Creating medical and drug code lists to identify cases in primary care databases

Davé, Shreya; Petersen, Irene

doi:10.1002/pds.1770

Cited by 157 publications

(161 citation statements)

References 3 publications

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“…A Read code lists for gallstones including cholecystectomy was developed using a previously reported method [25]. Incident events were defined using a method similar to that used for defining new cases of Gilbert's syndrome described above [23].…”

Section: Discussionmentioning

confidence: 99%

Gilbert's syndrome and the risk of death: A population‐based cohort study

Horsfall

Nazareth

Pereira

et al. 2013

J of Gastro and Hepatol

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Background and Aims Gilbert's syndrome is a common familial hyperbilirubinemia that may reduce the risk of various age‐related diseases because of the antioxidant properties of bilirubin. We conducted a large cohort study using The Health Improvement Network primary care database and compared all‐cause mortality rates in those with and without Gilbert's syndrome. Methods Mortality rates in patients with a diagnosis of Gilbert's syndrome and raised bilirubin level (n = 4266) were compared with those of patients with similar characteristics but with normal bilirubin levels (n = 21 968). Multivariate Poisson regression was also used to estimate adjusted mortality rate ratios. Results During the 350 000 PYs of follow up across the Gilbert's and comparison cohorts, there were 1174 deaths. Mortality rates were 24/10 000 PYs in the Gilbert's cohort versus 50/10 000 PYs in the comparison cohort. Mortality rates were around half in patients with Gilbert's syndrome after accounting for sociodemographics and general health indicators (adjusted mortality rate ratio: 0.5 [95% confidence interval; 0.4–0.7; P < 0.001]). Conclusions Mortality rates observed for people with Gilbert's syndrome in the general population are almost half those of people without evidence of Gilbert's syndrome.

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Section: Discussionmentioning

confidence: 99%

Gilbert's syndrome and the risk of death: A population‐based cohort study

Horsfall

Nazareth

Pereira

et al. 2013

J of Gastro and Hepatol

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“…Lists of Read codes for identifying CVD events were developed with the use of previously reported guidelines. 22 Within CVD, we examined coronary heart disease (CHD), including MI, ischemic heart disease, or angina. We also examined MI and death resulting from any cause as outcomes that are probably less susceptible to any misclassification bias.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Events as a Function of Serum Bilirubin Levels in a Large, Statin-Treated Cohort

2012

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Background-Serum bilirubin is an endogenous antioxidant that is routinely measured before a statin is prescribed primarily to assess liver function, but the association with cardiovascular disease (CVD) in this population has not been explored. Method and Results-We identified patients from a United Kingdom primary care database (The Health Improvement Network) with measurements of serum total bilirubin levels recorded 3 months before the first statin treatment between January 1, 2000, and December 31, 2010, and no history of liver disease or CVD. In total, 130 052 patients met the inclusion criteria, and after a median follow-up of 43 months, there were 7850 CVD events. In men, the incidence of CVD in the lowest decile category of bilirubin (1-6 mol/L [0.06 -0.35 mg/dL]) was 215 per 10 000 person-years compared with 163 per 10 000 person-years in the highest decile (19 -40 mol/L [1.1-2.3 mg/dL]). Similar differences were seen for women. After conventional CVD risk factors were accounted for, the associations with bilirubin were nonlinear (L shaped), and the models predicted that, compared with patients with a bilirubin level of 10 mol/L (0.6 mg/dL), those with a similar CVD risk profile but a bilirubin level of 5 mol/L (0.3 mg/dL) had an 18% (95% confidence interval, 9 -27) higher risk of any CVD event, a 34% (95% confidence interval, 13-56) higher risk of myocardial infarction, and a 33% (95% confidence interval, 21-46) higher risk of death resulting from any cause. Conclusions-Serum bilirubin level measured before a statin prescription to assess liver function is an independent risk factor for CVD and death in both men and women. (Circulation. 2012;126:2556-2564.)

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“…Diagnoses and symptoms are recorded by practice staff using Read codes, which is a hierarchical coding system including more than 100,000 codes. 23,24 Although the Read code system can be mapped to the International Classification of Diseases, Tenth Edition (ICD-10), the Read codes also include a number of symptoms and administrative codes. 24 Information on weight, height, smoking habits, alcohol intake and illicit drug problems is also recorded as well as information on antenatal care and birth details, pregnancy outcomes and postnatal care.…”

Section: The Health Improvement Network Primary Care Database and Thementioning

confidence: 99%

“…23,24 Although the Read code system can be mapped to the International Classification of Diseases, Tenth Edition (ICD-10), the Read codes also include a number of symptoms and administrative codes. 24 Information on weight, height, smoking habits, alcohol intake and illicit drug problems is also recorded as well as information on antenatal care and birth details, pregnancy outcomes and postnatal care. Prescriptions are issued electronically and directly recorded on the general practice computer systems and thus captured in specific therapy records that hold information on dates of prescription and generic names.…”

Section: The Health Improvement Network Primary Care Database and Thementioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

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BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Creating medical and drug code lists to identify cases in primary care databases

Cited by 157 publications

References 3 publications

Gilbert's syndrome and the risk of death: A population‐based cohort study

Gilbert's syndrome and the risk of death: A population‐based cohort study

Cardiovascular Events as a Function of Serum Bilirubin Levels in a Large, Statin-Treated Cohort

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

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