Completeness and representativeness of small area socioeconomic data linked with the UK Clinical Practice Research Datalink (CPRD)

Mahadevan, Preveina; Harley, Mia; Fordyce, Stuart; Hodgson, Susan; Ghosh, Rebecca; Myles, Puja; Booth, Helen; Axson, Eleanor L

doi:10.1136/jech-2022-219200

Cited by 21 publications

(20 citation statements)

References 13 publications

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“…We considered the number of hospitalizations in the year before cohort entry as a surrogate marker for overall health. Finally, we adjusted for socioeconomic status using the Index of Multiple Deprivation, categorized in deciles …”

Section: Methodsmentioning

confidence: 99%

Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding

Rahman,

Platt,

Beradid

et al. 2024

JAMA Netw Open

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ImportanceSelective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants associated with a small increased risk of major bleeding. However, the risk of bleeding associated with the concomitant use of SSRIs and oral anticoagulants (OACs) has not been well characterized.ObjectivesTo assess whether concomitant use of SSRIs with OACs is associated with an increased risk of major bleeding compared with OAC use alone, describe how the risk varies with duration of use, and identify key clinical characteristics modifying this risk.Design, Setting, and ParticipantsA population-based, nested case-control study was conducted among patients with atrial fibrillation initiating OACs between January 2, 1998, and March 29, 2021. Patients were from approximately 2000 general practices in the UK contributing to the Clinical Practice Research Datalink. With the use of risk-set sampling, for each case of major bleeding during follow-up, up to 30 controls were selected from risk sets defined by the case and matched on age, sex, cohort entry date, and follow-up duration.ExposuresConcomitant use of SSRIs and OACs (direct OACs and vitamin K antagonists [VKAs]) compared with OAC use alone.Main Outcomes and MeasuresThe main outcome was incidence rate ratios (IRRs) of hospitalization for bleeding or death due to bleeding.ResultsThere were 42 190 patients with major bleeding (mean [SD] age, 74.2 [9.3] years; 59.8% men) matched to 1 156 641 controls (mean [SD] age, 74.2 [9.3] years; 59.8% men). Concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding compared with OACs alone (IRR, 1.33; 95% CI, 1.24-1.42). The risk peaked during the initial months of treatment (first 30 days of use: IRR, 1.74; 95% CI, 1.37-2.22) and persisted for up to 6 months. The risk did not vary with age, sex, history of bleeding, chronic kidney disease, and potency of SSRIs. An association was present both with concomitant use of SSRIs and direct OACs compared with direct OAC use alone (IRR, 1.25; 95% CI, 1.12-1.40) and concomitant use of SSRIs and VKAs compared with VKA use alone (IRR, 1.36; 95% CI, 1.25-1.47).Conclusions and RelevanceThis study suggests that among patients with atrial fibrillation, concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding compared with OAC use alone, requiring close monitoring and management of risk factors for bleeding, particularly in the first few months of use.

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Section: Methodsmentioning

confidence: 99%

Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding

Rahman,

Platt,

Beradid

et al. 2024

JAMA Netw Open

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“…This retrospective cohort study (GSK ID: 213951) used de‐identified, coded medical and prescription records from the Clinical Practice Research Datalink (CPRD) Aurum database with Hospital Episodes Statistics (HES) linkage in the UK (between 1 January 2007 and 30 June 2019). CPRD database populations including CPRD Aurum are considered highly complete and broadly representative of the broader English population, in terms of factors such as geographical spread, age, gender, socioeconomic status and rural–urban classification 21,22 . Linked HES data comprised of medical records on hospital admissions and outpatient visits from the Admitted Patient Care (APC) and Outpatient (OP) HES databases, respectively.…”

Section: Methodsmentioning

confidence: 99%

Real‐world characterisation of patients with chronic rhinosinusitis with nasal polyps with and without surgery in England

Benson¹,

Yang

et al. 2023

Clinical Otolaryngology

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“…The analyses were adjusted for potential covariates at the individual level including the Cambridge Multimorbidity Score (general outcome based on 37 long-term conditions),28 the number of GP consultations in the last 2 years, neighbourhood socioeconomic deprivation level divided into deciles (based on the national Index of Multiple Deprivation,29 30 whether the patient had or had not received a medication review within the last year prior the index date, gender and age (categorised between 30 and 49, between 50 and 64, between 65 and 84, and those 85 or older). The analyses on medication adherence were also adjusted for the number of medicines a patient was prescribed.…”

Section: Methodsmentioning

confidence: 99%

Association between continuity of primary care and both prescribing and adherence of common cardiovascular medications: a cohort study among patients in England

2022

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ObjectivesTo investigate whether better continuity of care is associated with increased prescribing of clinically relevant medication and improved medication adherence.SettingRandom sample of 300 000 patients aged 30+ in 2017 within 83 English general practitioner (GP) practices from the Clinical Practice Research Datalink.DesignPatients were assigned to a randomly selected index date in 2017 on which medication use and continuity of care were determined. Adjusted associations between continuity of care and the prescribing and adherence of five cardiovascular medication groups were examined using logistic regression.ParticipantsContinuity of Care Index was calculated for 173 993 patients with 4+ GP consultations 2 years prior to their index date and divided into five categories: absence of continuity, below-average continuity, average, above-average continuity and perfect continuity.Main outcome measures(A) Prescription for statins (primary or secondary prevention separately), anticoagulants, antiplatelet agents and antihypertensives covering the patient’s index date. (B) Adherence (>80%) estimated using medication possession ratio.ResultsThere was strong evidence (p<0.01) that prescription of all five cardiovascular medication groups increased with greater continuity of care. Patients with absence of continuity were less likely to be prescribed cardiovascular medications than patients with above-average continuity (statins primary prevention OR 0.73, 95% CI 0.59 to 0.85; statins secondary prevention 0.77, 95% CI 0.57 to 1.03; antiplatelets 0.55, 95% CI 0.33 to 0.92; antihypertensives 0.51, 95% CI 0.39 to 0.65). Furthermore, patients with perfect continuity were more likely to be prescribed cardiovascular medications than those with above-average continuity (statins primary prevention OR 1.23, 95% CI 1.01 to 1.49; statins secondary prevention 1.37, 95% CI 1.10 to 1.71; antiplatelets 1.37, 95% CI 1.08 to 1.74; antihypertensives 1.10, 95% CI 0.99 to 1.23). Continuity was generally not associated with medication adherence, except for adherence to statins for secondary prevention (OR 0.75, 95% CI 0.60 to 0.94 for average compared with above-average continuity).ConclusionBetter continuity of care is associated with improved prescribing of medication to patients at higher risk of cardiovascular disease but does not appear to be related to patient’s medication adherence.

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Completeness and representativeness of small area socioeconomic data linked with the UK Clinical Practice Research Datalink (CPRD)

Cited by 21 publications

References 13 publications

Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding

Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding

Real‐world characterisation of patients with chronic rhinosinusitis with nasal polyps with and without surgery in England

Association between continuity of primary care and both prescribing and adherence of common cardiovascular medications: a cohort study among patients in England

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