Challenges of harmonising data from UK national health surveys: a case study of attempts to estimate the UK prevalence of asthma

Nwaru, Bright I.; Mukherjee, Mome; Gupta, Ramyani; Farr, Angela; Heaven, Martin; Stoddart, Andrew; Bandyopadhyay, Amrita; Fitzsimmons, Deborah; Shields, Michael; Phillips, Ceri; Chamberlain, George; Fischbacher, Colin; Dibben, Christopher; Aftab, Chantelle; Simpson, Colin R; Lyons, Ronan A; Strachan, David P.; Davies, Gwyn; McKinstry, Brian; Sheikh, Aziz

doi:10.1177/0141076815600909

Cited by 7 publications

(12 citation statements)

References 14 publications

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“…Operational definitions of asthma used in epidemiological studies are inconsistent, which warrants an impact on asthma prevalence . For epidemiological purposes, there should be an inclusive approach for defining asthma.…”

Section: Discussionmentioning

confidence: 99%

“…For epidemiological purposes, there should be an inclusive approach for defining asthma. This strategy has been followed by an UK group that proposed a core set of asthma questions which would allow harmonization of the definitions of asthma across UK national surveys . A set of different questions has been used in adults, but they might not apply to children.…”

Section: Discussionmentioning

confidence: 99%

“…TA B L E 2 Odds ratio of each parameter used to classify individuals within each pattern studies are inconsistent, which warrants an impact on asthma prevalence. 1,3 For epidemiological purposes, there should be an inclusive approach for defining asthma. This strategy has been followed by an UK group that proposed a core set of asthma questions which would allow harmonization of the definitions of asthma across UK national surveys.…”

Section: Discussionmentioning

confidence: 99%

“…Asthma prevalence in epidemiological studies varies according to different factors, particularly age, region, and asthma definition used. [1][2][3] Diagnosing asthma in children is challenging as wheezing can follow different trajectories during growth, 4 and lung function tests are not frequently performed in this population. 5 At present, there is no standard operational definition of asthma to be applied in epidemiological studies of children.…”

Section: Introductionmentioning

confidence: 99%

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Setting definitions of childhood asthma in epidemiologic studies

Silva

Severo

Paciência

et al. 2019

Pediatric Allergy Immunology

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Background The definitions of childhood asthma differ among epidemiological studies. We aimed to compare the diagnostic accuracy and agreement of previous asthma definitions and to evaluate questionnaire‐driven asthma definition patterns. Methods Data on 808 participants aged 7‐12 years from 20 schools were analyzed. Asthma definitions based on symptoms assessed by questionnaire, parent‐reported medical asthma diagnosis, current use of asthma medication, airway reversibility after bronchodilatation, and increased (≥35 ppb) levels of exhaled nitric oxide (eNO) were compared with a gold standard (medical diagnosis of asthma with asthma symptoms in the past 12 months and/or airway reversibility). Concordance was assessed by Cohen's kappa. Data‐driven analysis was applied to the questionnaire, and six scores were determined “asthma,” “rhinitis,” “cough,” “non‐specific respiratory symptoms,” “treated asthma,” and “uncontrolled asthma.” Tree decisions were built using these scores. Results Definitions of asthma based on respiratory symptoms, airway reversibility, and parent‐reported medical diagnosis had a low sensitivity but high specificity. Agreement between reported and objective measures was poor. Parent‐reported medical asthma diagnosis, but not reversibility or eNO, was able to predict questionnaire‐driven symptom patterns. Decision trees indicated that those with recent non‐specific respiratory symptoms had a higher probability of positive bronchodilation. Conclusion A standardized operational definition of asthma should include a composite score based on reported asthma medical diagnosis, symptoms, and lung function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Setting definitions of childhood asthma in epidemiologic studies

Silva

Severo

Paciência

et al. 2019

Pediatric Allergy Immunology

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“…In addition, standardising such algorithms across different populations may be impractical since databases differ in content, validity may not hold across different populations and no best practice currently exists [68]. Similar challenges arise when comparing asthma epidemiology between multiple populations [73]. These methodological issues, in addition to suboptimal reporting, should be considered when interpreting and synthesising evidence from geographically dispersed studies.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review

et al. 2017

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There is currently no consensus on approaches to defining asthma or assessing asthma outcomes using electronic health record-derived data. We explored these approaches in the recent literature and examined the clarity of reporting.We systematically searched for asthma-related articles published between January 1, 2014 and December 31, 2015, extracted the algorithms used to identify asthma patients and assess severity, control and exacerbations, and examined how the validity of these outcomes was justified.From 113 eligible articles, we found significant heterogeneity in the algorithms used to define asthma (n=66 different algorithms), severity (n=18), control (n=9) and exacerbations (n=24). For the majority of algorithms (n=106), validity was not justified. In the remaining cases, approaches ranged from using algorithms validated in the same databases to using nonvalidated algorithms that were based on clinical judgement or clinical guidelines. The implementation of these algorithms was suboptimally described overall.Although electronic health record-derived data are now widely used to study asthma, the approaches being used are significantly varied and are often underdescribed, rendering it difficult to assess the validity of studies and compare their findings. Given the substantial growth in this body of literature, it is crucial that scientific consensus is reached on the underlying definitions and algorithms.

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Monitoring epidemiological trends in back to school asthma among preschool and school-aged children using real-time syndromic surveillance in England, 2012–2016

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Verlander

Morbey

et al. 2019

J Epidemiol Community Health

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Background Back to school (BTS) asthma has been previously reported in children; however, its epidemiology and associated healthcare burden are unclear. We aimed to describe the timing and magnitude of BTS asthma using surveillance data from different health services in England.Methods Asthma morbidity data from emergency department attendances and general practitioner (GP) consultations between April 2012 and December 2016 were used from national syndromic surveillance systems in England. Age-specific and sex-specific rates and time series of asthma peaks relative to school term dates were described. The timing of a BTS excess period and adjusted rates of asthma relative to a baseline period were estimated using cumulative sum control chart plots and negative binomial regression.Results BTS asthma among children aged below 15 years was most pronounced at the start of the school year in September. This effect was not present among those aged 15 years and above. After controlling for sex and study year, the adjusted daily rate of childhood GP in-hours asthma consultations was 2.5–3 times higher in the BTS excess period, with a significantly higher effect among children aged 0–4 years. A distinct age-specific pattern of sex differences in asthma presentations was present, with a higher burden among males in children and among females aged over 15 years.ConclusionWe found evidence of a BTS asthma peak in children using surveillance data across a range of healthcare systems, supporting the need for further preventative work to reduce the impact of BTS asthma in children.

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Challenges of harmonising data from UK national health surveys: a case study of attempts to estimate the UK prevalence of asthma

Cited by 7 publications

References 14 publications

Setting definitions of childhood asthma in epidemiologic studies

Setting definitions of childhood asthma in epidemiologic studies

Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review

Monitoring epidemiological trends in back to school asthma among preschool and school-aged children using real-time syndromic surveillance in England, 2012–2016

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