Data Resource Profile: Clinical Practice Research Datalink (CPRD)

Herrett, Emily; Gallagher, Arlene M.; Bhaskaran, Krishnan; Forbes, Harriet; Mathur, Rohini; Staa, Tjeerd van; Smeeth, Liam

doi:10.1093/ije/dyv098

Cited by 2,156 publications

(3,165 citation statements)

References 34 publications

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“…The CPRD contains anonymized patient records from 674 GP practices and more than 11 million patients (some 7% of the UK population). CPRD is representative in terms of socio‐demographic characteristics and has good validity and replicability in relation to chronic illness 38, 39, 40. Linked cause‐specific mortality data from the Office for National Statistics (ONS) are available on more than half the records only for GP practices (395) in England 38.…”

Section: Methodsmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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AimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all‐cause mortality (ACM) and opioid drug‐related poisoning (DRP) mortality.DesignCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.SettingUK primary care.ParticipantsA total of 11 033 opioid‐dependent patients who received OST from 1998 to 2014, followed‐up for 30 410 person‐years.MeasurementsExposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed‐up for 16 363 person‐years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.FindingsACM and DRP rates were 1.93 and 0.53 per 100 person‐years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97–3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45–12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47–3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01–0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17–0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.ConclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all‐cause and drug‐related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.

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Section: Methodsmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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“…More than 98% of the UK population are registered with primary care general practitioners, who act as gatekeepers to the health system. The CPRD undertakes assessment of data quality at the patient level and at the practice level to assign patients and the latest date at which practices meet minimum quality criteria 20. It has been validated in venous thromboembolism research 21…”

Section: Methodsmentioning

confidence: 99%

Testosterone treatment and risk of venous thromboembolism: population based case-control study

Martínez¹,

Suissa

Rietbrock³

et al. 2016

BMJ

138

119

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Objective To determine the risk of venous thromboembolism associated with use of testosterone treatment in men, focusing particularly on the timing of the risk.Design Population based case-control studySetting 370 general practices in UK primary care with linked hospital discharge diagnoses and in-hospital procedures and information on all cause mortality.Participants 19 215 patients with confirmed venous thromboembolism (comprising deep venous thrombosis and pulmonary embolism) and 909 530 age matched controls from source population including more than 2.22 million men between January 2001 and May 2013.Exposure of interest Three mutually exclusive testosterone exposure groups were identified: current treatment, recent (but not current) treatment, and no treatment in the previous two years. Current treatment was subdivided into duration of more or less than six months.Main outcome measure Rate ratios of venous thromboembolism in association with current testosterone treatment compared with no treatment were estimated using conditional logistic regression and adjusted for comorbidities and all matching factors.Results The adjusted rate ratio of venous thromboembolism was 1.25 (95% confidence interval 0.94 to 1.66) for current versus no testosterone treatment. In the first six months of testosterone treatment, the rate ratio of venous thromboembolism was 1.63 (1.12 to 2.37), corresponding to 10.0 (1.9 to 21.6) additional venous thromboembolisms above the base rate of 15.8 per 10 000 person years. The rate ratio after more than six months’ treatment was 1.00 (0.68 to 1.47), and after treatment cessation it was 0.68 (0.43 to 1.07). Increased rate ratios within the first six months of treatment were observed in all strata: the rate ratio was 1.52 (0.94 to 2.46) for patients with pathological hypogonadism and 1.88 (1.02 to 3.45) for those without it, and 1.41 (0.82 to 2.41) for those with a known risk factor for venous thromboembolism and 1.91 (1.13 to 3.23) for those without one.Conclusions Starting testosterone treatment was associated with an increased risk of venous thromboembolism, which peaked within six months and declined thereafter.

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“…We carried out a population‐based matched cohort study using UK data from the Clinical Practice Research Datalink (CPRD5) and Hospital Episodes Statistics (HES6) databases. The CPRD is a collection of anonymized longitudinal patient‐level electronic health records from primary care in the United Kingdom.…”

Section: Methodsmentioning

confidence: 99%

“…The CPRD is a collection of anonymized longitudinal patient‐level electronic health records from primary care in the United Kingdom. Data collection was initiated in 1987 and includes information on diagnoses, prescriptions, and various lifestyle characteristics as recorded by general practitioners (eg, smoking status, alcohol use, weight, and height) 5. In the United Kingdom, more than 98% of the population is registered with a primary care general practitioner, and the National Health Service provides for general practitioner access which is free at the point of use.…”

Section: Methodsmentioning

confidence: 99%

Acute Pericarditis and Cancer Risk: A Matched Cohort Study Using Linked UK Primary and Secondary Care Data

Søgaard

Sørensen

Smeeth

et al. 2018

JAHA

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BackgroundWe aimed to examine whether acute pericarditis is an indicator of undetected cancer and identify patient‐level factors associated with high cancer risk among patients presenting with pericarditis.Methods and ResultsA population‐based matched cohort study was conducted using primary care data from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics. Patients with acute pericarditis (n=6530) were matched to a comparison cohort (n=26 111) on age, sex, calendar time, and general practice. We estimated cumulative cancer incidences, and calculated hazard ratios using Cox regression. Effect modification by patients' characteristics and lifestyle factors was examined, and we fitted a parsimonious model to evaluate absolute excess risk of later cancer among pericarditis patients by key patient‐level factors. We identified 728 and 1379 incidents of cancer among pericarditis patients and the comparison cohort (median follow‐up, 2.8 and 3.5 years). Pericarditis was associated with an elevated subsequent risk of any cancer (hazard ratio=3.03; 95% confidence interval, 2.74–3.36). The association was particularly pronounced 0 to 3 months after pericarditis (hazard ratio=23.56; 95% confidence interval, 18.00–30.83), but a more‐modest association remained thereafter (hazard ratio=1.95; 95% confidence interval, 1.48–2.57 after 3–12 months, and hazard ratio=1.40; 95% confidence interval, 1.21–1.62 after >12 month). Older individuals hospitalized with pericarditis and with combinations of obesity and smoking were at the highest excess risk of having a cancer diagnosis 3 to 12 months later, reaching 4.8%.ConclusionsOccult cancers may be going undiagnosed during the acute episode of pericarditis. Patients presenting with pericarditis and combinations of older age, obesity, smoking, and a need for hospitalization might warrant targeted investigations for cancer.

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Data Resource Profile: Clinical Practice Research Datalink (CPRD)

Cited by 2,156 publications

References 34 publications

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

Testosterone treatment and risk of venous thromboembolism: population based case-control study

Acute Pericarditis and Cancer Risk: A Matched Cohort Study Using Linked UK Primary and Secondary Care Data

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