Linked electronic health records for research on a nationwide cohort of more than 54 million people in England: data resource

Abstract

Objective To describe a novel England-wide electronic health record (EHR) resource enabling whole population research on covid-19 and cardiovascular disease while ensuring data security and privacy and maintaining public trust. Design Data resource comprising linked person level records from national healthcare settings for the English population, accessible within NHS Digital’s new trusted research environment. Setting EHRs from primary care, hospital episodes, death registry, covid-19 laboratory test results, and community dispensing data, with further enrichment planned from specialist intensive care, cardiovascular, and covid-19 vaccination data. Participants 54.4 million people alive on 1 January 2020 and registered with an NHS general practitioner in England. Main measures of interest Confirmed and suspected covid-19 diagnoses, exemplar cardiovascular conditions (incident stroke or transient ischaemic attack and incident myocardial infarction) and all cause mortality between 1 January and 31 October 2020. Results The linked cohort includes more than 96% of the English population. By combining person level data across national healthcare settings, data on age, sex, and ethnicity are complete for around 95% of the population. Among 53.3 million people with no previous diagnosis of stroke or transient ischaemic attack, 98 721 had a first ever incident stroke or transient ischaemic attack between 1 January and 31 October 2020, of which 30% were recorded only in primary care and 4% only in death registry records. Among 53.2 million people with no previous diagnosis of myocardial infarction, 62 966 had an incident myocardial infarction during follow-up, of which 8% were recorded only in primary care and 12% only in death registry records. A total of 959 470 people had a confirmed or suspected covid-19 diagnosis (714 162 in primary care data, 126 349 in hospital admission records, 776 503 in covid-19 laboratory test data, and 50 504 in death registry records). Although 58% of these were recorded in both primary care and covid-19 laboratory test data, 15% and 18%, respectively, were recorded in only one. Conclusions This population-wide resource shows the importance of linking person level data across health settings to maximise completeness of key characteristics and to ascertain cardiovascular events and covid-19 diagnoses. Although this resource was initially established to support research on covid-19 and cardiovascular disease to benefit clinical care and public health and to inform healthcare policy, it can broaden further to enable a wide range of research.

Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action

“…Among the 149 eligible articles, 227,351,954 participants were included in our meta-analysis; and 89,235,737 were COVID-19 patients. We included 27 studies (132,727,798 participants) for susceptibility [ [20] , [21] , [22] , [23] , [24] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [108] , [109] , [110] , [111] , [112] , [113] , [114] , [115] , [116] , [117] , [118] , [119] , 132 , 166 ], 56 studies (83,097,968 participants) for illness severity [ 21 , 24 , 28 , 31 , 32 , 34 , [38] , [39] , [40] , [41] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , 83 , 108 , 110 , 116 , 117 ...…”

Obesity, Ethnicity, and Covid-19 Mortality: A population-based cohort study of 12.6 Million Adults in England

“…Nevertheless, it has been demonstrated that missing data within clinical records can provide unbiased estimates of adjusted exposure-outcome associations under a wide range of missing data assumptions [25]. In addition, primary care data in England provide some of the most detailed electronic health-care records internationally and are routinely used to identify individuals at risk of chronic and infectious diseases, including COVID-19 mortality [19,26], giving this study real world utility. This study utilized data from the 2011 Census, therefore any sociodemographic changes within the last decade will not be reflected in the analysis.…”

Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort

“…We conducted a cohort analysis using the newly established NHS Digital Trusted Research Environment (TRE) for England which provides secure, remote access to linked, person level EHR data for over 56 million people[12]. Available data sources cover primary care, secondary care, pharmacy dispensing, death registrations and COVID-19 tests and vaccines.…”

“…This study, therefore, set out to conduct the largest scale evaluation of AT use in individuals with AF to date in routinely updated, linked, population-scale electronic health record (EHR) data for 56 million people in England[12]. Utilising this statistical power, this study investigated what factors are associated with pre-existing AT use and whether pre-existing AT use (across sub-types) may reduce COVID-19 related hospitalisation and death.…”