Abstract The COVID-19 pandemic led to unparalleled pressure on healthcare services. Improved health-care planning in relation to diseases affecting the respiratory system has consequently become a key concern. We investigated the value of integrating sales of non-prescription medications commonly bought for managing respiratory symptoms, to improve forecasting of weekly registered deaths from respiratory disease at local levels across England, by using over 2 billion transactions logged by a UK high street retailer from March 2016 to March 2020. We report the results from the novel AI explainability variable importance tool Model Class Reliance implemented on the PADRUS model. PADRUS is a machine learning model optimised to predict registered deaths from respiratory disease in 314 local authority areas across England through the integration of shopping sales data and focused on purchases of non-prescription medications. We found strong evidence that models incorporating sales data significantly out-perform other models that solely use vari-ables traditionally associated with respiratory disease (e.g. sociodemographics and weather data). Accuracy gains are highest (increases in R2 between 0.09 to 0.11) in periods of maximum risk to the general public. Results demonstrate the potential to utilise sales data to monitor population health with information at a high level of geographic granularity.
Our aim was to quantify the risk of community-acquired infective pneumonia (CAP) among patients with coeliac disease (CD), vaccinated and unvaccinated against pneumococcus, compared to the general population.
Method
We identified all subjects with diagnosed CD within the Clinical Practice Research Datalink linked with Hospital Episodes Statistics between 1stApril 1997 and 31stMarch 2011 and up to 10 controls per CD patient by frequency matching within 10-year age bands. We calculated rates per 1000 person-years of the first CAP among all patients with CD and controls, separately in those vaccinated and unvaccinated against pneumococcus, and in CD patients before and after their diagnosis. We used a Cox regression model to estimate the hazard ratio (HR) of pneumonia among CD patients compared to the controls.
Results
Among 9,803 CD patients and 101,755 controls, respectively there were 179 (1.82%) and 1864 (1.83%) CAP events. The overall rate of CAP in CD was 3.42 per 1000 person-years and 3.12 per 1000 person-years in controls. We found an increased risk of pneumonia among the unvaccinated CD patients compared to unvaccinated controls (HR 1.28, 95% CI 1.02–1.60), but not in vaccinated CD patients compared to vaccinated controls (HR 0.88, 95% CI 0.70–1.10). The increased risk in unvaccinated CD subjects was limited to those younger than 65 years, was particularly increased around the time of diagnosis (HR 2.31, 95% CI 1.03–5.19 within 1 year after diagnosis) and was maintained for more than 5 years after diagnosis (Table 1).
Conclusion
Unvaccinated people with CD under the age of 65 have a higher risk of CAP compared to the general population around the time of diagnosis and subsequently. Pneumococcal vaccination in people with CD following diagnosis and treatment would appear to be good medical advice.
Summary Background: A 15‐fold increased risk of gastrointestinal bleeding has been reported with concurrent use of selective serotonin reuptake inhibitors and non‐steroidal anti‐inflammatory drugs. Recent guidance cautions against concurrent prescription, particularly in older people. Aim: To quantify the risk of gastrointestinal bleeding associated with current exposure to non‐steroidal anti‐inflammatory drugs, selective serotonin reuptake inhibitors, and both drugs concurrently. Methods: We conducted a case–control analysis of 11 261 cases with upper gastrointestinal bleeding and 53 156 controls matched by gender, age and general practice from computerized primary care data. We coupled this with self‐controlled case series analysis. Results: Both drugs were associated with a twofold increased risk of gastrointestinal bleeding (odds ratio =2.38, 95% confidence interval 2.08–2.72 for selective serotonin reuptake inhibitors and odds ratio = 2.15, 95% confidence interval 2.02–2.28 for non‐steroidal anti‐inflammatory drugs). This increased risk was marginally higher for concurrent prescription (odds ratio = 2.93, 95%confidence interval 2.25–3.82). The self‐controlled analysis showed a greater incidence rate ratio for gastrointestinal bleeding with non‐steroidal anti‐inflammatory drugs (2.71, 95% confidence interval 2.51–2.91) and lower incidence rate ratio with selective serotonin reuptake inhibitors (1.71, 95% confidence interval 1.48–1.98). The incidence rate ratio when both drugs were combined was 3.25, 95% confidence interval 1.95–5.42. Estimates were similar after restricting to people over 80 years of age. Increased risk of gastrointestinal bleeding was not specifically related to class of non‐steroidal anti‐inflammatory drugs and was similar when we looked at tricyclic anti‐depressants. Conclusions: Our study suggests that the risk of gastrointestinal bleeding is not substantially increased when non‐steroidal anti‐inflammatory drugs and selective serotonin reuptake inhibitors are prescribed together, compared with their use alone.
Scald injury is common, accounting for half of all burns in pre-school children. Most scalds are preventable and health professionals can play an important role in targeting interventions to those at greatest risk. However, the potential for routinely collected medical data to be used to identify high risk children has not been well explored. We used a matched case-control study to identify risk factors for first scald injury in children under 5 using a large, nationally representative database of routinely collected primary care records. Among 986 cases and 9240 controls, male gender, age (2 years), higher birth order, single-parent families and increasing index of material deprivation were associated with increased odds of scald injury. Older maternal age at childbirth was associated with decreased odds of scald injury. Children at risk of scald injury can be identified from routinely collected primary care data and primary care practitioners can use this information to target evidence-based safety interventions.
We aimed to assess the potential usefulness of primary care data in the UK for estimating smoking prevalence in pregnancy by comparing the primary care data estimates with those obtained from other data sources. In The Health Improvement Network (THIN) primary care database, we identified pregnant smokers using smoking information recorded during pregnancy. Where this information was missing, we used smoking information recorded prior to pregnancy. We compared annual smoking prevalence from 2000 to 2012 in THIN with measures from the Infant Feeding Survey (IFS), Smoking At Time of Delivery (SATOD), Child Health Systems Programme (CHSP) and Scottish Morbidity Record (SMR). Smoking estimates from THIN data converged with estimates from other sources after 2004, though still do not agree completely. For example, in 2012 smoking prevalence at booking was 11.6% in THIN using data recorded only during pregnancy, compared with 19.6% in SMR data. However, the use of smoking data recorded up to 27 months before conception increased the THIN prevalence to 20.3%, improving the comparability. Under-recording of smoking status during pregnancy results in unreliable prevalence estimates from primary care data and needs improvement. However, in the absence of gestational smoking data, the inclusion of pre-conception smoking records may increase the utility of primary care data. One strategy to improve gestational smoking status recording in primary care could be the inclusion of pregnancy in the Quality and Outcome’s Framework as a condition for which smoking status and smoking cessation advice must be recorded electronically in patient records.
Injury is a significant cause of childhood death and can result in substantial long-term disability. Injuries are more common in children from socio-economically deprived families, contributing to health inequalities between the most and least affluent. However, little is known about how the relationship between injuries and deprivation has changed over time in the UK.We conducted a cohort study of all children under 5 registered in one of 495 UK general practices that contributed medical data to The Health Improvement Network database between 1990-2009. We estimated the incidence of fractures, burns and poisonings by age, sex, socio-economic group and calendar period and adjusted incidence rate ratios (IRR) comparing the least and most socio-economically deprived areas over time. Estimates of the UK annual burden of injuries and the excess burden attributable to deprivation were derived from incidence rates.The cohort of 979,383 children experienced 20,804 fractures, 15,880 burns and 10,155 poisonings, equating to an incidence of 75.8/10,000 person-years (95% confidence interval 74.8-76.9) for fractures, 57.9 (57.0-58.9) for burns and 37.3 (35.6-38.0) for poisonings. Incidence rates decreased over time for burns and poisonings and increased for fractures (p<0.001 test for trend for each injury). They were significantly higher in more deprived households (IRR test for trend p<0.001 for each injury type) and these gradients persisted over time. We estimate that 865 fractures, 3,763 burns and 3,043 poisonings could be prevented each year in the UK if incidence rates could be reduced to those of the most affluent areas.The incidence of burns and poisonings declined between 1990 and 2009 but increased for fractures. Despite these changes, strong socio-economic inequalities persisted resulting in an estimated 9,000 additional medically-attended injuries per year in under-5s.
To describe patterns in thermal injury incidence and hospitalisations by age, gender, calendar year and socioeconomic status among 0–4 year olds in England for the period 1998–2013. 708,050 children with linked primary care and hospitalisation data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES), respectively. Incidence rates of all thermal injuries (identified in CPRD and/or HES), hospitalised thermal injuries, and serious thermal injuries (hospitalised for ≥72 h). Adjusted incidence rate ratios (IRR) and 95% confidence intervals (95%CI), estimated using Poisson regression. Incidence rates of all thermal injuries, hospitalised thermal injuries, and serious thermal injuries were 59.5 per 10,000 person-years (95%CI 58.4–60.6), 11.3 (10.8–11.8) and 2.15 (1.95–2.37), respectively. Socioeconomic gradients, between the most and least deprived quintiles, were steepest for serious thermal injuries (IRR 3.17, 95%CI 2.53–3.96). Incidence of all thermal injuries (IRR 0.64, 95%CI 0.58–0.70) and serious thermal injuries (IRR 0.44, 95%CI 0.33–0.59) reduced between 1998/9 and 2012/13. Incidence rates of hospitalised thermal injuries did not significantly change over time. Incidence of all thermal injuries and those hospitalised for ≥72 h reduced over time. Steep socioeconomic gradients support continued targeting of preventative interventions to those living in the most deprived areas.
Previous studies have raised concern that women with asthma have increased risks of adverse obstetric and pediatric complications, but these have generally been underpowered.To quantify risks of major adverse pregnancy outcomes and obstetric complications in women with and without asthma.We extracted information on 281,019 pregnancies from the Health Improvement Network database between 1988 and 2004. We analyzed the data using logistic regression.In 37,585 pregnancies of women with asthma compared with 243,434 pregnancies of women without asthma, risks of stillbirth and therapeutic abortion were similar; however, the risk of miscarriage was slightly higher (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.06-1.13). Risks of most obstetric complications (placental abruption, placental insufficiency, placenta previa, preeclampsia, hypertension, gestational diabetes, thyroid disorders in pregnancy, and assisted delivery) were not higher in pregnancies of women with asthma compared with those without asthma, with the exception of increases in antepartum (OR, 1.20; 95% CI, 1.08-1.34) or postpartum (OR, 1.38; 95% CI, 1.21-1.57) hemorrhage, anemia (OR, 1.06; 95% CI, 1.01-1.12), depression (OR, 1.52; 95% CI, 1.36-1.69), and caesarean section (OR, 1.11; 95% CI, 1.07-1.16). Risks of miscarriage, depression, and caesarean section increased moderately in women with more severe asthma and previous asthma exacerbations.We found some increased risks in women with asthma that need to be considered in the future; however, our results indicate that women with asthma have similar reproductive risks compared with women without asthma in the general population for most of the range of outcomes studied.
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