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Journal articleRaslan AS, Quint J, Cook S, 2023,
All-cause, cardiovascular and respiratory mortality in people with Type 2 Diabetes and Chronic Obstructive Pulmonary Disease (COPD) in England: a cohort study using the Clinical Practice Research Datalink (CPRD)
, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 18, Pages: 1207-1218, ISSN: 1176-9106Background: Type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD) are common non-communicable diseases. Both have an inflammatory nature and similar risk factors, and there is overlap and interaction between them. To date, there is a lack of research on outcomes in people that have both conditions. The aim of this study was to investigate whether the presence of COPD in people with T2D was associated with an increased risk of all-cause, respiratory-cause and cardiovascular-cause mortality.Methods: A three-year cohort study (2017– 19) was done using the Clinical Practice Research Datalink Aurum database. The study population was 121,563 people with T2D aged ≥ 40. The exposure was COPD status at baseline. Incident rates for all-cause, respiratory-cause and cardiovascular-cause mortality were calculated. Poisson models for each outcome were fitted to estimate rate ratios for COPD status adjusted for age, sex, Index of Multiple Deprivation, smoking status, body mass index, prior asthma and cardiovascular disease.Results: COPD was present in 12.1% people with T2D. People with COPD had a higher all-cause mortality rate (448.7 persons per 1000 person years) compared with people without COPD (296.6 persons per 1000 person years). People with COPD also had substantially higher respiratory mortality incidence rates and moderately raised cardiovascular mortality rates. Fully adjusted Poisson models showed that people with COPD had a 1.23 (95% CI 1.21, 1.24) times higher rate of all-cause mortality as compared with those without COPD and a 3.03 (95% CI 2.89, 3.18) times higher rate of respiratory-cause mortality. There was no evidence of an association with cardiovascular mortality after adjusting for existing cardiovascular disease.Conclusion: Co-morbid COPD in people with T2D was associated with increased mortality overall and particularly from respiratory causes. People with both COPD and T2D are a high-risk group who would benefit from particularly
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Journal articleWhittaker HR, Wing K, Douglas I, et al., 2022,
Inhaled corticosteroid withdrawal and change in lung function in primary care chronic obstructive pulmonary disease patients in England
, Annals of the American Thoracic Society, Vol: 19, Pages: 1834-1841, ISSN: 1546-3222RATIONALE: In COPD, inhaled corticosteroids (ICS) are associated with pneumonia highlighting the importance of investigating subgroups of patients who may benefit from prolonged ICS use. Despite this, the WISDOM trial found a greater decline in forced expiratory volume in 1 second (FEV1) in COPD patients who withdrew from inhaled corticosteroids (ICS) compared to patients who remained on triple therapy (TT). OBJECTIVES: We investigated the association between ICS withdrawal and rate of FEV1 decline in COPD patients using routinely collected electronic healthcare records. METHODS: Using Clinical Practice Research Datalink (CPRD) Aurum and Hospital episode statistics we included COPD patients who had been on TT for at least four months. Patients were categorised into those who withdrew from ICS and those who remained on TT during follow-up. Three cohorts were created: i) patients meeting the WISDOM trial eligibility criteria; ii) patients with COPD not restricted by the WISDOM trial eligibility criteria; and iii) patients who would have been excluded from the WISDOM trial based on their comorbidities. Mixed linear regression was used to model the association between ICS withdrawal and rate of FEV1 decline (ml/year) adjusted for baseline characteristics. RESULTS: 6,008 COPD patients met the WISDOM eligibility criteria, of which 9.0% withdrew from ICS. Mean rates of FEV1 decline -7.8 ml/year (95% CI -19.7 to +4.1) for withdrawers and -15.2 ml/year (95% CI -18.7 to -11.8) for those who remained on TT (difference p=0.264). 60,645 COPD patients were not restricted by the WISDOM eligibility criteria. Mean rate of FEV1 decline was -32.6ml/year (-33.6 to -31.5) for withdrawers and -36.4ml/year (-39.4 to -33.4) for those who remained on TT. 32,882 COPD patients were included in the last population representing those would have been excluded from the WISDOM trial due to their comorbidities. Mean rate of FEV1 decline was -29.4ml/year in withdrawers and -31.3ml/year in those who
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Journal articleStone P, Hickman K, Holmes S, et al., 2022,
Comparison of COPD primary care in England, Scotland, Wales, and Northern Ireland
, npj Primary Care Respiratory Medicine, Vol: 32, ISSN: 2055-1010Currently the National Asthma and COPD audit programme (NACAP) only undertakes audit of COPD primary care in Wales due to its near complete data coverage. We aimed to determine if the quality of COPD primary care in the other UK nations is comparable with Wales. We found that English, Scottish, and Northern Irish practices were significantly worse than Welsh practices at recording coded lung function parameters used in COPD diagnosis (ORs: 0.51 [0.43–0.59], 0.29 [0.23–0.36], 0.42 [0.31–0.58], respectively) and referring appropriate patients for pulmonary rehabilitation (ORs: 0.10 [0.09–0.11], 0.12 [0.11–0.14], 0.22 [0.19–0.25], respectively). Completing national audits of primary care in Wales only may have led to improvements in care, or at least improvements in the recording of care in Wales that are not occurring elsewhere in the UK. This highlights the potential importance of audit in improving care quality and accurate recording of that care.
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Journal articleHargreaves JR, Langan SM, Oswald WE, et al., 2022,
Epidemiology of SARS-CoV-2 infection among staff and students in a cohort of English primary and secondary schools during 2020–2021
, The Lancet Regional Health - Europe, Vol: 21Background: There remains uncertainty about the epidemiology of SARS-CoV-2 among school students and staff and the extent to which non-pharmaceutical-interventions reduce the risk of school settings. Methods: We conducted an open cohort study in a sample of 59 primary and 97 secondary schools in 15 English local authority areas that were implementing government guidance to schools open during the pandemic. We estimated SARS-CoV-2 infection prevalence among those attending school, antibody prevalence, and antibody negative to positive conversion rates in staff and students over the school year (November 2020–July 2021). Findings: 22,585 staff and students participated. SARS-CoV-2 infection prevalence among those attending school was highest during the first two rounds of testing in the autumn term, ranging from 0.7% (95% CI 0.2, 1.2) among primary staff in November 2020 to 1.6% (95% CI 0.9, 2.3) among secondary staff in December 2020. Antibody conversion rates were highest in the autumn term. Infection patterns were similar between staff and students, and between primary and secondary schools. The prevalence of nucleoprotein antibodies increased over the year and was lower among students than staff. SARS-CoV-2 infection prevalence in the North-West region was lower among secondary students attending school on normal school days than the regional estimate for secondary school-age children. Interpretation: SARS-CoV-2 infection prevalence in staff and students attending school varied with local community infection rates. Non-pharmaceutical interventions intended to prevent infected individuals attending school may have partially reduced the prevalence of infection among those on the school site. Funding: UK Department of Health and Social Care.
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Journal articleWhittaker H, Van Ganse E, Dalon F, et al., 2022,
Differences in severe exacerbations rates and health care utilisation in COPD populations in the UK and France
, BMJ Open, Vol: 9, ISSN: 2044-6055IntroductionChronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of COPD patients in the UK and France between 2008 and 2017. MethodsWe used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify COPD patients each year between 2008 and 2017. We compared patient characteristics, all-cause mortality, and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and chi-squared tests. ResultsCOPD patients were similar in gender and comorbidities in both countries. In the UK, incidence of COPD exacerbations remained stable in the UK and France between 2007-2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs. 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD related causes was shorted in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). DiscussionOverall, UK patients were more likely to go to accident and emergency (A&E) and be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared to patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Journal articleThygesen JH, Tomlinson C, Hollings S, et al., 2022,
COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records
, LANCET DIGITAL HEALTH, Vol: 4, Pages: E542-E557- Author Web Link
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- Citations: 17
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Journal articleGulea C, Zakeri R, Kallis C, et al., 2022,
Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis
, BMJ Open, Vol: 12, ISSN: 2044-6055Objective: To evaluate the association between having concomitant COPD or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute HF.Setting: Data were obtained from patients enrolled in the National Heart Failure Audit.Participants: 217,329 patients hospitalised for HF in England-Wales between March 2012 and 2018.Outcomes: In-hospital mortality, referrals to cardiology follow-up and prescriptions for HF medications were compared between patients with comorbid COPD (COPD-HF) or asthma (asthma-HF) versus HF-alone using mixed-effects logistic regression. Results: Patients with COPD-HF were more likely to die during hospitalisation, and those with asthma-HF had a reduced likelihood of death, compared with patients who had HF-alone ([adjusted]ORadj, 95% CI: 1.10, 1.06-1.14 and ORadj, 95%CI: 0.85, 0.79-0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: COPD-HF patients had reduced odds of cardiology follow-up (ORadj, 95%CI 0.79, 0.77-0.81), whilst cardiology referral odds for asthma-HF were similar to HF-alone. Overall, proportions of HF medication prescriptions at discharge were low for both COPD-HF and asthma-HF groups, particularly prescriptions for beta-blockers. Conclusions: In this nationwide analysis, we showed that COPD and asthma significantly impact the clinical course in patients hospitalised for HF. COPD is associated with higher in-patient mortality and lower cardiology referral odds, whilst COPD and asthma are both associated with lower use of prognostic HF therapies on discharge. These data highlight therapeutic gaps and a need for better integration of cardiopulmonary services to improve healthcare provision for patients with HF and coexisting respiratory disease.
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Journal articleKoteci A, Morgan A, Portas L, et al., 2022,
Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study
, BMC Pulmonary Medicine, Vol: 22, Pages: 1-11, ISSN: 1471-2466BackgroundCardiovascular disease is prevalent in idiopathic pulmonary fibrosis (IPF), yet the extent of left-sided heart failure (HF) burden, whether this has changed with time and whether HF impacts mortality risk in these patients are unknown. The aims of this study were therefore to determine the temporal trends in incidence and prevalence of left-sided HF in patients with IPF in England and compare these to published estimates in the general population and those with comparable chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), as well as determine the risk of all-cause and cause-specific mortality in patients with comorbid left-sided HF and IPF at population-level using electronic healthcare data.MethodsClinical Practice Research Datalink (CPRD) Aurum primary-care data linked to mortality and secondary-care data was used to identify IPF patients in England. Left-sided HF prevalence and incidence rates were calculated for each calendar year between 2010 and 2019, stratified by age and sex. Risk of all-cause, cardiovascular and IPF-specific mortality was calculated using multivariate Cox regression.ResultsFrom 40,577patients with an IPF code in CPRD Aurum, 25, 341 IPF patients met inclusion criteria. Left-sided HF prevalence decreased from 33.4% (95% CI 32.2–34.6) in 2010 to 20.9% (20.0–21.7) in 2019. Left-sided HF incidence rate per 100 person-years (95% CI) remained stable between 2010 and 2017 but decreased from 4.3 (3.9–4.8) in 2017 to 3.4 (3.0–3.9) in 2019. Throughout follow-up, prevalence and incidence were higher in men and with increasing age. Comorbid HF was associated with poorer survival (adjusted HR (95%CI) 1.08 (1.03–1.14) for all-cause mortality; 1.32 (1.09–1.59) for cardiovascular mortality).ConclusionLeft-sided HF burden in IPF patients in England remains high, with incidence almost 4 times higher than in COPD, a comparable lung disease with similar cardiovascular risk factors.
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Conference paperKallis C, Morgan AD, Maslova E, et al., 2022,
Sabina Jr UK: The Association Between Saba (Short-Acting Beta Agonist) Prescriptions and Frequency of Asthma Exacerbations in a Paediatric Cohort
, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X -
Journal articleWood JL, Kallis C, Coid JW, 2022,
Gang Members, Gang Affiliates, and Violent Men: Perpetration of Social Harms, Violence-Related Beliefs, Victim Types, and Locations
, JOURNAL OF INTERPERSONAL VIOLENCE, Vol: 37, Pages: NP3703-NP3727, ISSN: 0886-2605- Author Web Link
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- Citations: 1
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