Concurrent comorbidities substantially alter long-term health behaviours and outcomes of headache patients

AbstractObjectivesTo investigate factors affecting the long-term health behaviours and outcomes of headache patients and to design a risk-stratification tool.MethodsA population based observational-longitudinal cohort study using primary care electronic healthcare records from the UK Clinical Practice Research Datalink. 550,103 participants with a headache or migraine diagnosis of which 170,336 patients were identified as having recurrent headache-related events. Univariate and multivariable survival analysis was performed to determine factors influencing remission and a neural network classifier was developed.ResultsThere were almost twice as many female patients (352,330) as males (197,802). The median age at which a patient first saw their GP in males was 38 years, and in females was 37 years. Whilst age, gender and social deprivation significantly influenced the likelihood of seeing a GP, these factors had little effect on likelihood of remission from a period of recurrent headache-related events. In contrast, a comorbidity during the recurrent headache period reduced the risk of remission and increased median survival time from approximately 400-days up 1600. Increasing numbers of comorbidities progressively reduced the hazard risks for remission. The prediction models on remission within two and five years, demonstrated high precision and recall, with an F1 score of 0.795 and 0.887, respectively.InterpretationHeadache patients who suffer comorbidities have a substantively reduced likelihood of remission, highlighting an opportunity to considerably improve health outcomes in recurrent headache patients through addressing multi-morbidity more effectively. The prediction model could be used to help stratify patients most at risk of poor long-term outcomes.

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Long-term oral prednisolone exposure in primary care for bullous pemphigoid: population-based study

British Journal of General Practice ◽

10.3399/bjgp.2020.0870 ◽

2021 ◽

pp. BJGP.2020.0870

Author(s):

Monica SM Persson ◽

Karen E Harman ◽

Kim S Thomas ◽

Joanne Chalmers ◽

Yana Vinogradova ◽

...

Keyword(s):

Primary Care ◽

Bullous Pemphigoid ◽

Secondary Care ◽

Oral Prednisolone ◽

Population Based ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

High Dose ◽

The Uk

Background: Oral prednisolone is the mainstay treatment for bullous pemphigoid, an auto-immune blistering skin disorder affecting older people. Moderate to high dose treatment is often initiated in secondary care, but then continued in primary care. Aim: To describe long-term oral prednisolone prescribing in UK primary care for adults with bullous pemphigoid 1998-2017. Design and setting: A prospective cohort study using routinely collected data from the Clinical Practice Research Datalink, a primary care database containing the healthcare records for over 17 million people in the UK. Method: Oral prednisolone exposure was characterised in terms of the proportion of individuals with incident bullous pemphigoid prescribed oral prednisolone following their diagnosis and the duration and dose of prednisolone. Results: 2,312 (69.6%) of 3,322 people with bullous pemphigoid were prescribed oral prednisolone in primary care. The median duration of exposure was 10.6 months (IQR 3.4 to 24.0). Of prednisolone users, 71.5% were continuously exposed for >3 months, 39.8% for >1 year, 14.7% for >3 years, 5.0% for >5 years, and 1.7% for >10 years. The median cumulative dose was 2,974mg (IQR 1,059 to 6,456). Maximum daily doses were ≥10mg/day in 74.4% of users, ≥20mg/day in 40.7%, ≥30mg/day in 18.2%, ≥40mg/day in 6.6%, ≥50mg/day in 3.8%, and ≥60mg/day in 1.9%. Conclusions: A high proportion of people with incident bullous pemphigoid are treated with oral prednisolone in UK primary care. Primary and secondary care should address steroid-sparing alternatives and, where switching is not possible, ensure prophylactic treatments and proactive monitoring of potential side-effects are in place.

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Validity of an algorithm to identify cardiovascular deaths from administrative health records: a multi-database population-based cohort study

BMC Health Services Research ◽

10.1186/s12913-021-06762-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lisa M. Lix ◽

Shamsia Sobhan ◽

Audray St-Jean ◽

Jean-Marc Daigle ◽

Anat Fisher ◽

...

Keyword(s):

Cohort Study ◽

Cardiovascular Mortality ◽

Population Based ◽

Vital Statistics ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Health Records ◽

Predictive Values ◽

Site Specific ◽

Hospital Deaths

Abstract Background Cardiovascular death is a common outcome in population-based studies about new healthcare interventions or treatments, such as new prescription medications. Vital statistics registration systems are often the preferred source of information about cause-specific mortality because they capture verified information about the deceased, but they may not always be accessible for linkage with other sources of population-based data. We assessed the validity of an algorithm applied to administrative health records for identifying cardiovascular deaths in population-based data. Methods Administrative health records were from an existing multi-database cohort study about sodium-glucose cotransporter-2 (SGLT2) inhibitors, a new class of antidiabetic medications. Data were from 2013 to 2018 for five Canadian provinces (Alberta, British Columbia, Manitoba, Ontario, Quebec) and the United Kingdom (UK) Clinical Practice Research Datalink (CPRD). The cardiovascular mortality algorithm was based on in-hospital cardiovascular deaths identified from diagnosis codes and select out-of-hospital deaths. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for the cardiovascular mortality algorithm using vital statistics registrations as the reference standard. Overall and stratified estimates and 95% confidence intervals (CIs) were computed; the latter were produced by site, location of death, sex, and age. Results The cohort included 20,607 individuals (58.3% male; 77.2% ≥70 years). When compared to vital statistics registrations, the cardiovascular mortality algorithm had overall sensitivity of 64.8% (95% CI 63.6, 66.0); site-specific estimates ranged from 54.8 to 87.3%. Overall specificity was 74.9% (95% CI 74.1, 75.6) and overall PPV was 54.5% (95% CI 53.7, 55.3), while site-specific PPV ranged from 33.9 to 72.8%. The cardiovascular mortality algorithm had sensitivity of 57.1% (95% CI 55.4, 58.8) for in-hospital deaths and 72.3% (95% CI 70.8, 73.9) for out-of-hospital deaths; specificity was 88.8% (95% CI 88.1, 89.5) for in-hospital deaths and 58.5% (95% CI 57.3, 59.7) for out-of-hospital deaths. Conclusions A cardiovascular mortality algorithm applied to administrative health records had moderate validity when compared to vital statistics data. Substantial variation existed across study sites representing different geographic locations and two healthcare systems. These variations may reflect different diagnostic coding practices and healthcare utilization patterns.

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Development and validation of prediction models to estimate risk of primary total hip and knee replacements using data from the UK: two prospective open cohorts using the UK Clinical Practice Research Datalink

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-213894 ◽

2018 ◽

Vol 78 (1) ◽

pp. 91-99 ◽

Cited By ~ 7

Author(s):

Dahai Yu ◽

Kelvin P Jordan ◽

Kym I E Snell ◽

Richard D Riley ◽

John Bedson ◽

...

Keyword(s):

Clinical Practice ◽

Large Scale ◽

Prediction Models ◽

Cox Proportional Hazards ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Total Hip ◽

Risk Of Death ◽

Geographical Regions ◽

The Uk

ObjectivesThe ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual’s risk of primary THR and TKR in patients newly presenting to primary care.MethodsWe identified two cohorts of patients aged ≥40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free ‘Record-Wide Association Study’ with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal–external cross-validation (IECV) was then applied over geographical regions to validate two models.Results45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70–0.74 (THR model) and 0.76–0.82 (TKR model); the IECV calibration slope ranged between 0.93–1.07 (THR model) and 0.92–1.12 (TKR model).ConclusionsTwo prediction models with good discrimination and calibration that estimate individuals’ risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records.

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Epidemiology of first and recurrent venous thromboembolism: A population-based cohort study in patients without active cancer

Thrombosis and Haemostasis ◽

10.1160/th13-09-0793 ◽

2014 ◽

Vol 112 (08) ◽

pp. 255-263 ◽

Cited By ~ 80

Author(s):

Alexander T. Cohen ◽

Luke Bamber ◽

Stephan Rietbrock ◽

Carlos Martinez

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

The Elderly ◽

Population Based ◽

Incidence Rates ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Recurrence Rates ◽

Recurrent Vte ◽

Active Cancer

SummaryContemporary data from population studies on the incidence and complications of venous thromboembolism (VTE) are limited. An observational cohort study was undertaken to estimate the incidence of first and recurrent VTE. The cohort was identified from all patients in the UK Clinical Practice Research Datalink (CPRD) with additional linked information on hospitalisation and cause of death. Between 2001 and 2011, patients with first VTE were identified and the subset without active cancer-related VTE observed for up to 10 years for recurrent VTE. The 10-year cumulative incidence rates (CIR) were derived with adjustment for mortality as a competing risk event. A total of 35,373 first VTE events (12,073 provoked, 16,708 unprovoked and 6592 active cancer-associated VTE) among 26.9 million person-years of observation were identified. The overall incidence rate (IR) of VTE was 131.5 (95% CI, 130.2–132.9) per 100,000 person-years and 107.0 (95% CI, 105.8–108.2) after excluding cancer-associated VTE. DVT was more common in the young and PE was more common in the elderly. VTE recurrence occurred in 3671 (CIR 25.2%). The IR for recurrence peaked in the first six months at around 11 per 100 person years. It levelled out after three years and then remained at around 2 per 100 person years from year 4–10 of follow-up. The IRs for recurrences were particularly high in young men. In conclusion, VTE is common and associated with high recurrence rates. Effort is required to prevent VTE and to reduce recurrences.

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Primary Care Consultations after Hospitalisation for Pneumonia: A Large Population-based Cohort Study

British Journal of General Practice ◽

10.3399/bjgp.2020.0890 ◽

2020 ◽

pp. BJGP.2020.0890

Author(s):

Vadsala Baskaran ◽

Fiona Pearce ◽

Rowan H Harwood ◽

Tricia McKeever ◽

Wei Shen Lim

Keyword(s):

Primary Care ◽

Cohort Study ◽

Large Population ◽

Significant Proportion ◽

Antibiotic Use ◽

Population Based ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Respiratory Disorder ◽

The Impact

Background: Up to 70% of patients report ongoing symptoms four weeks after hospitalisation for pneumonia, and the impact on primary care is poorly understood. Aim: To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. Design: Population-based cohort study. Setting: UK primary care database of anonymised medical records (Clinical Practice Research Datalink, CPRD) linked to Hospital Episode Statistics (HES), England. Methods: Adults with the first ICD-10 code for pneumonia (J12-J18) recorded in HES between July 2002-June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Results: Of 56,396 adults, 55.9% (n=31,542) consulted primary care within 30 days of discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year prior to index admission (adjusted sHR 8.98, 95% CI 6.42-12.55). The commonest reason for consultation was for a respiratory disorder (40.7%, n=12,840), 12% for pneumonia specifically. At consultation, 31.1% (n=9,823) received further antibiotics. Penicillins (41.6%, n=5,753) and macrolides (21.9%, n=3,029) were the commonest antibiotics prescribed. Conclusion: Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

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Frailty Assessed by Administrative Tools and Mortality in Patients With Pneumonia Admitted to the Hospital and ICU: a Population-based Data-linkage Study

10.21203/rs.3.rs-450880/v1 ◽

2021 ◽

Author(s):

Tamas Szakmany ◽

Joe Hollinghurst ◽

Richard Pugh ◽

Ashley Akbari ◽

Rowena Griffiths ◽

...

Keyword(s):

Data Linkage ◽

Social Deprivation ◽

Frailty Index ◽

Significant Risk ◽

Population Based ◽

Linkage Study ◽

Increased Risk ◽

Comorbidity Index ◽

Population Scale

Abstract Background: The ideal method of identifying frailty is uncertain, and data on long-term outcomes is relatively limited. We examined frailty indices derived from population-scale linked data on Intensive Care Unit (ICU) and hospitalised non-ICU patients with pneumonia to elucidate the influence of frailty on mortality.Methods: Longitudinal cohort study between 2010-2018 using population-scale anonymised data linkage of healthcare records for adults admitted to hospital with pneumonia in Wales. Primary outcome was in-patient mortality. Age, hospital frailty risk score (HFRS), electronic frailty index (eFI), Charlson comorbidity index (CCI), and social deprivation index were entered in the multivariate regression models.Results: Of the 107,188 patients, mean (SD) age was 72.6 (16.6) years, 50% were men. The two frailty indices and the comorbidity index had an increased risk of mortality for individuals with an ICU admission. Advancing age, increased frailty and comorbidity affected short- and long-term mortality. For predicting inpatient deaths, the CCI and HFRS based models were similar, however for longer term outcomes the CCI based model was superior. Discussion: Frailty and comorbidity are significant risk factors for patients admitted to hospital with pneumonia. Frailty and comorbidity scores based on administrative data have only moderate ability to predict outcome.

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