scholarly journals Drug prescriptions and dementia incidence: a medication-wide association study of 17000 dementia cases among half a million participants

2021 ◽  
pp. jech-2021-217090
Author(s):  
Tim Wilkinson ◽  
Christian Schnier ◽  
Kathryn Bush ◽  
Kristiina Rannikmäe ◽  
Ronan A Lyons ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Association Study ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Mortality Data ◽  
Care Hospital ◽  
Dementia Incidence ◽  
Primary Care Hospital

BackgroundPrevious studies have suggested that some medications may influence dementia risk. We conducted a hypothesis-generating medication-wide association study to investigate systematically the association between all prescription medications and incident dementia.MethodsWe used a population-based cohort within the Secure Anonymised Information Linkage (SAIL) databank, comprising routinely-collected primary care, hospital admissions and mortality data from Wales, UK. We included all participants born after 1910 and registered with a SAIL general practice at ≤60 years old. Follow-up was from each participant’s 60th birthday to the earliest of dementia diagnosis, deregistration from a SAIL general practice, death or the end of 2018. We considered participants exposed to a medication if they received ≥1 prescription for any of 744 medications before or during follow-up. We adjusted for sex, smoking and socioeconomic status. The outcome was any all-cause dementia code in primary care, hospital or mortality data during follow-up. We used Cox regression to calculate hazard ratios and Bonferroni-corrected p values.ResultsOf 551 344 participants, 16 998 (3%) developed dementia (median follow-up was 17 years for people who developed dementia, 10 years for those without dementia). Of 744 medications, 221 (30%) were associated with dementia. Of these, 217 (98%) were associated with increased dementia incidence, many clustering around certain indications. Four medications (all vaccines) were associated with a lower dementia incidence.ConclusionsAlmost a third of medications were associated with dementia. The clustering of many drugs around certain indications may provide insights into early manifestations of dementia. We encourage further investigation of hypotheses generated by these results.

scholarly journals Identifying dementia outcomes in UK Biobank: a validation study of primary care, hospital admissions and mortality data

2019 ◽  
Vol 34 (6) ◽  
pp. 557-565 ◽  
Author(s):  
Tim Wilkinson ◽  
◽  
Christian Schnier ◽  
Kathryn Bush ◽  
Kristiina Rannikmäe ◽  
...  
Keyword(s):  
Primary Care ◽  
Validation Study ◽  
Hospital Admissions ◽  
Mortality Data ◽  
Care Hospital ◽  
Uk Biobank ◽  
Primary Care Hospital

scholarly journals Primary, secondary care and mortality data-linked to identify the prevalence of cerebral palsy in children and young people

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Bethan Carter ◽  
Hywel Jones ◽  
Jackie Bethell ◽  
Ting Wang ◽  
Sarah Rees ◽  
...  
Keyword(s):  
Young People ◽  
Secondary Care ◽  
Chronic Conditions ◽  
Hospital Admissions ◽  
Mortality Data ◽  
Care Hospital ◽  
Children And Young People ◽  
Period Prevalence ◽  
Primary Care Hospital ◽  
Clinical Records

IntroductionEvaluations of healthcare utilisation for children and young people (CYP) with chronic conditions, are increasingly relying upon routinely collected healthcare data to estimate healthcare burden and inform national policy and practice. However, chronic conditions are not consistently or accurately recorded making it difficult to conduct valid epidemiological analyses. Objectives and ApproachWe explored routinely collected healthcare datasets of 2,122,914 CYP in the English Clinical Practice Research Dataset (CPRD) and 1,636,252 CYP in the Welsh Secure Anonymous Information Linkage (SAIL) databank to identify patients with CP (an exemplar of a chronic neurodisability) from diagnosis coding (G80-83.3). Linked primary care, hospital admission outpatient and mortality data were searched from birth and populations of CYP aged 0-25 years between 2004 and 2014 with and without CP were identified. We detected the ascertainment sources and compared the results from CPRD and SAIL. In a sample of cases G80-83 codes were validated against clinical records. Results England: Some 7,500 cases of CP were identified (period prevalence: 3.5 per 1000 CYP). Of those, 36.6% were identified from hospital admissions; 20.6% from GP data, 42.0% were in both datasets with 0.8% from outpatient/ONS mortality data. Wales: Some 5,400 cases of CP were identified (period prevalence: 3.3 per 1000 CYP). Of those, 38.6% were identified from hospital admissions, 25.3% from GP data, 36.0% were in both datasets, and 0.1% from mortality/outpatient datasets. 729/877(83.1%) cases coded as G80-83 in secondary care case notes were validated cases of CP leaving 16.9% that were incorrectly coded. Approximately 70% of G80 cases were recorded as G80.8-9 (CP other/unspecified). Roughly 30% of cases were only coded as CP on one occasion within the primary and secondary care datasets. Conclusion/ImplicationsSimilar proportions of CP cases were identified in the two datasets giving similar period prevalences. Inconsistent and incorrect coding will affect the accuracy of these figures and precludes any analysis by disease type/severity. Improved coding of chronic conditions is needed before accurate healthcare analysis of routine data can be undertaken.

scholarly journals The Secure Anonymised Information Linkage databank Dementia e-cohort (SAIL-DeC)

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Christian Schnier ◽  
Tim Wilkinson ◽  
Ashley Akbari ◽  
Chris Orton ◽  
Kristel Sleegers ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Care ◽  
Demographic Data ◽  
International Classification Of Diseases ◽  
Observation Time ◽  
Care Hospital ◽  
Healthcare Data ◽  
Primary Care Hospital ◽  
Dementia Research

IntroductionThe rising burden of dementia is a global concern, and there is a need to study its causes, natural history and outcomes. The Secure Anonymised Information Linkage (SAIL) Databank contains anonymised, routinely-collected healthcare data for the population of Wales, UK. It has potential to be a valuable resource for dementia research owing to its size, long follow-up time and prospective collection of data during clinical care. ObjectivesWe aimed to apply reproducible methods to create the SAIL dementia e-cohort (SAIL-DeC). We created SAIL-DeC with a view to maximising its utility for a broad range of research questions whilst minimising duplication of effort for researchers. MethodsSAIL contains individual-level, linked primary care, hospital admission, mortality and demographic data. Data are currently available until 2018 and future updates will extend participant follow-up time. We included participants who were born between 1st January 1900 and 1st January 1958 and for whom primary care data were available. We applied algorithms consisting of International Classification of Diseases (versions 9 and 10) and Read (version 2) codes to identify participants with and without all-cause dementia and dementia subtypes. We also created derived variables for comorbidities and risk factors. Results From 4.4 million unique participants in SAIL, 1.2 million met the cohort inclusion criteria, resulting in 18.8 million person-years of follow-up. Of these, 129,650 (10%) developed all-cause dementia, with 77,978 (60%) having dementia subtype codes. Alzheimer’s disease was the most common subtype diagnosis (62%). Among the dementia cases, the median duration of observation time was 14 years. ConclusionsWe have created a generalisable, national dementia e-cohort, aimed at facilitating epidemiological dementia research.

A preliminary study of the relationship between general practice care and hospitalisation using a diabetes register, CARDIAB

2013 ◽  
Vol 37 (2) ◽  
pp. 210 ◽  
Author(s):  
Elizabeth J. Comino ◽  
Duong Thuy Tran ◽  
Jane R. Taggart ◽  
Siaw-Teng Liaw ◽  
Warwick Ruscoe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Emergency Department ◽  
General Practice ◽  
Data Collection ◽  
Hospital Admissions ◽  
Processes Of Care ◽  
Control Of Diabetes ◽  
Diabetes Register

Background. Diabetes can be effectively managed in general practice (GP). This study used record linkage to explore associations between diabetes care in GP and hospitalisation. Methods. Data on patients with type 2 diabetes were extracted from a Division of GP diabetes register (CARDIAB) for 2002–05 and were linked to the New South Wales Admitted Patient and Emergency Department (ED) Data Collection to create a unit record data collection containing demographic, clinical and health service records. Rates of admission and ED presentation per patient-year of follow up were calculated for the year following CARDIAB record. Results. The study included 1178 diabetic patients with 2959 patient-years of follow up. Their mean age was 65.7 years and duration of diabetes was 5.9 years. All-cause admission and ED presentation rates were 0.7 and 0.2 per patient-year of follow up respectively and length of admission 3.2 days (s.d. 11.7 days). Admission was associated with age, duration of diabetes and prior admission. The number of processes of care recorded for each patient-year was associated with admission. Admission and length of stay were not associated with achievement of clinical targets. Conclusions. These data suggest that receipt of processes of care, rather than clinical targets, will prevent admission. One explanation may be that continuity of care in GP provides opportunity for early intervention and treatment. What is known about the topic? Diabetes is a serious public health problem that is largely managed in primary care. Health care planners use health service use (hospital admissions) for diabetes as an indicator of primary care. Guidelines for diabetes care are known to be effective in reducing diabetes-related complications. What does this paper add? This paper created a linked data collection comprising demographic and clinical data from general practice and administrative health records of hospital admissions and emergency department presentations. The paper explores the associations between processes of primary care and control of diabetes and cardiovascular risk factors, and use of health services for a general practice population with diabetes. What are the implications for practitioners? The study suggests that processes of care and not technical control of diabetes and cardiovascular risk factors are important in preventing hospital admission. Continuity of care in general practice that ensures implementation of processes of care provides opportunity for early intervention and treatment.

scholarly journals An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018331 ◽  
Author(s):  
Johannes M I H Gho ◽  
Amand F Schmidt ◽  
Laura Pasea ◽  
Stefan Koudstaal ◽  
Mar Pujades-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Electronic Health Records ◽  
Hospital Admissions ◽  
Sensitivity Analyses ◽  
Mortality Data ◽  
Care Hospital ◽  
Health Records ◽  
Primary Care Hospital ◽  
Electronic Health

ObjectivesTo investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs).MethodsData were used from the CALIBER programme, linking EHRs in England from primary care, hospital admissions, an MI registry and mortality data. Subjects were eligible if they were 18 years or older, did not have a history of HF and survived a first MI. Factors associated with time to HF were examined using Cox proportional hazard models.ResultsOf the 24 479 patients with MI, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% CI 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% CI 1.51 to 1.75), age (per 10 years increase: 1.45, 1.41 to 1.49), diabetes (1.45, 1.35 to 1.56), peripheral arterial disease (1.38, 1.26 to 1.51), chronic obstructive pulmonary disease (1.28, 1.17 to 1.40), greater socioeconomic deprivation (5th vs 1st quintile: 1.27, 1.13 to 1.41), ST-segment elevation MI at presentation (1.19, 1.11 to 1.27) and hypertension (1.16, 1.09 to 1.23). Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation.ConclusionIn England, one in four survivors of a first MI develop HF within 4 years. This contemporary study demonstrates that patients with MI are at considerable risk of HF. Baseline patient characteristics associated with time until HF were identified, which may be used to target preventive strategies.

scholarly journals Concordance and timing in recording cancer events in primary care, hospital and mortality records for patients with and without psoriasis: A population-based cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254661
Author(s):  
Alex M. Trafford ◽  
Rosa Parisi ◽  
Martin K. Rutter ◽  
Evangelos Kontopantelis ◽  
Christopher E. M. Griffiths ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Linked Data ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Care Hospital ◽  
Health Records ◽  
Primary Care Hospital ◽  
Electronic Health ◽  
Risk Of Cancer

Background The association between psoriasis and the risk of cancer has been investigated in numerous studies utilising electronic health records (EHRs), with conflicting results in the extent of the association. Objectives To assess concordance and timing of cancer recording between primary care, hospital and death registration data for people with and without psoriasis. Methods Cohort studies delineated using primary care EHRs from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, with linkage to hospital episode statistics (HES), Office for National Statistics (ONS) mortality data and indices of multiple deprivation (IMD). People with psoriasis were matched to those without psoriasis by age, sex and general practice. Cancer recording between databases was investigated by proportion concordant, that being the presence of cancer record in both source and comparator datasets. Delay in recording cancer diagnoses between CPRD and HES records and predictors of discordance were also assessed. Results 58,904 people with psoriasis and 350,592 comparison patients were included using CPRD GOLD; whereas 213,400 people with psoriasis and 1,268,998 comparison patients were included in CPRD Aurum. For all cancer records (excluding keratinocyte), concordance between CPRD and HES was greater than 80%. Concordance for same-site cancer records was markedly lower (<68% GOLD-linked data; <72% Aurum-linked data). Concordance of non-Hodgkin lymphoma and liver cancer recording between CPRD and HES was lower for people with psoriasis compared to those without. Conclusions Concordance between CPRD and HES is poor when restricted to cancers of the same site, with greater discordance in people with psoriasis for some cancers of specific sites. The use of linked patient-level data is an important step in reducing misclassification of cancer outcomes in epidemiological studies using routinely collected electronic health records.

scholarly journals Broad-based SARS-CoV-2 Testing Program for Healthcare Workers in a Primary Care Hospital In France

2021 ◽  
Author(s):  
Julie Chas ◽  
Marine Nadal ◽  
Martin Siguier ◽  
Anne Fajac ◽  
Michel Denis ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Workers ◽  
Care Hospital ◽  
Testing Program ◽  
Primary Care Hospital

scholarly journals Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old

2020 ◽  
Author(s):  
Tam Watermeyer ◽  
Jantje Goerdten ◽  
Boo Johansson ◽  
Graciela Muniz-Terrera
Keyword(s):  
Cognitive Performance ◽  
Cox Regression ◽  
Oldest Old ◽  
Cost Effective ◽  
Carrier Status ◽  
Dementia Diagnosis ◽  
Cognitive Domains ◽  
Dementia Incidence ◽  
Composite Scores

Abstract Background Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (&gt;80 years) and its relationship to dementia incidence. Objective The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. Methods Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. Results Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. Conclusions The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.

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