Aldridge Robert W, Evans Hannah E R, Yavlinsky Alexei, Moayyeri Alireza, Bhaskaran Krishnan, Mathur Rohini, Jordan Kelvin P, Croft Peter, Denaxas Spiros, Shah Anoop D, Blackburn Ruth M, Moller Henrik, Ng Edmond S W, Hughes Andrew, Fox Sebastian, Flowers Julian, Schmidt Jurgen, Hayward Andrew, Gilbert Ruth, Smeeth Liam, Hemingway Harry
Institute of Health Informatics, University College London, London, England, NW1 2DA, UK.
Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
Wellcome Open Res. 2024 Jun 19;8:262. doi: 10.12688/wellcomeopenres.19470.2. eCollection 2023.
Electronic health records (EHRs) have the potential to be used to produce detailed disease burden estimates. In this study we created disease estimates using national EHR for three high burden conditions, compared estimates between linked and unlinked datasets and produced stratified estimates by age, sex, ethnicity, socio-economic deprivation and geographical region.
EHRs containing primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and mortality records (Office for National Statistics) were used. We used existing disease phenotyping algorithms to identify cases of cancer (breast, lung, colorectal and prostate), type 1 and 2 diabetes, and lower back pain. We calculated age-standardised incidence of first cancer, point prevalence for diabetes, and primary care consultation prevalence for low back pain.
7.2 million people contributing 45.3 million person-years of active follow-up between 2000-2014 were included. CPRD-HES combined and CPRD-HES-ONS combined lung and bowel cancer incidence estimates by sex were similar to cancer registry estimates. Linked CPRD-HES estimates for combined Type 1 and Type 2 diabetes were consistently higher than those of CPRD alone, with the difference steadily increasing over time from 0.26% (2.99% for CPRD-HES vs. 2.73 for CPRD) in 2002 to 0.58% (6.17% vs. 5.59) in 2013. Low back pain prevalence was highest in the most deprived quintile and when compared to the least deprived quintile the difference in prevalence increased over time between 2000 and 2013, with the largest difference of 27% (558.70 per 10,000 people vs 438.20) in 2013.
We use national EHRs to produce estimates of burden of disease to produce detailed estimates by deprivation, ethnicity and geographical region. National EHRs have the potential to improve disease burden estimates at a local and global level and may serve as more automated, timely and precise inputs for policy making and global burden of disease estimation.
电子健康记录（EHRs）有潜力用于生成详细的疾病负担估计。在本研究中，我们利用国家电子健康记录对三种高负担疾病进行了疾病估计，比较了链接数据集和未链接数据集之间的估计，并按年龄、性别、种族、社会经济剥夺程度和地理区域生成了分层估计。
使用了包含初级保健（临床实践研究数据链）、二级保健（医院事件统计）和死亡率记录（国家统计局）的电子健康记录。我们使用现有的疾病表型算法来识别癌症（乳腺癌、肺癌、结直肠癌和前列腺癌）、1型和2型糖尿病以及下背痛的病例。我们计算了首次癌症的年龄标准化发病率、糖尿病的点患病率以及下背痛的初级保健咨询患病率。
纳入了2000年至2014年间720万人，累计提供了4530万人年的有效随访。CPRD-HES合并数据集以及CPRD-HES-ONS合并数据集按性别划分的肺癌和肠癌发病率估计与癌症登记处的估计相似。1型和2型糖尿病合并症的链接CPRD-HES估计始终高于单独的CPRD估计，差异随时间稳步增加，从2002年的0.26%（CPRD-HES为2.99%，CPRD为2.73%）增至2013年的0.58%（分别为6.17%和5.59%）。下背痛患病率在最贫困五分位数人群中最高，与最不贫困五分位数人群相比，2000年至2013年间患病率差异随时间增加，2013年差异最大，为27%（每万人558.70例对438.20例）。
我们利用国家电子健康记录生成疾病负担估计，以按剥夺程度、种族和地理区域生成详细估计。国家电子健康记录有潜力在地方和全球层面改善疾病负担估计，并可为政策制定和全球疾病负担估计提供更自动化、及时和精确的输入。
