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  • Journal article
    Mansfield KE, Mathur R, Tazare J, Henderson AD, Mulick AR, Carreira H, Matthews AA, Bidulka P, Gayle A, Forbes H, Cook S, Wong AYS, Strongman H, Wing K, Warren-Gash C, Cadogan SL, Smeeth L, Hayes JF, Quint JK, McKee M, Langan SMet al., 2021,

    Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study

    , The Lancet Digital Health, Vol: 3, Pages: e217-e230, ISSN: 2589-7500

    BACKGROUND: There are concerns that the response to the COVID-19 pandemic in the UK might have worsened physical and mental health, and reduced use of health services. However, the scale of the problem is unquantified, impeding development of effective mitigations. We aimed to ascertain what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic. METHODS: Using de-identified electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (covering 13% of the UK population), between 2017 and 2020, we calculated weekly primary care contacts for selected acute physical and mental health conditions: anxiety, depression, self-harm (fatal and non-fatal), severe mental illness, eating disorder, obsessive-compulsive disorder, acute alcohol-related events, asthma exacerbation, chronic obstructive pulmonary disease exacerbation, acute cardiovascular events (cerebrovascular accident, heart failure, myocardial infarction, transient ischaemic attacks, unstable angina, and venous thromboembolism), and diabetic emergency. Primary care contacts included remote and face-to-face consultations, diagnoses from hospital discharge letters, and secondary care referrals, and conditions were identified through primary care records for diagnoses, symptoms, and prescribing. Our overall study population included individuals aged 11 years or older who had at least 1 year of registration with practices contributing to CPRD Aurum in the specified period, but denominator populations varied depending on the condition being analysed. We used an interrupted time-series analysis to formally quantify changes in conditions after the introduction of population-wide restrictions (defined as March 29, 2020) compared with the period before their introduction (defined as Jan 1, 2017 to March 7, 2020), with data excluded for an adjustment-to-restrictions period (March 8-28). FINDINGS: The overall population included 9 863 903 individuals
  • Journal article
    Hopstock LA, Morseth B, Cook S, Eggen AE, Grimsgaard S, Lundblad MW, Løchen M-L, Mathiesen E, Nilsen A, Njølstad Iet al., 2021,

    Treatment target achievement after myocardial infarction and ischaemic stroke: cardiovascular risk factors, medication use, and lifestyle: the Tromsø Study 2015–16

    , European Journal of Preventive Cardiology, Vol: 29, Pages: 362-370, ISSN: 2047-4873

    AimsTo investigate European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after myocardial infarction (MI) or ischaemic stroke, in women and men living in Norway.Methods and resultsIn the population-based Tromsø Study 2015–16 (attendance 65%), 904 participants had previous validated MI and/or stroke. Cross-sectionally, we investigated target achievement for blood pressure (<140/90 mmHg, <130/80 mmHg if diabetes), LDL cholesterol (<1.8 mmol/L), HbA1c (<7.0% if diabetes), overweight (body mass index (BMI) <25 kg/m2, waist circumference women <80 cm, men <94 cm), smoking (non-smoking), physical activity (self-reported >sedentary, accelerometer-measured moderate-to-vigorous ≥150 min/week), diet (intake of fruits ≥200 g/day, vegetables ≥200 g/day, fish ≥200 g/week, saturated fat <10E%, fibre ≥30 g/day, alcohol women ≤10 g/day, men ≤20 g/day), and medication use (antihypertensives, lipid-lowering drugs, antithrombotics, and antidiabetics), using regression models. Proportion of target achievement was for blood pressure 55.2%, LDL cholesterol 9.0%, HbA1c 42.5%, BMI 21.1%, waist circumference 15.7%, non-smoking 86.7%, self-reported physical activity 79%, objectively measured physical activity 11.8%, intake of fruit 64.4%, vegetables 40.7%, fish 96.7%, saturated fat 24.3%, fibre 29.9%, and alcohol 78.5%, use of antidiabetics 83.6%, lipid-lowering drugs 81.0%, antihypertensives 75.9%, and antithrombotics 74.6%. Only 0.7% achieved all cardiovascular risk factor targets combined. Largely, there was little difference between the sexes, and in characteristics, medication use, and lifestyle among target achievers compared to non-achievers.Conclusion Secondary prevention of cardiovascular disease was suboptimal. A negligible proportion achieved the treatment target for all
  • Journal article
    Whittaker H, Bloom C, Morgan A, Jarvis D, Kiddle S, Quint Jet al., 2021,

    Accelerated FEV1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients

    , European Respiratory Journal, Vol: 57, ISSN: 0903-1936

    Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD-GOLD) primary care dataset (n=36 282). Accelerated FEV1 decline was defined using the fastest quartile of the COPD population's decline. Cox regression assessed the association between baseline accelerated FEV1 decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease, and CVD mortality). The model was adjusted for age, gender, smoking status, BMI, history of asthma, hypertension, diabetes, statin use, mMRC dyspnoea, exacerbation frequency, and baseline FEV1 percent predicted.6110 (16.8%) COPD patients had a CVD event during follow-up; median length of follow-up was 3.6 years [IQR 1.7–6.1]). Median rate of FEV1 decline was –19.4 mL·year−1 (IQR, –40.5 to 1.9); 9095 (25%) patients had accelerated FEV1 decline (>–40.5 mL·year−1), 27 287 (75%) did not (≤ –40.5 mL·year−1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1 decline (HRadj 0.98 [95%CI, 0.90–1.06]). Corresponding risk estimates were 0.99 (95%CI 0.83–1.20) for heart failure, 0.89 (95%CI 0.70–1.12) for myocardial infarction, 1.01 (95%CI 0.82–1.23) for stroke, 0.97 (95%CI 0.81–1.15) for atrial fibrillation, 1.02 (95%CI 0.87–1.19) for coronary artery disease, and 0.94 (95%CI 0.71–1.25) for CVD mortality. Rather, risk of CVD was associated with mMRC score ≥2 and ≥2 exacerbations in the year prior.CVD out
  • Journal article
    Jones R, Davis A, Stanley B, Julious S, Ryan D, Jackson DJ, Halpin DMG, Hickman K, Pinnock H, Quint JK, Khunti K, Heaney LG, Oliver P, Siddiqui S, Pavord I, Jones DHM, Hyland M, Ritchie L, Young P, Megaw T, Davis S, Walker S, Holgate S, Beecroft S, Kemppinen A, Appiagyei F, Roberts E-J, Preston M, Hardjojo A, Carter V, van Melle M, Price Det al., 2021,

    Risk Predictors and Symptom Features of Long COVID Within a Broad Primary Care Patient Population Including Both Tested and Untested Patients

    , PRAGMATIC AND OBSERVATIONAL RESEARCH, Vol: 12, Pages: 93-104, ISSN: 1179-7266
  • Journal article
    Coid J, Gonzalez RA, Kallis C, Zhang Y, Liu Y, Wood J, Quigg Z, Ullrich Set al., 2020,

    Gang membership and sexual violence: associations with childhood maltreatment and psychiatric morbidity

    , BRITISH JOURNAL OF PSYCHIATRY, Vol: 217, Pages: 583-590, ISSN: 0007-1250
  • Journal article
    Coid J, Gonzalez Rodriguez R, Kallis C, Zhang Y, Bhui K, De Stavola B, Bebbington P, Ullrich Set al., 2020,

    Ethnic disparities in psychotic experiences explained by area-level syndemic effects

    , BRITISH JOURNAL OF PSYCHIATRY, Vol: 217, Pages: 555-561, ISSN: 0007-1250
  • Journal article
    Whittaker H, Quint JK, 2020,

    Using routine health data for research: the devil is in the detail

    , Thorax, Vol: 75, Pages: 714-715, ISSN: 0040-6376
  • Journal article
    Kiddle S, Whittaker H, Seaman S, Quint Jet al., 2020,

    Prediction of five-year mortality after COPD diagnosis using primary care records

    , PLoS One, Vol: 15, ISSN: 1932-6203

    Accurate prognosis information after a diagnosis of chronic obstructive pulmonary disease (COPD) would facilitate earlier and better informed decisions about the use of prevention strategies and advanced care plans. We therefore aimed to develop and validate an accurate prognosis model for incident COPD cases using only information present in general practitioner (GP) records at the point of diagnosis. Incident COPD patients between 2004–2012 over the age of 35 were studied using records from 396 general practices in England. We developed a model to predict all-cause five-year mortality at the point of COPD diagnosis, using 47,964 English patients. Our model uses age, gender, smoking status, body mass index, forced expiratory volume in 1-second (FEV1) % predicted and 16 co-morbidities (the same number as the Charlson Co-morbidity Index). The performance of our chosen model was validated in all countries of the UK (N = 48,304). Our model performed well, and performed consistently in validation data. The validation area under the curves in each country varied between 0.783–0.809 and the calibration slopes between 0.911–1.04. Our model performed better in this context than models based on the Charlson Co-morbidity Index or Cambridge Multimorbidity Score. We have developed and validated a model that outperforms general multimorbidity scores at predicting five-year mortality after COPD diagnosis. Our model includes only data routinely collected before COPD diagnosis, allowing it to be readily translated into clinical practice, and has been made available through an online risk calculator
  • Journal article
    Kallis C, Dixon P, Silberberg B, Affarah L, Shawihdi M, Grainger R, Prospero N, Pearson M, Marson A, Ramakrishnan S, Richardson P, Hood S, Bodger Ket al., 2020,

    Reducing variation in hospital mortality for alcohol-related liver disease in North West England

    , ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 52, Pages: 182-195, ISSN: 0269-2813
  • Journal article
    Mitchell JW, Kallis C, Dixon PA, Grainger R, Marson AGet al., 2020,

    Computed tomography in patients with epileptic seizures admitted acutely to hospital: A population level analysis of routinely collected healthcare data

    , CLINICAL MEDICINE, Vol: 20, Pages: 178-182, ISSN: 1470-2118

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