Sociodemographic inequalities in the management of depression in adults aged 55 and over: an analysis of English primary care data

AbstractBackgroundWe do not know how primary care treatment of depression varies by age across both psychotropic medication and psychological therapies.MethodsCohort study including 19 710 people aged 55+ with GP recorded depression diagnoses and 26 276 people with recorded depression symptoms during the period 2009–2013, from 373 General Practices in The Health Improvement Network (THIN) database in England. Main outcomes were initiation of treatment with anti-depressants, anxiolytics, hypnotics, anti-psychotic drugs, referrals to psychological therapies within 6 months of onset.ResultsTreatment rates with antidepressants are high for those recorded with new depression diagnoses (87.1%) or symptoms of depression (58.7%). Treatment in those with depression diagnoses varies little by age. In those with depressive symptoms there was a J-shaped pattern with reduced antidepressant treatment in those in their 60s and 70s followed by increased treatment in the oldest age groups (85+ years), compared with those aged 55–59 years. Other psychotropic drug prescribing (hypnotics/anxiolytics, antipsychotics) all increase with increasing age. Recorded referrals for psychological therapies were low, and decreased steadily with increasing age, such that women aged 75–79 years with depression diagnoses had around six times lower odds of referral (OR 0.17, 95% CI 0.1–0.29) than those aged 55–59 years, and men aged 80–84 years had around seven times lower (OR 0.14, 95% CI 0.05–0.36).ConclusionsThe oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and higher psychotropic drug treatment rates in primary care. This suggests potential inequalities in access to psychological therapies.

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Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

Family Medicine and Community Health ◽

10.1136/fmch-2020-000780 ◽

2021 ◽

Vol 9 (2) ◽

pp. e000780

Author(s):

Lisanne Andra Gitsels ◽

Ilyas Bakbergenuly ◽

Nicholas Steel ◽

Elena Kulinskaya

Keyword(s):

Primary Care ◽

Older People ◽

Clinical Information ◽

Cardiac Risk ◽

Health Improvement ◽

Network Database ◽

Statin Prescription ◽

The Health Improvement Network ◽

Care Practices ◽

Primary Care Practices

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

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Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽

10.1136/bmjopen-2018-027315 ◽

2019 ◽

Vol 9 (6) ◽

pp. e027315 ◽

Cited By ~ 1

Author(s):

Harjeet Kaur Bhachu ◽

Paul Cockwell ◽

Anuradhaa Subramanian ◽

Krishnarajah Nirantharakumar ◽

Derek Kyte ◽

...

Keyword(s):

Primary Care ◽

Kidney Disease ◽

Secondary Care ◽

Health Improvement ◽

Cross Sectional ◽

Risk Equation ◽

Failure Risk ◽

The Health Improvement Network ◽

The Uk ◽

The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

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Frequency and heritability of depression symptomatology in the second half of life: evidence from Danish twins over 45

Psychological Medicine ◽

10.1017/s0033291702006207 ◽

2002 ◽

Vol 32 (7) ◽

pp. 1175-1185 ◽

Cited By ~ 36

Author(s):

W. JOHNSON ◽

M. McGUE ◽

D. GAIST ◽

J. W. VAUPEL ◽

K. CHRISTENSEN

Keyword(s):

Depressive Symptoms ◽

Age Groups ◽

Well Being ◽

The Elderly ◽

Depression Symptoms ◽

Same Sex ◽

Symptoms Of Depression ◽

Genetic Origins ◽

Depression Symptomatology ◽

Special Risk

Background. Self-reported depressive symptoms among the elderly have generated considerable interest because they are readily available measures of overall well-being in a population often thought to be at special risk for mental disorder.Method. The heritability of depression symptoms was investigated in a sample of 2169 pairs of Danish twins (1033 MZ and 1136 same sex DZ) ranging in age from 45 to over 95. Twins completed an interview assessment that identified symptoms of depression, which were scored on Affective, Somatic and Total scales.Results. Overall heritability estimates (a2) for the Affective (a2 = 0.27, (95% CI 0.22–0.32)). Somatic (a2 = 0.26, (0.21–0.32)), and Total (a2 = 0.29, (0.22–0.34)) scales were all moderate, statistically significant and similar to results from other studies. To assess possible variations in heritability across the wide age span, the sample was stratified into age groups in increments of 10 years. The magnitude of heritable influence did not vary significantly with age or sex. Somatic scale heritability tended to be greater for females than for males, though this difference was not statistically significant. The genetic correlation between the Affective and Somatic scales was 0.71, suggesting substantial common genetic origins.Conclusions. Though the frequency of self-reported depressive symptoms increased with age in this sample, their heritability did not.

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The reporting and diagnosis of uterine fibroids (UF) in UK primary care, based on data from the health improvement network (thin)

Fertility and Sterility ◽

10.1016/j.fertnstert.2013.07.664 ◽

2013 ◽

Vol 100 (3) ◽

pp. S404

Author(s):

L.A. García Rodríguez ◽

E. Martín Merino ◽

M.-A. Wallander ◽

S. Andersson ◽

M.M. Soriano-Gabarró

Keyword(s):

Primary Care ◽

Uterine Fibroids ◽

Health Improvement ◽

The Health Improvement Network

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The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017

10.22541/au.162505075.57308701/v3 ◽

2021 ◽

Author(s):

Nurunnahar Akter ◽

Elena Kulinskaya ◽

Nicholas Steel ◽

Ilyas Bakbergenuly

Keyword(s):

Primary Care ◽

Cohort Study ◽

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Cox Regression ◽

Hormone Replacement ◽

Health Improvement ◽

All Cause Mortality ◽

The Health Improvement Network

Objective: To estimate the effect of oestrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46 to 65 at first prescription. Design: Matched cohort study. Setting: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984−2017). Population: 105,199 HRT users (cases) and 224,643 non-users (controls) matched on age and general practice. Methods: Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy/hysterectomy, body mass index, smoking, and deprivation status. Main outcome measures: All-cause mortality. Results: A total of 21,751 women died over an average of 13.5 years follow-up per participant, of whom 6,329 were users and 15,422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95%CI 0.88−0.94), and in oestrogen-only users was 0.99 (0.93−1.07), compared to non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60, and 61-65 years at first treatment were 0.98 (0.92−1.04), 0.87 (0.82−0.92), 0.88 (0.82−0.93), and 0.92 (0.85−0.98), for combined HRT users compared to non-users, and 1.01 (0.84−1.21), 1.03 (0.89−1.18), 0.98 (0.86−1.12), and 0.93 (0.81−1.07) for oestrogen-only users, respectively. Conclusions: Combined HRT was associated with a 9% lower risk of all-cause mortality and oestrogen-only formulation was not associated with any significant changes. Funding: IFoA. Keywords: Hormone replacement therapy, menopause, mortality, primary care records, THIN. Tweetable abstract: Oestrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

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Trends in the incidence of testing for vitamin D deficiency in primary care in the UK: a retrospective analysis of The Health Improvement Network (THIN), 2005–2015

BMJ Open ◽

10.1136/bmjopen-2018-028355 ◽

2019 ◽

Vol 9 (6) ◽

pp. e028355 ◽

Cited By ~ 12

Author(s):

Francesca L Crowe ◽

Kate Jolly ◽

Christine MacArthur ◽

Semira Manaseki-Holland ◽

Neil Gittoes ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Vitamin D ◽

Ethnic Minority ◽

Vitamin D Deficiency ◽

Future Research ◽

Health Improvement ◽

Economically Deprived ◽

The Health Improvement Network ◽

The Uk

ObjectiveTo investigate trends in the incidence of testing for vitamin D deficiency and the prevalence of patients with circulating concentrations of 25-hydroxyvitamin D (25(OH)D) indicative of deficiency (<30 nmol/L) between 2005 and 2015.DesignLongitudinal analysis of electronic health records in The Health Improvement Network primary care database.SettingUK primary care.InterventionNone.ParticipantsThe analysis included 6 416 709 participants aged 18 years and older.Primary outcomesIncidence of having a blood test for vitamin D deficiency between 2005 and 2015, the prevalence with blood 25(OH)D <30 nmol/L and the effects of age, ethnicity and socioeconomic status on these measures were assessed.ResultsAfter a mean follow-up time of 5.4 (SD 3.7) years, there were 210 502 patients tested for vitamin D deficiency. The incidence of vitamin D testing rose from 0.29 per 1000 person-years at risk (PYAR) (95% CI 0.27 to 0.31) in 2005 to 16.1 per 1000 PYAR (95% CI 15.9 to 16.2) in 2015. Being female, older, non-white ethnicity and more economically deprived were all strongly associated with being tested. One-third (n=69 515) had 25(OH)D <30 nmol/L, but the per cent deficient among ethnic minority groups ranged from 43% among mixed ethnicity to 66% in Asians. Being male, younger and more economically deprived were also all associated with vitamin D deficiency (p<0.001).ConclusionsTesting for vitamin D deficiency increased over the past decade among adults in the UK. One-third of UK adults who had a vitamin D test performed in primary care were vitamin D deficient, and deficiency was much higher among ethnic minority patients. Future research should focus on strategies to ensure population intake of vitamin D, particularly in at-risk groups, meets recommendations to reduce the risk of deficiency and need for testing.

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