OP0074 MULTIMORBIDITY CLUSTERS, DETERMINANTS AND TRAJECTORIES IN OSTEOARTHRITIS IN THE UK: FINDINGS FROM THE CLINICAL PRACTICE RESEARCH DATALINK

Background:Multimorbidity (≥2 chronic conditions) escalates the risk of adverse health outcomes. However, its burden in people with osteoarthritis (OA) remains largely unknown.Objectives:To identify the clusters of patients with multimorbidity and associated factors in OA and non-OA populations and to estimate the risk of developing multimorbidity clusters after the index date (after diagnosis).Methods:The study used the Clinical Practice Research Datalink – a primary care database from the UK. Firstly, age, sex and practice matched OA and non-OA people aged 20+ were identified to explore patterns and associations of clusters of multimorbidity within each group. Non-OA controls were assigned with same index date as that of matched OA cases. Secondly, multimorbidity trajectories for 20 years after the index date were examined in people without any comorbidities at baseline in both OA and non-OA groups. Latent class analysis was used to identify clusters and latent class growth modelling was used for cluster trajectories. The associations between clusters and age, sex, body mass index (BMI), alcohol use, smoking habits at baseline were quantified through multinomial logistic regression.Results:In total, 47 long-term conditions were studied in 443,822 people (OA- 221922; non-OA- 221900), with a mean age of 62 years (standard deviation ± 13 years), and 58% being women. The prevalence of multimorbidity was 76.6% and 68.9% in the OA and non-OA groups, respectively. In the OA group five clusters were identified including relatively healthy (18%), ‘cardiovascular (CVD) and musculoskeletal (MSK)’ (12.3%), metabolic syndrome (28.2%), ‘pain and psychological (9.1%), and ‘musculoskeletal’ (32.4%). The non-OA group had similar patterns except that the ‘pain+ psychological’ cluster was replaced by ‘thyroid and psychological’. (Figure 1) Among people with OA, ‘CVD+MSK’ and metabolic syndrome clusters were strongly associated with obesity with a relative risk ratio (RRR) of 2.04 (95% CI 1.95-2.13) and 2.10 (95% CI 2.03-2.17), respectively. Women had four times higher risk of being in the ‘pain+ psychological’ cluster than men when compared to the gender ratio in the healthy cluster, (RRR 4.28; 95% CI 4.09-4.48). In the non-OA group, obesity was significantly associated with all the clusters.Figure 1: Posterior probability distribution of chronic conditions across the clusters in Osteoarthritis (OA, n=221922) and Non-Osteoarthritis (Non-OA, n=221900) group. COPD- Chronic Obstructive Pulmonary Disease; CVD- Cardiovascular; MSK- MusculoskeletalOA (n=24139) and non-OA (n=24144) groups had five and four multimorbidity trajectory clusters, respectively. Among the OA population, 2.7% had rapid onset of multimorbidity, 9.5% had gradual onset and 11.6% had slow onset, whereas among the non-OA population, there was no rapid onset cluster, 4.6% had gradual onset and 14.3% had slow onset of multimorbidity. (Figure 2)Figure 2: Clusters of multimorbidity trajectories after index date in OA (n=24139) and Non-OA (n=24144)Conclusion:Distinct identified groups in OA and non-OA suggests further research for possible biological linkage within each cluster. The rapid onset of multimorbidity in OA should be considered for chronic disease management.Supported by:Acknowledgments:We would like to thank the University of Nottingham, UK, Beijing Joint Care Foundation, China and Foundation for Research in Rheumatology (FOREUM) for supporting the study.Disclosure of Interests:Subhashisa Swain: None declared, Carol Coupland: None declared, Victoria Strauss: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Chang-Fu Kuo: None declared, Aliya Sarmanova: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium

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O16 Incidence, prevalence and associated comorbidity of axSpA within the UK: a retrospective database analysis

Rheumatology ◽

10.1093/rheumatology/keaa110.015 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Christopher L. I Morgan ◽

Abigail White ◽

Mark Tomlinson ◽

Amie Scott ◽

Haijun Tian

Keyword(s):

Primary Care ◽

Index Date ◽

Practice Research ◽

Care Practice ◽

Clinical Practice Research Datalink ◽

Case Ascertainment ◽

International Statistical Classification ◽

The Uk ◽

Primary Care Practices ◽

Incident Cases

Abstract Background This study reports the incidence and prevalence of axial spondyloarthritis (axSpA) in the UK, and describes the baseline characteristics and comorbidities associated with the condition. Methods This study was conducted using the Clinical Practice Research Datalink, a large routine primary care database in the UK. Approximately 60% of contributing English primary care practices are linked to Hospital Episode Statistics (HES) secondary care data. AxSpA and relevant comorbidities were identified from Read or International Statistical Classification of Diseases and Related Health Problems-10 codes in primary care or HES datasets, respectively. The date of first axSpA diagnosis defined the index date. Patients with ≥90 days between practice registration and first axSpA diagnosis were classified as incident cases. The incidence and prevalence of axSpA were calculated annually from 2003-2017 for the UK as a whole, each constituent nation and English practices linked to HES data, to maximise case ascertainment. Comorbidities occurring prior to the index date (inclusive) were reported and compared with non-axSpA patients matched for age, sex, primary care practice and concurrent practice registration. Results Overall, 20,199 axSpA patients were identified, of whom 8,387 (41.5%) were classified as incident cases. Of the incident cases, 2,600 (31.0%) were female. Mean age at first diagnosis was 45.5 years (standard deviation [SD]: 17.2), mean body mass index was 27.2 kg/m2 (SD: 5.9) and 2,481 (29.6%) patients were current smokers. In 2017, the incidence of axSpA was 8.0 per 100,000 person-years and the prevalence was 15.8 per 10,000 population, an increase from 12.7 per 10,000 population in 2003. For patients from English practices linked to HES data, the incidence was 10.8 per 100,000 person-years and the prevalence was 17.5 per 10,000 population. 8,385 (∼100.0%) axSpA patients could be matched to non-axSpA controls. At baseline, all selected comorbidities were significantly increased in axSpA cases vs controls (Table). Conclusion This study reports an increasing prevalence of axSpA over the study period and higher rates of specific comorbidities in patients with axSpA vs matched controls. Caveats related to routine database studies, including secular changes in case ascertainment and observation bias, should be considered when interpreting these results. Disclosures C.L.I. Morgan: Other; Employee of: Pharmatelligence. A. White: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. M. Tomlinson: Consultancies; Novartis. A. Scott: Consultancies; Novartis. H. Tian: Other; Employee of: Novartis.

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Dynamics of multimorbidity in England between 2004 and 2019: a descriptive epidemiology study

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.818 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Head ◽

K Fleming ◽

C Kypridemos ◽

P Schofield ◽

M O'Flaherty

Keyword(s):

Chronic Conditions ◽

Large Population ◽

Temporal Trends ◽

Population Level ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Long Term Conditions ◽

The Uk ◽

Three Body ◽

Over Time

Abstract Background An estimated 25% of GP patients within the UK have multimorbidity, a large proportion of which is attributable to non-communicable diseases, many of them preventable. The heterogeneity of existing study methodologies limits comparisons to assess temporal trends. This study aims to use a large population-representative dataset to describe changes over time in multimorbidity incidence and prevalence. Methods We used two measures of multimorbidity a) basic: two or more chronic conditions; b) complex: at least three chronic conditions affecting at least three body systems. Chronic conditions for inclusion were discussed by a multidisciplinary team. A 1m random sample of patients registered between 2004 and 2019 at GP practices in England were drawn from the UK Clinical Practice Research Datalink. We calculated crude and age-sex standardised annual multimorbidity prevalence and incidence using standard formulae. Analyses were conducted using R v3.6.3. Participants will be linked to the 2015 Index of Multiple Deprivation to describe equity trends over time. Results Preliminary results show that age-sex standardised annual prevalence increased from 32.9% (95% CI: 32.7% - 33.1%) with basic multimorbidity and 14.9% (95% CI: 14.7%-15.0%) with complex multimorbidity in 2004 to 51.0% (95% CI: 50.8% - 51.3%) and 29.9% (95% CI: 29.7% - 30.1%) in 2019. Basic multimorbidity incidence per 10,000 person-years showed little change, however there was an increase in the incidence of complex multimorbidity from 322 (95% CI: 315- 330) to 418 (95% CI: 407 - 430). Conclusions The burden of multimorbidity has increased substantially over the last 15 years. Complex multimorbidity incidence and prevalence have increased more rapidly than for basic multimorbidity. This highlights the need for improved population-level prevention strategies to postpone and prevent the onset of long-term conditions. Next, we will assess whether there are socioeconomic differences in these temporal trends. Key messages The burden of multimorbidity increased between 2004 and 2019. The increase in incidence and prevalence of complex multimorbidity was greater than for basic multimorbidity.

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P252 Treatment pathways for patients with axSpA: a retrospective UK database analysis

Rheumatology ◽

10.1093/rheumatology/keaa111.245 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Christopher L. I Morgan ◽

Abigail White ◽

Mark Tomlinson ◽

Amie Scott ◽

Haijun Tian

Keyword(s):

Rheumatoid Arthritis ◽

Back Pain ◽

Index Date ◽

Systemic Disease ◽

Inpatient Admission ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Secondary Diagnosis ◽

Treatment Pathways ◽

The Uk

Abstract Background This UK study aimed to identify a population with axial spondyloarthritis (axSpA) and to describe the presence of prior reported symptoms and treatment pathways associated with the condition. Methods The study was performed using a large routine primary care database from the UK, the Clinical Practice Research Datalink. Only patients whose record could be linked to Hospital Episode Statistics (HES) were included for analysis. Patients with an incident diagnosis of axSpA recorded from 2003-2017 were identified. The date of first axSpA diagnosis defined the index date and patients were observed until the end of database follow up. Recordings of axSpA-related symptoms (back pain, rheumatoid arthritis and fatigue) in the 12 months prior to the index date, before and after attendance at orthopaedic or rheumatology outpatient clinics, and after inpatient contact with either a primary or secondary diagnosis of axSpA were flagged. The proportion of patients prescribed tumour necrosis factor inhibitors (TNFis), corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) or conventional systemic disease-modifying anti-rheumatic drugs (csDMARDs) subsequent to the index date and estimated first three lines of therapy were described. Results A total of 2,756 incident axSpA cases were identified. In the 12 months prior to the index date, 1,289 (46.8%) of these patients had at least one recorded symptom related to axSpA: back pain (1,195 [43.4%]), rheumatoid arthritis (140 [5.1%]) and fatigue (6 [0.2%]). Prior to the index date, 1,025 (37.2%) patients had been seen in an orthopaedic outpatient clinic and 1,274 (46.2%) in a rheumatology clinic. Subsequent to the index date, the respective figures were 815 (29.6%) and 1,641 (59.5%). In addition, 133 (4.8%) patients had a post-index inpatient admission with a primary diagnosis of axSpA and 895 (32.5%) had an inpatient admission with a secondary diagnosis. TNFis were prescribed for 97 (3.5%) patients, corticosteroids for 727 (26.4%), NSAIDs for 1,885 (68.4%) and csDMARDs for 461 (16.7%) patients. The most common first-line therapy was NSAIDs (1,579 [57.3%]) (Table). Conclusion This study describes the symptoms of and treatment pathways for axSpA patients within the UK. Issues regarding missing data within routine data should be considered when interpreting the results. Disclosures C.L.I. Morgan: Other; Employee of: Pharmatelligence. A. White: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. M. Tomlinson: Consultancies; Novartis. A. Scott: Consultancies; Novartis. H. Tian: Other; Employee of: Novartis.

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Variation in tests for people with type 2 diabetes, hypertension, or chronic kidney disease in UK primary care

British Journal of General Practice ◽

10.3399/bjgp19x703193 ◽

2019 ◽

Vol 69 (suppl 1) ◽

pp. bjgp19X703193

Author(s):

Rita Patel ◽

Martha Elwenspoek ◽

Jessica Watson ◽

Ed Mann ◽

Katharine Alsop ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Chronic Conditions ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Patient Anxiety ◽

The Uk

BackgroundRates of pathology testing are rising in the UK, with significant geographical variability. Around 50% of overall GP laboratory testing represents monitoring for chronic conditions such as high blood pressure, type 2 diabetes, and chronic kidney disease (CKD). Overuse of tests for monitoring chronic conditions may be a potential source of harm; causing patient anxiety, downstream tests/referrals, overdiagnosis, increase GP workload and increase health service costs. On the other hand, failure to test may lead to missed diagnoses, complications, patient harm and litigation.AimThis study aims to use an open cohort to examine current variation in the use of tests for individuals with type 2 diabetes, hypertension, and CKD>2 across the UK.MethodClinical Practice Research Datalink (CPRD) data will be used to consider what tests have been ordered for people with these conditions and look at variation over time, and by region, age, sex, ethnicity, and socioeconomic position using age–sex-standardised utilisation rates, descriptive statistics, and multilevel Poisson regression.ResultsAn estimated 1.2 million patients within the CPRD database have previously been diagnosed with any of the chronic conditions with over 11 million tests. Some 1 029 496 patients have hypertension, 344 613 with diabetes, and 271 897 with CKD>2, with much overlap. The results from this study will help to find what tests are currently used among patients with these conditions and to quantify variation in testing.ConclusionThis work will be used to inform the development of testing algorithms for patients with these conditions in primary care.

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Temporal relationship between osteoarthritis and comorbidities: a combined case control and cohort study in the UK primary care setting

Rheumatology ◽

10.1093/rheumatology/keab067 ◽

2021 ◽

Author(s):

Subhashisa Swain ◽

Carol Coupland ◽

Christian Mallen ◽

Chang Fu Kuo ◽

Aliya Sarmanova ◽

...

Keyword(s):

Primary Care ◽

Index Date ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Developing Heart ◽

Temporal Relationships ◽

Hazard Ratios ◽

Before And After ◽

Irritable Bowel ◽

The Uk

Abstract Objective To determine the burden of comorbidities in osteoarthritis (OA) and their temporal relationships in the UK. Methods The Clinical Practice Research Datalink (CPRD) GOLD was used to identify people with incident OA and age, gender and practice matched non-OA controls from UK primary care. Controls were assigned the same index date as matched cases (date of OA diagnosis). Associations between OA and 49 individual comorbidities and multimorbidity (≥2 comorbidities excluding OA) both before and after OA diagnosis were estimated, adjusting for covariates, using odds ratios (aOR) and hazard ratios (aHR) respectively. Results During 1997–2017, we identified 221 807 incident OA cases and 221 807 matched controls. Of 49 comorbidities examined, 38 were associated with OA both prior to, and following, the diagnosis of OA, and 2 (dementia and SLE) were associated with OA only following the diagnosis of OA. People with OA had higher risk of developing heart failure (aHR 1.63; 95% CI 1.56–1.71), dementia (aHR 1.62; 95% CI 1.56–1.68), liver diseases (aHR 1.51; 95% CI 1.37–1.67), irritable bowel syndrome (aHR 1.51; 95% CI 1.45–1.58), gastrointestinal bleeding (aHR 1.49; 95% CI 1.39–1.59), 10 musculoskeletal conditions and 25 other conditions following OA diagnosis. The aOR for multimorbidity prior to the index date was 1.71 (95% CI 1.69–1.74), whereas the aHR for multimorbidity after the index date was 1.29 (95% CI 1.28–1.30). Conclusions People with OA are more likely to have other chronic conditions both before and after the OA diagnosis. Further study on shared aetiology and causality of these associations is needed.

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Paediatric rotavirus vaccination, coeliac disease and type 1 diabetes in children: a population-based cohort study

BMC Medicine ◽

10.1186/s12916-021-02017-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Thomas Inns ◽

Kate M. Fleming ◽

Miren Iturriza-Gomara ◽

Daniel Hungerford

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Coeliac Disease ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Rotavirus Vaccine ◽

Rotavirus Vaccination ◽

Increased Risk ◽

The Uk

Abstract Background Rotavirus infection has been proposed as a risk factor for coeliac disease (CD) and type 1 diabetes (T1D). The UK introduced infant rotavirus vaccination in 2013. We have previously shown that rotavirus vaccination can have beneficial off-target effects on syndromes, such as hospitalised seizures. We therefore investigated whether rotavirus vaccination prevents CD and T1D in the UK. Methods A cohort study of children born between 2010 and 2015 was conducted using primary care records from the Clinical Practice Research Datalink. Children were followed up from 6 months to 7 years old, with censoring for outcome, death or leaving the practice. CD was defined as diagnosis of CD or the prescription of gluten-free goods. T1D was defined as a T1D diagnosis. The exposure was rotavirus vaccination, defined as one or more doses. Mixed-effects Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Models were adjusted for potential confounders and included random intercepts for general practices. Results There were 880,629 children in the cohort (48.8% female). A total of 343,113 (39.0%) participants received rotavirus vaccine; among those born after the introduction of rotavirus vaccination, 93.4% were vaccinated. Study participants contributed 4,388,355 person-years, with median follow-up 5.66 person-years. There were 1657 CD cases, an incidence of 38.0 cases per 100,000 person-years. Compared with unvaccinated children, the adjusted HR for a CD was 1.05 (95% CI 0.86–1.28) for vaccinated children. Females had a 40% higher hazard than males. T1D was recorded for 733 participants, an incidence of 17.1 cases per 100,000 person-years. In adjusted analysis, rotavirus vaccination was not associated with risk of T1D (HR = 0.89, 95% CI 0.68–1.19). Conclusions Rotavirus vaccination has reduced diarrhoeal disease morbidity and mortality substantial since licencing in 2006. Our finding from this large cohort study did not provide evidence that rotavirus vaccination prevents CD or T1D, nor is it associated with increased risk, delivering further evidence of rotavirus vaccine safety.

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Calcium channel blockers and cancer: a risk analysis using the UK Clinical Practice Research Datalink (CPRD)

BMJ Open ◽

10.1136/bmjopen-2015-009147 ◽

2016 ◽

Vol 6 (1) ◽

pp. e009147 ◽

Cited By ~ 25

Author(s):

Lamiae Grimaldi-Bensouda ◽

Olaf Klungel ◽

Xavier Kurz ◽

Mark C H de Groot ◽

Ana S Maciel Afonso ◽

...

Keyword(s):

Clinical Practice ◽

Risk Analysis ◽

Calcium Channel ◽

Calcium Channel Blockers ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Channel Blockers ◽

The Uk

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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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Statin use and reduced risk of biliary tract cancers in the UK Clinical Practice Research Datalink

Gut ◽

10.1136/gutjnl-2018-317504 ◽

2018 ◽

Vol 68 (8) ◽

pp. 1458-1464 ◽

Cited By ~ 3

Author(s):

Zhiwei Liu ◽

Rotana Alsaggaf ◽

Katherine A McGlynn ◽

Lesley A Anderson ◽

Huei-Ting Tsai ◽

...

Keyword(s):

Clinical Practice ◽

Biliary Tract ◽

Conditional Logistic Regression ◽

Incidence Density ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Biliary Tract Cancers ◽

The Uk ◽

Reduced Risk ◽

Statin Use

ObjectiveTo evaluate the association between statin use and risk of biliary tract cancers (BTC).DesignThis is a nested case–control study conducted in the UK Clinical Practice Research Datalink. We included cases diagnosed with incident primary BTCs, including cancers of the gall bladder, bile duct (ie, both intrahepatic and extrahepatic cholangiocarcinoma), ampulla of Vater and mixed type, between 1990 and 2017. For each case, we selected five controls who did not develop BTCs at the time of case diagnosis, matched by sex, year of birth, calendar time and years of enrolment in the general practice using incidence density sampling. Exposures were defined as two or more prescription records of statins 1 year prior to BTC diagnosis or control selection. ORs and 95% CIs for associations between statins and BTC overall and by subtypes were estimated using conditional logistic regression, adjusted for relevant confounders.ResultsWe included 3118 BTC cases and 15 519 cancer-free controls. Current statin use versus non-use was associated with a reduced risk of all BTCs combined (adjusted OR=0.88, 95% CI 0.79 to 0.98). The reduced risks were most pronounced among long-term users, as indicated by increasing number of prescriptions (ptrend=0.016) and cumulative dose of statins (ptrend=0.008). The magnitude of association was similar for statin use and risk of individual types of BTCs. The reduced risk of BTCs associated with a record of current statin use versus non-use was more pronounced among persons with diabetes (adjusted OR=0.72, 95% CI 0.57 to 0.91). Among non-diabetics, the adjusted OR for current statin use versus non-use was 0.91 (95% CI 0.81 to 1.03, pheterogeneity=0.007).ConclusionCompared with non-use of statins, current statin use is associated with 12% lower risk of BTCs; no association found with former statin use. If replicated, particularly in countries with a high incidence of BTCs, our findings could pave the way for evaluating the value of statins for BTC chemoprevention.

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