Clinical Practice Research Datalink

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Data Resource Profile: Clinical Practice Research Datalink (CPRD).

Data Resource Profile: Clinical Practice Research Datalink (CPRD).

The Clinical Practice Research Datalink (CPRD) is an ongoing primary care database of ano- nymised medical records from general practitioners, with coverage of over 11.3 million patients from 674 practices in the UK. With 4.4 million active (alive, currently registered) patients meeting quality criteria, approximately 6.9% of the UK population are included and patients are broadly representative of the UK general population in terms of age, sex and ethnicity. General practitioners are the gatekeepers of primary care and specialist re- ferrals in the UK. The CPRD primary care database is therefore a rich source of health data for research, including data on demographics, symptoms, tests, diagnoses, thera- pies, health-related behaviours and referrals to secondary care. For over half of patients, linkage with datasets from secondary care, disease-specific cohorts and mortality re- cords enhance the range of data available for research. The CPRD is very widely used internationally for epidemiological research and has been used to produce over 1000 re- search studies, published in peer-reviewed journals across a broad range of health out- comes. However, researchers must be aware of the complexity of routinely collected electronic health records, including ways to manage variable completeness, misclassifi- cation and development of disease definitions for research.
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Data Resource Profile: Clinical Practice Research Datalink (CPRD).

Data Resource Profile: Clinical Practice Research Datalink (CPRD).

The Clinical Practice Research Datalink (CPRD) is an ongoing primary care database of ano- nymised medical records from general practitioners, with coverage of over 11.3 million patients from 674 practices in the UK. With 4.4 million active (alive, currently registered) patients meeting quality criteria, approximately 6.9% of the UK population are included and patients are broadly representative of the UK general population in terms of age, sex and ethnicity. General practitioners are the gatekeepers of primary care and specialist re- ferrals in the UK. The CPRD primary care database is therefore a rich source of health data for research, including data on demographics, symptoms, tests, diagnoses, thera- pies, health-related behaviours and referrals to secondary care. For over half of patients, linkage with datasets from secondary care, disease-specific cohorts and mortality re- cords enhance the range of data available for research. The CPRD is very widely used internationally for epidemiological research and has been used to produce over 1000 re- search studies, published in peer-reviewed journals across a broad range of health out- comes. However, researchers must be aware of the complexity of routinely collected electronic health records, including ways to manage variable completeness, misclassifi- cation and development of disease definitions for research.
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The incidence, prevalence and survival of systemic sclerosis in the UK Clinical Practice Research Datalink

The incidence, prevalence and survival of systemic sclerosis in the UK Clinical Practice Research Datalink

Received: 17 February 2018 / Revised: 11 May 2018 / Accepted: 17 June 2018 # The Author(s) 2018 Abstract To estimate the incidence, prevalence, and survival of systemic sclerosis in the United Kingdom. We conducted a historical cohort study using data from the Clinical Practice Research Datalink (CPRD). We calculated the incidence and survival of systemic sclerosis between 1994 and 2013 and examined its association with age, sex, and socioeconomic status. We calculated point prevalence on 1 July 2013 and examined its association with the same exposures. We identified 1327 cases with incident systemic sclerosis. Annual incidence was 19.4 per million person-years between 1994 and 2013. The incidence was 4.7 times higher in women than in men, was not influenced by socioeconomic status, and has remained stable over the 20 year study period.
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The incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK Clinical Practice Research Datalink

The incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK Clinical Practice Research Datalink

ABSTRACT Objectives: To estimate the incidence, prevalence and mortality of Granulomatosis with polyangiitis (GPA) in the United Kingdom. Methods: We conducted a historical cohort study using data from the Clinical Practice Research Datalink and Hospital Episode Statistics (CPRD-HES). We calculated incidence rate ratios, adjusted for age, gender and ethnicity, using Poisson regression.

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A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink

A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink

Purpose: The CirCom score has been developed from Danish data as a specific measure of comorbidity for cirrhosis to predict all-cause mortality. We compared its performance with the Charlson Comorbidity Index (CCI) in an English cirrhosis population. Patients and methods: We used comorbidity scores in a survival model to predict mortal- ity in a cirrhosis cohort in the Clinical Practice Research Datalink. The discrimination of each score was compared by age, gender, socioeconomic status, cirrhosis etiology, cirrhosis stage, and year after cirrhosis diagnosis. We also measured their ability to predict liver-related versus non-liver-related death.
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Novel insights into the aetiology of granulomatosis with polyangiitis—a case–control study using the Clinical Practice Research Datalink

Novel insights into the aetiology of granulomatosis with polyangiitis—a case–control study using the Clinical Practice Research Datalink

Methods. We compared all incident cases of GPA in the Clinical Practice Research Datalink 1990–2014, with up to 10 age-, sex- and general practice-matched controls. We identified potential risk factors, recorded numbers of cases and controls exposed to each, and calculated odds ratios (ORs) using con- ditional logistic regression. Our main analysis excluded data recorded during 1 year before diagnosis, to prevent early symptoms being mistaken for risk factors.

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Validation of autism spectrum disorder diagnoses recorded in the Clinical Practice Research Datalink, 1990–2014

Validation of autism spectrum disorder diagnoses recorded in the Clinical Practice Research Datalink, 1990–2014

however, both genetic and environmental factors are likely to play an important role. Over the last two decades, large electronic data sources have been used in epidemiologic studies seeking to identify potential risk factors for ASD. One potential concern with use of these existing data sources is uncertainty about the validity of the ASD cases identified and the availability of clinical details. The United Kingdom’s Clinical Practice Research Datalink (CPRD) is a large population-based electronic medical record database that has been used in investigations of risk factors of ASD. Previously published studies have indicated that ASD diagnoses recorded in the CPRD were of high validity; 7,8 however, the children described in these studies were born in the 1990s and medical knowledge, ASD diagnostic criteria, and screening practices have changed extensively since the last of those studies was published. In this study, we sought to provide an updated assessment of the quality of ASD diagnoses recorded in the CPRD between 1990 and 2014. We conducted a validation study to assess the quality of ASD diagnoses recorded in the CPRD and calcu- lated the positive predictive value (PPV) of ASD diagnoses recorded in the CPRD compared to original medical records.
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Prevalence of hypercalcemia of malignancy among pediatric cancer patients in the UK Clinical Practice Research Datalink database

Prevalence of hypercalcemia of malignancy among pediatric cancer patients in the UK Clinical Practice Research Datalink database

and 5%. HCM can be observed with any type of cancer but occurs most commonly in children with leukemia. While HCM can lead to death, we do not know what proportion of pediatric cancer patients have this condition. We conducted this study to estimate the proportion of HCM in children in the UK’s Clinical Practice Research Datalink. We identified all children in the database from 2003 through 2014 who had a cancer diagnosis. From this population, we identified those who developed HCM and then estimated the HCM prevalence rates. The prevalence of pediatric HCM was very low over the 12-year study period (ranging from 0.24% to 0.81%).
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Methods to generate and validate a Pregnancy Register in the UK Clinical Practice Research Datalink primary care database.

Methods to generate and validate a Pregnancy Register in the UK Clinical Practice Research Datalink primary care database.

CPRD; UKRI Innovation Fellowship, Grant/ Award Number: MR/S003932/1 Abstract Purpose: Primary care databases are increasingly used for researching pregnancy, eg, the effects of maternal drug exposures. However, ascertaining pregnancies, their timing, and outcomes in these data is challenging. While individual studies have adopted different methods, no systematic approach to characterise all pregnancies in a primary care database has yet been published. Therefore, we developed a new algorithm to establish a Pregnancy Register in the UK Clinical Practice Research Datalink (CPRD) GOLD primary care database.
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Genomewide Association Study of Statin‐Induced Myopathy in Patients Recruited Using the UK Clinical Practice Research Datalink

Genomewide Association Study of Statin‐Induced Myopathy in Patients Recruited Using the UK Clinical Practice Research Datalink

Maryse Lapeyre-Mestre 9 , Anita Conforti 10 , Ana Alfirevic 1 , Tjeerd van Staa 11,12 and Munir Pirmohamed 1 Statins can be associated with myopathy. We have undertaken a genomewide association study (GWAS) to discover and validate genetic risk factors for statin-induced myopathy in a “real-world” setting. One hundred thirty- five patients with statin myopathy recruited via the UK Clinical Practice Research Datalink were genotyped using the Illumina OmniExpress Exome version 1.0 Bead Chip and compared with the Wellcome Trust Case-Control

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Incident acute pseudogout and prior bisphosphonate use: matched case-control study in the UK-Clinical Practice Research Datalink

Incident acute pseudogout and prior bisphosphonate use: matched case-control study in the UK-Clinical Practice Research Datalink

A matched case-control study was undertaken using data from the UK-Clinical Practice Research Datalink (CPRD). Adults who consulted for incident acute pseudogout between 1987 and 2012 were each matched for gender, age at pseudogout diagnosis, and general practice to up to four control subjects without pseudogout. The exposure of interest was a prescription for an oral bisphosphonate issued within the 60-day period prior to the date of incident acute pseudogout. Associations between incident acute pseudogout and prior bisphosphonate prescription were examined using conditional logistic regression, adjusting for hyperparathyroidism, osteoarthritis, rheumatoid arthritis, haemochromatosis,
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Electronic health records for biological sample collection: feasibility study of statin-induced myopathy using the Clinical Practice Research Datalink.

Electronic health records for biological sample collection: feasibility study of statin-induced myopathy using the Clinical Practice Research Datalink.

Introduction Healthcare systems are increasingly using computers to record and store clinical information. Electronic health records are also valuable for undertaking epidemiological research using anonymized individual patient data. A typical example is the General Practice Research Database, recently renamed as the Clinical Practice Research Datalink (CPRD). The CPRD has evolved over time, with increasing population coverage and, through linkages with second- ary care data and laboratory data, provides access to more complete data sets. This makes it a highly valuable resource that is widely used by academic, regulatory and industry sectors. Although the CPRD has been widely used for observational research, the data have not been linked to biological samples, such as DNA. The UK biobank, in contrast, currently has access to biological samples and will eventually have access to linked health records. The CPRD is much larger than the UK biobank and would be particularly valuable to improve our understanding of the genetic basis of rarer phenotypes, if these could be linked to biological samples. One area of medical research that would greatly benefit from this is the pharmacogenetics of adverse drug reactions.
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Serum potassium as a predictor of adverse clinical outcomes in patients with chronic kidney disease: new risk equations using the UK clinical practice research datalink

Serum potassium as a predictor of adverse clinical outcomes in patients with chronic kidney disease: new risk equations using the UK clinical practice research datalink

Real-world studies associating serum potassium and adverse clinical outcomes in CKD patients, including death, major adverse cardiac events (MACE), hospital- isation and RAASi discontinuation, have previously been conducted in the US [2–6]. In contrast to other industrialised countries, healthcare in the US is largely privatised, and the availability of clinical data may be limited by the size, length and claims-based nature of US healthcare records. Thus, it is unclear whether existing data describing the epidemiology and burden of hyperkalaemia may be generalisable to a European CKD population. Using primary care data obtained from the Clinical Practice Research Datalink (CPRD) [15], this study sought to develop risk equa- tions describing the relationship between serum po- tassium concentration and incidence of death, MACE and RAASi discontinuation, in a contemporary UK cohort of CKD patients.
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Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004–2014

Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004–2014

Despite extensive literature detailing the prevalence and incidence of diabetes in the UK, population-wide measures of incidence and prevalence of DR in the UK context have not been determined. Previous UK focussed research on retinopathy has largely been limited to estimates based on regional screening pro- grammes or small general practices samples. 28–32 Having a more complete understanding of the burden of disease due to DR across the diverse UK population will help improve future service planning and provision of preventive and therapeutic care. The aim of this study was to generate nationally representative estimates of the incidence and prevalence of DR in the UK between 2004 and 2014 using the Clinical Practice Research Datalink (CPRD), and to examine trends in the preva- lence and relative risk of retinopathy by diabetes type, age, sex, ethnicity, socioeconomic deprivation and region.
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Rheumatoid arthritis and excess mortality: down but not out: a primary care cohort study using data from Clinical Practice Research Datalink

Rheumatoid arthritis and excess mortality: down but not out: a primary care cohort study using data from Clinical Practice Research Datalink

Methods. Data from the Clinical Practice Research Datalink were used. Incident RA cases and four age-, sex- and general practice–matched controls were identified from at-risk cohorts for each calendar year and followed-up for up to 5 years. Mortality rates and 95% CIs were computed. Cox proportional hazard ratios (HRs) were calculated to estimate associations and adjusted for covariates. The temporal trend in mortality was examined using the Joinpoint regression program. Data management and analysis were performed using Stata version 14.

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Under-recording of hospital bleeding events in UK primary care: a linked Clinical Practice Research Datalink and Hospital Episode Statistics study

Under-recording of hospital bleeding events in UK primary care: a linked Clinical Practice Research Datalink and Hospital Episode Statistics study

Methods: The study population consisted of adults with non-valvular atrial fibrillation who had at least one bleed recorded in either the Clinical Practice Research Datalink (CPRD) or Hospital Episode Statistics (HES) while receiving prescriptions for an oral anticoagulant. The propor- tion of bleeds recorded in HES that had a corresponding bleed recorded in the subsequent 12 weeks in CPRD was calculated, and factors associated with having a corresponding record were identified. Cox proportional hazards analyses investigating the hazard of subsequent bleeding associated with antithrombotic treatment were carried out using linked CPRD-HES data and using CPRD only data, and the results were compared.
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Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004-2014.

Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004-2014.

Despite extensive literature detailing the prevalence and incidence of diabetes in the UK, population-wide measures of incidence and prevalence of DR in the UK context have not been determined. Previous UK focussed research on retinopathy has largely been limited to estimates based on regional screening pro- grammes or small general practices samples. 28–32 Having a more complete understanding of the burden of disease due to DR across the diverse UK population will help improve future service planning and provision of preventive and therapeutic care. The aim of this study was to generate nationally representative estimates of the incidence and prevalence of DR in the UK between 2004 and 2014 using the Clinical Practice Research Datalink (CPRD), and to examine trends in the preva- lence and relative risk of retinopathy by diabetes type, age, sex, ethnicity, socioeconomic deprivation and region.
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What is the impact of regulatory guidance and expiry of drug patents on dementia drug prescriptions in England? A trend analysis in the Clinical Practice Research Datalink

What is the impact of regulatory guidance and expiry of drug patents on dementia drug prescriptions in England? A trend analysis in the Clinical Practice Research Datalink

There are currently four licensed treatments that pro- vide symptomatic relief for patients with Alzheimer’s disease in England—three acetylcholinesterase (AChE) inhibitors (donepezil, rivastigmine, galantamine) and one N-methyl- D -aspartate (NMDA) receptor antagonist (memantine). These drugs are collectively referred to as drugs for dementia in the British National Formulary, despite their licensing for Alzheimer’s disease only [1]. Since the first of these drugs became available in 1997, there have been several changes in national guidelines for the treatment of Alzheimer’s disease, as well as several initiatives to encourage better diagnosis and treatment of the disease. Despite this, there has been lit- tle research into whether such changes to guidelines and initiatives have directly influenced clinical practice [2, 3]. We examined how prescription rates in England have changed since the launch of these drugs up to 1st January 2016, using data from the U.K. Clinical Practice Research Datalink (CPRD). We investigated how prescribing was affected by changes in National Institute for Health and Care Excellence (NICE) guidance (includ- ing the 2006 guidance that was subject to legal challenges), the addition of dementia to the Quality and Outcomes Framework (QOF), the introduction of ambi- tious government dementia strategies, and the expiry of drug patents. The timing of each of these changes, which may have influenced aspects of drug prescribing and clinical practice, is discussed further below and summarized in Table 1.
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Approach to record linkage of primary care data from Clinical Practice Research Datalink to other health-related patient data: overview and implications.

Approach to record linkage of primary care data from Clinical Practice Research Datalink to other health-related patient data: overview and implications.

Record linkage is increasingly used to expand the information available for public health research. An understanding of record linkage methods and the relevant strengths and limitations is important for robust analysis and interpretation of linked data. Here, we describe the approach used by Clinical Practice Research Datalink (CPRD) to link primary care data to other patient level datasets, and the potential implications of this approach for CPRD data analysis. General practice electronic health record software providers separately submit de-identified data to CPRD and patient identifiers to NHS Digital, excluding patients who have opted-out from contributing data. Data custodians for external datasets also send patient identifiers to NHS Digital. NHS Digital uses identifiers to link the datasets using an 8-stage deterministic methodology. CPRD subsequently receives a de-identified linked cohort file and provides researchers with anonymised linked data and metadata detailing the linkage process. This methodology has been used to generate routine primary care linked datasets, including data from Hospital Episode Statistics, Office for National Statistics and National Cancer Registration and Analysis Service. 10.6 million (M) patients from 411 English general practices were included in record linkage in June 2018. 9.1M (86%) patients were of research quality, of which 8.0M (88%) had a valid NHS number and were eligible for linkage in the CPRD standard linked dataset release. Linking CPRD data to other sources improves the range and validity of research studies. This manuscript, together with metadata generated on match strength and linkage eligibility, can be used to inform study design and explore potential linkage-related selection and misclassification biases.
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Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink.

Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink.

We attempt to address the knowledge gap with this longitudinal observational study, which investigates con- sultation rates in people with SMI and in a control group without SMI, matched on age, sex and general practice. We used routinely collected data from clinical computer systems and uploaded to a large primary care database, the Clinical Practice Research Datalink (CPRD). More speci fically, our aims were to: (1) report the recorded primary care consultation patterns by type (face-to-face, telephone and other) for people with an SMI diagnosis and their controls, over the study period; (2) investigate the associations between age, gender, SMI diagnosis and other comorbidities with primary care consultations; (3) compare primary care consult- ation frequency between people with SMI and controls, after controlling for other factors; and (4) assess the effect of the introduction of the QOF on consultation frequency for both people with SMI and controls. A detailed investigation of comorbidity patterns and their changes over time has been published elsewhere. 21
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