Publications
128 results found
Feigin VL, Krishnamurthi RV, Parmar P, et al., 2015, Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study, Neuroepidemiology, Vol: 45, Pages: 161-176
BACKGROUND: Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. OBJECTIVES: This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. METHODOLOGY: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs). RESULTS: In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a d
Feigin VL, Mensah GA, Norrving B, et al., 2015, Atlas of the Global Burden of Stroke (1990-2013): The GBD 2013 Study, Neuroepidemiology, Vol: 45, Pages: 230-236
BACKGROUND: World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. OBJECTIVES: To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke and hemorrhagic stroke in the world for 1990-2013. METHODOLOGY: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality (through April 2014) and stroke incidence, prevalence, case fatality and severity through 2013. Death was estimated using an ensemble modeling approach. A new software package, DisMod-MR 2.0, was used as part of a custom modeling process to estimate YLDs. All rates were age-standardized to new GBD estimates of global population. All estimates have been computed with 95% uncertainty intervals. RESULTS: Age-standardized incidence, mortality, prevalence and DALYs/YLDs declined over the period from 1990 to 2013. However, the absolute number of people affected by stroke has substantially increased across all countries in the world over the same time period, suggesting that the global stroke burden continues to increase. There were significant geographical (country and regional) differences in stroke burden in the world, with the majority of the burden borne by low- and middle-income countries. CONCLUSIONS: Global burden of stroke has continued to increase in spite of dramatic declines in age-standardized incidence, prevalence, mortality rates and disability. Population growth and aging have played an important role in the observed increase in stroke burden. 2015 S. Karger AG, Basel.
Krishnamurthi RV, deVeber G, Feigin VL, et al., 2015, Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013, Neuroepidemiology, Vol: 45, Pages: 177-189
BACKGROUND: There is increasing recognition of stroke as an important contributor to childhood morbidity and mortality. Current estimates of global childhood stroke burden and its temporal trends are sparse. Accurate and up-to-date estimates of childhood stroke burden are important for planning research and the resulting evidence-based strategies for stroke prevention and management. OBJECTIVES: To estimate the prevalence, mortality and disability-adjusted life years (DALYs) for ischemic stroke (IS), hemorrhagic stroke (HS) and all stroke types combined globally from 1990 to 2013. METHODOLOGY: Stroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease 2013 methods. All available data on stroke-related incidence, prevalence, excess mortality and deaths were collected. Statistical models and country-level covariates were employed to produce comprehensive and consistent estimates of prevalence and mortality. Stroke-specific disability weights were used to estimate years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013. RESULTS: In 2013, there were 97,792 (95% UI 90,564-106,016) prevalent cases of childhood IS and 67,621 (95% UI 62,899-72,214) prevalent cases of childhood HS, reflecting an increase of approximately 35% in the absolute numbers of prevalent childhood strokes since 1990. There were 33,069 (95% UI 28,627-38,998) deaths and 2,615,118 (95% UI 2,265,801-3,090,822) DALYs due to childhood stroke in 2013 globally, reflecting an approximately 200% decrease in the absolute numbers of death and DALYs in childhood stroke since 1990. Between 1990 and 2013, there were significant increases in the global prevalence rates of childhood IS, as well as significant decreases in the global death rate and DALYs rate of all strokes in those of age 0-19 years. While prevalence rat
Cowling TE, Soljak MA, Bell D, et al., 2014, Emergency Hospital Admissions via Accident and Emergency Departments in England: Time Trend, Conceptual Framework and Policy Implications, Journal of the Royal Society of Medicine, Vol: 107, Pages: 432-438, ISSN: 1758-1095
Negoescu AF, Tennekone D, Soljak MA, et al., 2014, Extraarticular Manifestations of Rheumatoid Arthritis Develop in Patients Receiving Anti-Tumor Necrosis Factor-α Treatment: A Retrospective Chart Review from a UK Center, JOURNAL OF RHEUMATOLOGY, Vol: 41, Pages: 1944-1947, ISSN: 0315-162X
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- Citations: 5
Gibbons DC, Soljak MA, Millett C, et al., 2014, Use of hospital admissions data to quantify the burden of emergency admissions in people with diabetes mellitus, DIABETIC MEDICINE, Vol: 31, Pages: 971-975, ISSN: 0742-3071
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- Citations: 2
Dalton ARH, Bottle A, Soljak M, et al., 2014, Ethnic group differences in cardiovascular risk assessment scores: national cross-sectional study, ETHNICITY & HEALTH, Vol: 19, Pages: 367-384, ISSN: 1355-7858
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- Citations: 20
Calderon-Larranaga A, Soljak M, Cecil E, et al., 2014, Does higher quality of primary healthcare reduce hospital admissions for diabetes complications? A national observational study, DIABETIC MEDICINE, Vol: 31, Pages: 657-665, ISSN: 0742-3071
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- Citations: 18
Soljak M, Calderon-Larranaga A, Bell D, et al., 2014, Authors' response to: primary healthcare factors and hospital admission rates for COPD: no association, THORAX, Vol: 69, Pages: 590-U127, ISSN: 0040-6376
Majeed A, Soljak M, 2014, Can higher NHS spending in deprived areas reduce health inequalities?, BMJ-BRITISH MEDICAL JOURNAL, Vol: 348, ISSN: 1756-1833
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- Citations: 2
Calderón-Larrañaga A, Soljak M, Cowling TE, et al., 2014, Association of primary care factors with hospital admissions for epilepsy in England, 2004-10: national observational study, Seizure-European Journal of Epilepsy
Poblador-Plou B, Calderon-Larranaga A, Marta-Moreno J, et al., 2014, Comorbidity of dementia: a cross-sectional study of primary care older patients, BMC PSYCHIATRY, Vol: 14
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- Citations: 129
Adomaviciute S, Watt H, Soljak M, et al., 2014, Impact of the Integrated Care Pilot on HbA1c, cholesterol and systolic blood pressure levels in patients with diabetes, DIABETIC MEDICINE, Vol: 31, Pages: 175-175, ISSN: 0742-3071
Brettell R, Soljak M, Cecil E, et al., 2014, Reducing heart failure admission rates in England 2004–2011 are not related to changes in primary care quality: national observational study, European Journal of Heart Failure, Vol: 15, Pages: 1335-1342, ISSN: 1879-0844
Aims Heart failure (HF) is an important clinical problem. Expert consensus has defined HF as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. We analysed time trends in HF admission rates in England and risk and protective factors for admission.Methods and results We used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004–2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality (‘Quality and Outcomes Framework’ indicator.) There were 327 756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100 000 in 2004 to 5.60/100 000 in 2010 (P < 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates.Conclusions The observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.
Soljak M, Watt H, Adomaviciute S, et al., 2014, Impact of the Northwest London Integrated Care Pilot on diabetes control, INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 14, ISSN: 1568-4156
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- Citations: 1
Chang K, Millett C, Soljak M, et al., 2014, National coverage of the English NHS Health Check programme, The European Journal of Public Health, Vol: 24
Michael SoljakK Chang, C Millett, M Soljak and A MajeedDepartment of Primary Care &amp; Public Health, School of Public Health, Imperial College London, London, UKContact: m.soljak{at}imperial.ac.ukBackgroundThe NHS Health Check programme is a national vascular disease prevention programme launched in April 2009 in England. The aim of this research study is to quantify coverage of the programme in the first four years after its implementation, and to gain an understanding of the risk profile and impacts among those who attended a Health Check.MethodsCohort study using a randomly selected sample of 95,571 Health Check eligible persons aged 40-74 years from …
Cowling TE, Harris MJ, Soljak MA, et al., 2013, Opening hours of general practices in England, British Medical Journal, Vol: 347
Brettell R, Soljak M, Cecil E, et al., 2013, Reducing heart failure admission rates in England 20042011 are not related to changes in primary care quality: national observational study, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 15, Pages: 1335-1342, ISSN: 1388-9842
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- Citations: 26
Soljak M, 2013, Population-based health checks are here, RCTs or not., Evid Based Med, Vol: 18, Pages: 216-217
Soljak M, Majeed A, Millett C, 2013, Response to Krogsboll and colleagues: NHS health checks or government by randomised controlled trial?, BMJ-BRITISH MEDICAL JOURNAL, Vol: 347, ISSN: 1756-1833
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- Citations: 4
Soljak M, Millett C, Artac M, et al., 2013, Dépistage des risques cardiovasculaires : pourrait-il réduire les inégalités sociales de santé ?, Revue d'Épidémiologie et de Santé Publique, Vol: 61, Pages: S247-S247, ISSN: 0398-7620
Curry N, Harris M, Gunn LH, et al., 2013, Integrated care pilot in north west London: a mixed methods evaluation, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156
Calderón-Larrañaga A, Carney L, Soljak M, 2013, Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: National cross-sectional study (Thorax (2001) 66, (191-196)), Thorax, Vol: 68, ISSN: 0040-6376
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- Citations: 1
Cowling T, Soljak M, Cecil E, et al., 2013, Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study, PLoS One, Vol: 8, ISSN: 1932-6203
BackgroundThe number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.MethodsA cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services.Main Result and ConclusionGeneral practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.
Greaves F, Pappas Y, Bardsley M, et al., 2013, Evaluation of complex integrated care programmes: the approach in North West London, International Journal of Integrated Care, Vol: 13, ISSN: 1568-4156
Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. Theory and discussion: This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. Conclusions: We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important.
Soljak MA, Majeed A, 2013, Understanding variation in utilisation: start with health needs, BMJ, Vol: 346
Falzon C, Soljak M, Elkin SL, et al., 2013, Finding the missing millions - the impact of a locally enhanced service for COPD on current and projected rates of diagnosis: a population-based prevalence study using interrupted time series analysis, Primary Care Respiratory Journal, ISSN: 1471-4418
BACKGROUND: Many patients with chronic obstructive pulmonary disease (COPD) are not identified until their condition is relatively advanced and there is a considerable gap between the modelled and diagnosed prevalence of the disease. We have previously shown that, in the first year after the introduction of a locally enhanced service (LES) for COPD in 2008, there was a significant step-up in the diagnosed prevalence. AIMS: To investigate whether this initial increase in prevalence was sustained, and the impact of this increase on future projected rates of COPD diagnosis. METHODS: Using data from 2005–2011, we compared the prevalence of diagnosed COPD in the LES Primary Care Trust (LES-PCT) before and after it was introduced. Data were compared with a neighbouring PCT, the London Strategic Health Authority, and England. The true prevalence of COPD was estimated based on data from the Health Survey for England. Trends were extrapolated to estimate the proportion of patients that would be diagnosed in 2017. RESULTS: The introduction of the LES was associated with a significant acceleration in the annual increase in diagnosed COPD (p<0.0001). By 2011 the prevalence was 1.17% in the LES-PCT compared with a predicted value of 0.91% (95% CI 0.86% to 0.95%) based on the pre-LES trend. There was no change in the rate of increase in COPD prevalence for the neighbouring PCT or for London as a whole. The LES-PCT would be expected to diagnose 55.6% of COPD patients by 2017 compared with only 27.3% without the LES, and only 33.3% would be diagnosed in the neighbouring PCT. CONCLUSIONS: These data suggest that, with appropriate incentives, it is possible to achieve a sustained improvement in COPD case-finding in primary care and that such policies need to be implemented systematically.
Kelly JL, Elkin SL, Fluxman J, et al., 2013, Breathlessness and Skeletal Muscle Weakness in Patients Undergoing Lung Health Screening in Primary Care, COPD: Journal of Chronic Obstructive Pulmonary Disease, Vol: 0
Bang JY, Yadegarfar G, Soljak M, et al., 2012, Primary care factors associated with cervical screening coverage in England, Journal of Public Health
Background The National Health Service Cervical Screening Programme was established to decrease the incidence and mortality of cervical cancer in England.Methods To identify socioeconomic and general practice factors associated with cervical screening coverage in England, a national cross-sectional study was conducted using data on 26 497 476 female patients registered with 7970 practices in 152 English primary care trusts (PCTs). The 2008–09 data on cervical screening coverage rates from the quality and outcomes framework (QOF) database were used with data on QOF indicators, staffing levels and socioeconomic status.Results The mean cervical screening coverage rate was 78.5% at the PCT level and 83.5% at the practice level. At both levels, cervical screening coverage was significantly negatively associated with the index of multiple deprivation score, percentage of female patients aged 25–49 years and percentage of ethnic minority patients. Also, at the practice level, the percentage of female patients aged 50–64 years, overall QOF score and records and information score were significantly positively associated with cervical screening coverage.Conclusions Cervical screening coverage was significantly lower in PCTs and practices serving higher percentages of younger-aged women, non-Caucasian individuals and those living in socioeconomic deprivation. It is therefore important to adopt strategies to improve cervical screening coverage in these groups.
Dalton ARH, Soljak M, 2012, The nationwide systematic prevention of cardiovascular disease: the UK's health check programme., J Ambul Care Manage, Vol: 35, Pages: 206-215
High-income countries have witnessed marked reductions in cardiovascular disease (CVD) in recent years. Aging populations, however, maintain CVD as a major threat to public health and health system's financial stability. England has commenced on a population-wide screening and prevention program for CVD, the NHS Health Check program, the first national program of its type. We outline the program, its implications for public health and primary care, potential threats to the program, and its implications for the US health system. We conclude that the universal approach adopted contains a number of risks and uncertainties. The program's ongoing evaluation is vital and will provide internationally valuable data.
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