Validity of diagnostic coding within the General Practice Research Database: a systematic review

Khan, Nada; Harrison, Siân; Rose, Peter W.

doi:10.3399/bjgp10x483562

Cited by 597 publications

(608 citation statements)

References 53 publications

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“…Second, our study population was unrestricted and thus was representative of patients with type 2 diabetes of varying age, disease stage, and severity. Third, the CPRD and HES databases used in this study have been validated extensively to ensure data accuracy (11,29). Moreover, the CPRD collects information on potentially important confounders, such as HbA 1c and BMI.…”

Section: Resultsmentioning

confidence: 99%

Incretin-Based Drugs and the Risk of Congestive Heart Failure

Filion

Azoulay

et al. 2014

Diabetes Care

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OBJECTIVETo determine whether the use of incretin-based drugs, including GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, is associated with an increased risk of congestive heart failure (CHF) among patients with type 2 diabetes. RESEARCH DESIGN AND METHODSThe U.K. Clinical Practice Research Datalink, linked to the Hospital Episode Statistics database, was used to conduct a cohort study with a nested case-control analysis among patients newly prescribed antidiabetic drugs between 1 January 2007 and 31 March 2012 and no prior history of CHF. Case subjects were defined as patients hospitalized for a first CHF and matched with up to 20 control subjects on age, duration of treated diabetes, calendar year, and time since cohort entry. Conditional logistic regression was used to estimate odds ratios (ORs) with corresponding 95% CIs of incident CHF comparing current use of incretin-based drugs with current use of two or more oral antidiabetic drugs. RESULTSThe cohort consisted of 57,737 patients followed for a mean 2.4 years, during which time 1,118 incident cases of hospitalized CHF were identified (incidence rate 8.1/1,000 person-years). Current use of incretin-based drugs was not associated with an increased risk of CHF (adjusted OR 0.85 [95% CI 0.62-1.16]). Secondary analyses revealed no duration-response relationship (P trend = 0.39). CONCLUSIONSIn our population-based study, incretin-based drug use was not associated with an increased risk of CHF among patients with type 2 diabetes. These findings provide some reassurance, but will need to be replicated in other large-scale studies.Incretin-based drugs, which consist of dipeptidyl peptidase-4 (DPP-4) inhibitors and GLP-1 analogs, were first approved by the U.S. Food and Drug Administration in 2006 for the treatment of type 2 diabetes. Both DPP-4 inhibitors and GLP-1 analogs improve glycemic control by increasing plasma levels of endogenous and exogenous GLP-1, respectively. This increase in GLP-1 stimulates insulin secretion and inhibits glucagon secretion (1).The cardiovascular safety of incretin-based drugs is currently under debate. This debate stems from a secondary analysis of the randomized controlled trial SAVOR-TIMI 53, in which saxagliptin was associated with an increased risk of congestive heart failure (CHF) (hazard ratio [HR] 1.27 [95% CI 1.07-1.51]) (2). In contrast, the EXAMINE trial found no association between alogliptin and CHF (HR 1.07 [95% CI 0.79-1.46]) (3). A subsequent meta-analysis of randomized controlled trials found an increased risk of CHF with DPP-4 inhibitors (relative risk 1.16 [95% CI 1.01-1.33]) (4), but these results were driven by those of SAVOR-TIMI 53. Although the safety

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Section: Resultsmentioning

confidence: 99%

Incretin-Based Drugs and the Risk of Congestive Heart Failure

Filion

Azoulay

et al. 2014

Diabetes Care

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“…Despite the possibility that the rise in diagnoses could refl ect better ascertainment rather than a true rise in the number of people acquiring the disease, (mediated by, e.g., an increase in diagnostic endoscopy or exploratory ultrasound), our fi gures refl ect the increase in the number of people subsequently treated with cirrhosis and a more accurate representation of the health-care burden this disease places on the health system than has previously been available. Th ere are oft en questions raised about the validity of coding seen in both primary-and secondary-care data ( 18,19,20 ) but in most studies that have validated recording of chronic disease accuracy has been high ( 21,22 ). A limitation of the HES data is that they cannot be directly validated against medical records because of the anonymization process used.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Diagnosis of Liver Cirrhosis in England, a Cohort Study, 1998–2009: A Comparison With Cancer

Ratib

West

Crooks

et al. 2014

American Journal of Gastroenterology

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There is no routine registration of the occurrence of newly diagnosed cases of cirrhosis in the United Kingdom. This study seeks to determine precise estimates and trends of the incidence of cirrhosis in England, and directly compare these fi gures with those for the 20 most commonly diagnosed cancers in the United Kingdom. METHODS:We used the Clinical Practice Research Datalink and linked English Hospital Episode Statistics to perform a population-based cohort study. Adult incident cases with a diagnosis of cirrhosis between January 1998 and December 2009 were identifi ed. We described trends in incidence by sex and etiology. We performed a direct standardization to estimate the number of people being newly diagnosed with cirrhosis in 2009, and calculated the change in incidence between 1998 and 2009. RESULTS:A total of 5,118 incident cases of cirrhosis were identifi ed, 57.9 % were male. Over the 12-year period, crude incidence increased by 50.6 % . Incidence increased for both men and women and all etiology types. We estimated approximately 17,000 people were newly diagnosed with cirrhosis in 2009 in the United Kingdom, greater than that of the fi fth most common cancer non-Hodgkin ' s lymphoma. The percentage change in incidence of cirrhosis between 1998 and 2009 for both men (52.4 % ) and women (38.3 % ) was greater than that seen for the top four most commonly diagnosed cancers in the United Kingdom (breast, lung, bowel, and prostate). CONCLUSIONS:The occurrence of cirrhosis increased more than that of the top four cancers during 1998 to 2009 in England. Strategies to monitor and reduce the incidence of this disease are urgently needed.SUPPLEMENTARY MATERIAL is linked to the online version of the paper at

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“…28,29 For example, one systematic review reported that on average 89% of diagnoses recorded on the GP electronic record are confirmed from other data sources. 28 Currently however, there is limited information on the QResearch database regarding the precise type of cancer which means it was not possible to include the precise type of pancreatic cancer in the outcome (that is, distinguish between endocrine and exocrine tumours), the stage, or the grade.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm

Hippisley‐Cox¹,

Coupland²

2012

Br J Gen Pract

104

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BackgroundPancreatic cancer has the worst survival for any cancer and is often diagnosed late when the cancer is advanced. Chances of survival are more likely if patients can be diagnosed earlier. AimTo derive and validate an algorithm to estimate absolute risk of having pancreatic cancer in patients with and without symptoms in primary care. Design and settingCohort study using data from 375 UK QResearch ® general practices for development and 189 for validation. MethodIncluded patients were aged 30-84 years, free at baseline from a diagnosis of pancreatic cancer and had not had dysphagia, abdominal pain, abdominal distension, appetite loss, or weight loss recorded in the preceding 12 months. The primary outcome was incident diagnosis of pancreatic cancer recorded in the following 2 years. Risk factors examined included: age, body mass index, smoking status, alcohol, deprivation, diabetes, pancreatitis, previous diagnosis of cancer apart from pancreatic cancer, dysphagia, abdominal pain, abdominal distension, appetite loss, weight loss, diarrhoea, constipation, tiredness, itching, and anaemia. Cox proportional hazards models were used to develop separate risk equations in males and females. Measures of calibration and discrimination assessed performance in the validation cohort. ResultsThere were a total of 1415 incident cases of pancreatic cancer from 4.1 million person-years in the derivation cohort. Independent predictors in both males and females were age, smoking, type 2 diabetes, chronic pancreatitis, abdominal pain, appetite loss, and weight loss. Abdominal distension was a predictor for females only; dysphagia and constipation were predictors for males only. On validation, the algorithms explained 59% of the variation in females and 62% in males. The receiver operating characteristic statistics were 0.84 (females) and 0.87 (males). The D statistic was 2.44 (females) and 2.61 (males). The 10% of patients with the highest predicted risks contained 62% of all pancreatic cancers diagnosed over the following 2 years. ConclusionThe algorithm has good discrimination and calibration and could potentially be used to help identify those at highest risk of pancreatic cancer to facilitate early referral and investigation.

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Validity of diagnostic coding within the General Practice Research Database: a systematic review

Cited by 597 publications

References 53 publications

Incretin-Based Drugs and the Risk of Congestive Heart Failure

Incretin-Based Drugs and the Risk of Congestive Heart Failure

Diagnosis of Liver Cirrhosis in England, a Cohort Study, 1998–2009: A Comparison With Cancer

Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm

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