León ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Celiac Disease ◽

Population Based ◽

Health Improvement ◽

Network Database ◽

The Health Improvement Network

Download Full-text

Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database

BMJ Open ◽

10.1136/bmjopen-2018-026714 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026714 ◽

Cited By ~ 1

Author(s):

Philip R Harvey ◽

Tom Thomas ◽

Joht Singh Chandan ◽

Neeraj Bhala ◽

Krishnarajah Nirantharakumar ◽

...

Keyword(s):

Cohort Study ◽

Learning Disability ◽

Incidence Rate ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Improvement ◽

History Of ◽

Study Population ◽

The Health Improvement Network

ObjectivesTo measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI.DesignRetrospective cohort study.Setting and participantsThe study population included patients with LD undergoing FG placement in the ‘The Health Improvement Network’ database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel.Main outcome measuresIncidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI.Results214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63) p<0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05).ConclusionIn LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.

Download Full-text

Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study

British Journal of General Practice ◽

10.3399/bjgp17x689917 ◽

2017 ◽

Vol 67 (657) ◽

pp. e300-e305 ◽

Cited By ~ 9

Author(s):

Lavanya Diwakar ◽

Carole Cummins ◽

Ronan Ryan ◽

Tom Marshall ◽

Tracy Roberts

Keyword(s):

Primary Care ◽

Cohort Study ◽

High Risk ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Improvement ◽

Number Of Children ◽

Prescription Rates ◽

The Uk ◽

Primary Care Practices

BackgroundAdrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified.Aim To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012.Design and setting Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database.MethodChildren and young people aged between 0–17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12).ResultsA total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%.ConclusionThe number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed.

Download Full-text

Incidence and Risk of Celiac Disease in Individuals with Type 1 Diabetes over the Lifespan—A Population-Based Cohort Study Using the Health Improvement Network Database

Diabetes ◽

10.2337/db18-1498-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1498-P

Author(s):

MARY ELLEN VAJRAVELU ◽

DIVA DE LEON ◽

DAVID R. WEBER ◽

RON KEREN ◽

MICHELLE R. DENBURG ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Celiac Disease ◽

Population Based ◽

Health Improvement ◽

Network Database ◽

The Health Improvement Network

Download Full-text

Correction:Discontinuation of non-Vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: a population-based cohort study using primary care data from The Health Improvement Network in the UK

BMJ Open ◽

10.1136/bmjopen-2019-031342corr1 ◽

2020 ◽

Vol 10 (4) ◽

pp. e031342corr1

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Cohort Study ◽

Oral Anticoagulants ◽

Population Based ◽

Vitamin K Antagonist ◽

Health Improvement ◽

Primary Care Data ◽

The Health Improvement Network ◽

The Uk

Download Full-text

All-Cause Mortality in Patients With Diabetes Under Treatment With Dapagliflozin: A Population-Based, Open-Cohort Study in The Health Improvement Network Database

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2016-3446 ◽

2017 ◽

Vol 102 (5) ◽

pp. 1719-1725 ◽

Cited By ~ 35

Author(s):

Konstantinos A. Toulis ◽

Brian H. Willis ◽

Tom Marshall ◽

Balachadran Kumarendran ◽

Krishna Gokhale ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Low Risk ◽

Health Improvement ◽

Total Study Population ◽

Risk Of Death ◽

Network Database ◽

All Cause Mortality ◽

Risk Patients ◽

The Health Improvement Network

Abstract Context: Empagliflozin was found to decrease mortality in patients with type 2 diabetes mellitus (T2DM) and a prior cardiovascular disease (CVD) event. Objectives: To establish whether these benefits can be replicated in a real-world setting, should be expected with the use of dapagliflozin, and apply to T2DM patients at low risk of CVD. Design: General practice, population-based, retrospective cohort study (January 2013 to September 2015). Setting: The Health Improvement Network database. Participants: A total of 22,124 T2DM patients (4444 exposed to dapagliflozin; 17,680 unexposed T2DM patients) matched for age, sex, body mass index, T2DM duration, and smoking. Main Outcome Measures: The primary outcome was all-cause mortality (high and low risk for CVD) in the total study population, expressed as the adjusted incidence rate ratio (aIRR) with 95% confidence intervals (CIs). As a secondary analysis in the low-risk population, all-cause mortality and incident CVD were considered. Results: Patients with T2DM exposed to dapagliflozin were significantly less likely to die of any cause (aIRR: 0.50; 95% CI: 0.33 to 0.75; P = 0.001). Similarly, in low-risk patients, death from any cause was significantly lower in the cohort exposed to dapagliflozin (aIRR: 0.44; 95% CI: 0.25 to 0.78; P = 0.002). The difference in the risk of incident CVD did not reach statistical significance between groups in low-risk patients (aIRR: 0.89; 95% CI: 0.61 to 1.31; P = 0.546). Conclusions: Patients with T2DM who were exposed to dapagliflozin had a lower risk of death from any cause irrespective of baseline CVD status.

Download Full-text