Increased risk of infections in Addison's disease and congenital adrenal hyperplasia patients: a longitudinal study based on a United Kingdom primary care database

Abstract Context Mortality and infection-related hospital admissions are increased in patients with primary adrenal insufficiency (PAI). However, the risk of primary care–managed infections in patients with PAI is unknown. Objective To estimate infection risk in PAI due to Addison’s disease (AD) and congenital adrenal hyperplasia (CAH) in a primary care setting. Design Retrospective cohort study using UK data collected from 1995 to 2018. Main outcome measures Incidence of lower respiratory tract infections (LRTIs), urinary tract infections (UTIs), gastrointestinal infections (GIIs), and prescription counts of antimicrobials in adult PAI patients compared to unexposed controls. Results A diagnosis of PAI was established in 1580 AD patients (mean age 51.7 years) and 602 CAH patients (mean age 35.4 years). All AD patients and 42% of CAH patients were prescribed glucocorticoids, most frequently hydrocortisone in AD (82%) and prednisolone in CAH (50%). AD and CAH patients exposed to glucocorticoids, but not CAH patients without glucocorticoid treatment, had a significantly increased risk of LRTIs (adjusted incidence rate ratio AD 2.11 [95% confidence interval (CI) 1.64–2.69], CAH 3.23 [95% CI 1.21–8.61]), UTIs (AD 1.51 [95% CI 1.29–1.77], CAH 2.20 [95% CI 1.43–3.34]), and GIIs (AD 3.80 [95% CI 2.99–4.84], CAH 1.93 [95% CI 1.06–3.52]). This was mirrored by increased prescription of antibiotics (AD 1.73 [95% CI 1.69–1.77], CAH 1.77 [95% CI 1.66–1.89]) and antifungals (AD 1.89 [95% CI 1.74–2.05], CAH 1.91 [95% CI 1.50–2.43]). Conclusions There is an increased risk of infections and antimicrobial use in PAI in the primary care setting at least partially linked to glucocorticoid treatment. Future studies will need to address whether more physiological glucocorticoid replacement modes could reduce this risk.

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Relative incidence of common cancers in people with severe mental illness. Cohort study in the United Kingdom THIN primary care database

Schizophrenia Research ◽

10.1016/j.schres.2012.11.009 ◽

2013 ◽

Vol 143 (1) ◽

pp. 44-49 ◽

Cited By ~ 22

Author(s):

David P.J. Osborn ◽

Heather Limburg ◽

Kate Walters ◽

Irene Petersen ◽

Michael King ◽

...

Keyword(s):

Primary Care ◽

Mental Illness ◽

Cohort Study ◽

United Kingdom ◽

Severe Mental Illness ◽

Primary Care Database ◽

Relative Incidence ◽

The United Kingdom ◽

Care Database

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Pregabalin prescriptions in the United Kingdom: a drug utilisation study of The Health Improvement Network (THIN) primary care database

International Journal of Clinical Practice ◽

10.1111/ijcp.12791 ◽

2016 ◽

Vol 70 (5) ◽

pp. 380-388 ◽

Cited By ~ 21

Author(s):

K. Asomaning ◽

S. Abramsky ◽

Q. Liu ◽

X. Zhou ◽

R. E. Sobel ◽

...

Keyword(s):

Primary Care ◽

United Kingdom ◽

Drug Utilisation ◽

Health Improvement ◽

Primary Care Database ◽

Drug Utilisation Study ◽

The United Kingdom ◽

The Health Improvement Network ◽

Care Database

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Increased infection risk in Addison’s disease and congenital adrenal hyperplasia: a primary care database cohort study

10.1101/628156 ◽

2019 ◽

Author(s):

Alberto S. Tresoldi ◽

Dana Sumilo ◽

Mary Perrins ◽

Konstantinos A. Toulis ◽

Alessandro Prete ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Care Setting ◽

Primary Care Setting ◽

Infection Risk ◽

Adrenal Hyperplasia ◽

Glucocorticoid Treatment ◽

Increased Risk ◽

Tract Infections ◽

Care Database

ABSTRACTContextMortality and infection-related hospital admissions are increased in patients with primary adrenal insufficiency (PAI). However, the risk of primary care-managed infections in patients with PAI is unknown.ObjectiveTo estimate infection risk in PAI due to Addison’s disease (AD) and congenital adrenal hyperplasia (CAH) in a primary care setting.DesignRetrospective cohort study using UK data collected from 1995 to 2018.Main outcome measuresIncidence of lower respiratory tract infections (LRTIs), urinary tract infections (UTIs), gastrointestinal infections (GIIs), and prescription counts of antimicrobials in adult PAI patients compared to unexposed controls.ResultsA diagnosis of PAI was established in 1580 AD patients (mean age 51.7 years) and 602 CAH patients (mean age 35.4 years). All AD patients and 42% of CAH patients were prescribed glucocorticoids, most frequently hydrocortisone in AD (82%) and prednisolone in CAH (50%). AD and CAH patients exposed to glucocorticoids, but not CAH patients without glucocorticoid treatment, had a significantly increased risk of LRTIs (adjusted incidence rate ratio AD 2.11 [95% confidence interval 1.64-2.69], CAH 3.23 [1.21-8.61]), UTIs (AD 1.51 [1.29-1.77], CAH 2.20 [1.43-3.34]), and GIIs (AD 3.80 [2.99-4.84], CAH 1.93 [1.06-3.52]). This was mirrored by increased prescription of antibiotics (AD 1.73 [1.69-1.77], CAH 1.77 [1.66-1.89]) and antifungals (AD 1.89 [1.74-2.05], CAH 1.91 [1.50-2.43]).ConclusionsThere is an increased risk of infections and antimicrobial use in PAI in the primary care setting at least partially linked to glucocorticoid treatment. Future studies will need to address whether more physiological glucocorticoid replacement modes could reduce this risk.PrécisUsing data from 1580 AD patients and 602 CAH patients collected in a UK primary care database from 1995 to 2018, we identified increased risk of infections and antimicrobial prescription counts.

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Validity and completeness of colorectal cancer diagnoses in a primary care database in the United Kingdom

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.3877 ◽

2015 ◽

Vol 25 (4) ◽

pp. 385-391 ◽

Cited By ~ 18

Author(s):

Lucía Cea Soriano ◽

Montse Soriano‐Gabarró ◽

Luis A. García Rodríguez

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

United Kingdom ◽

Primary Care Database ◽

The United Kingdom ◽

Care Database

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Prescribing Trends in Bipolar Disorder: Cohort Study in the United Kingdom THIN Primary Care Database 1995–2009

PLoS ONE ◽

10.1371/journal.pone.0028725 ◽

2011 ◽

Vol 6 (12) ◽

pp. e28725 ◽

Cited By ~ 78

Author(s):

Joseph Hayes ◽

Philip Prah ◽

Irwin Nazareth ◽

Michael King ◽

Kate Walters ◽

...

Keyword(s):

Primary Care ◽

Bipolar Disorder ◽

Cohort Study ◽

United Kingdom ◽

Primary Care Database ◽

The United Kingdom ◽

Prescribing Trends ◽

Care Database

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Risks for comorbidity in children with atopic disorders: an observational study in Dutch general practices

BMJ Open ◽

10.1136/bmjopen-2017-018091 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018091 ◽

Cited By ~ 7

Author(s):

David H J Pols ◽

Arthur M Bohnen ◽

Mark M J Nielen ◽

Joke C Korevaar ◽

Patrick J E Bindels

Keyword(s):

Primary Care ◽

Allergic Rhinitis ◽

Atopic Eczema ◽

Skin Diseases ◽

Services Research ◽

Primary Care Database ◽

Healthcare Data ◽

Atopic Disorder ◽

Increased Risk ◽

Care Database

ObjectiveThis study aimed to investigate both atopic and non-atopic comorbid symptoms and diseases in children with physician-diagnosed atopic disorders (atopic eczema, asthma and allergic rhinitis).MethodsAll children aged 0–18 years listed in a nationwide primary care database (the Netherlands Institute for Health Services Research-Primary Care Database) with routinely collected healthcare data in 2014 were selected. Children with atopic disorders were matched on age and gender with non-atopic controls within the same general practice. A total of 404 International Classification of Primary Care codes were examined. Logistic regression analyses were performed to examine the associations between the presence of atopic disorders and (non-)atopic symptoms and diseases by calculating ORs.ResultsHaving one of the atopic disorders significantly increased the risk of having other atopic-related symptoms, even if the child was not registered as having the related atopic disorder. Regarding non-atopic comorbidity, children with atopic eczema (n=15 530) were at significantly increased risk for (infectious) skin diseases (OR: 1.2–3.4). Airway symptoms or (infectious) diseases (OR: 2.1–10.3) were observed significantly more frequently in children with asthma (n=7887). Children with allergic rhinitis (n=6835) had a significantly distinctive risk of ear-nose-throat-related symptoms and diseases (OR: 1.5–3.9). Neither age nor gender explained these increased risks.ConclusionGeneral practitioners are not always fully aware of relevant atopic and non-atopic comorbidity. In children known to have at least one atopic disorder, specific attention is required to avoid possible insufficient treatment and unnecessary loss of quality of life.

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