Download CurrieCph2010

Introduction to UK GO data
GPRD: General Practice Research Database
THIN: Health Improvement Network
Some new data too
Data sources
• Records from GP routine records
• GPRD=THIN (almost)
• >6% of the UK population
• >350 GP practices
• >6½ million individual people
UK NHS―National Health Service
• Largest UK employer―4th largest employer in world
• 1.7 million employees
• 40,000 GPs
• 10,000 GP practices
• GPs see 140 patients per week
Data content
• Diagnoses: GP and some hospital
• Biochemistry: HbA1c etc
• Risk factors: weight, smoking etc
• Family history (some)
• Drugs (all prescribed drugs)
• Outpatient contacts
• Free text
• GPRD only….linked data:
• Cancer registry data
• Hospital inpatient data
Quality: representativeness
The Population of the United Kingdom (2001) Compared to the
Population of THIN
18
16
14
Population in %
12
10
8
6
4
2
0
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
Age Groups Years
Population of UK
Population of THIN
75-84
85+
Quality: completeness
THIN Data - Recording Over Time in adults
100
90
80
60
Smoking
Height
50
Weight
BP
40
30
20
10
0
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
Patients (%)
70
Year
Yo
rk
or
th
or
th
Ea
st
sh
i re
% death in THIN
Geographical region
Al
l
Lo
nd
on
So
ut
h
Ea
st
So
ut
h
N
W
or
es
th
t
er
n
Ire
la
nd
W
al
es
Sc
ot
la
nd
Ea
st
W
es
t
&
H
um
Ea
be
st
r
M
id
la
W
nd
es
s
tM
id
la
nd
s
N
N
% death*
Quality: completeness
1.200%
1.000%
0.800%
0.600%
0.400%
0.200%
0.000%
% death in UK
Strengths
• Size―over 5% UK population
• Nationally representative
• Fast―information already collected
• Frequent collections
• All prescribable drugs
• Population based
• Study design flexibility
• ‘Real Life’ data―collected during normal GP visit
• Link to GP and patient for additional information
Weaknesses
• £cost!
• No direct link to secondary care data (THIN)
• No direct link of prescriptions to diagnoses temporal implied link
• Limited information on OTC medications
• Limited data on lifestyles, diet etc
• Not dispensed prescriptions
• Limited information on hospital prescribing
• Some medications only administered by specialists
Weaknesses re Ca.
• Details of the cancer diagnosis variable
• No systematic cancer staging data
• Metastatic cancer: have to infer
• Hospital cancer treatments not known
New data!
Survival after incident cancer:
diabetes vs. non-diabetes
Incident cancers by cancer site
All cancers
Parameter
Patients – n; %
Age – years (mean)
Sex – % women
Smoking – % ever smoked
Diabetes duration – years (mean)
2
BMI males – kg/m (mean)
2
BMI females – kg/m (mean)
SBP – mmHg (mean)
Total cholesterol – mmol/l (mean)
HbA1c in year prior – %
Prior vascular disease – %
Large vessel disease
Eye problems (some)
Eye problems (severe visual
loss/blindness)
No renal disease
Mild renal disease
Moderate/severe renal disease
General morbidity:
Charlson index, adjusted – mean
Charlson index, unadjusted – mean
GP contacts in previous year – mean
Total observation time – years
Breast
Prostate
Colorectal
Lung
Bladder
Ovary and
Endometrium
Pancreas
Liver
NDM
140,141
65.7
53.3
42.4
n/a
26.0
25.8
139.5
5.0
5.8
DM
9,890
71.4
41.0
52.1
10.4
28.6
30.4
139.0
4.4
7.4
NDM
30,901
58.8
99.0
33.1
n/a
25.7
25.7
138.3
5.5
5.9
DM
1,286
70.0
97.7
35.8
11.3
27.8
30.7
141.8
4.8
7.5
NDM
16,872
72.1
n/a
44.3
n/a
26.1
n/a
141.4
4.9
5.8
DM
1,475
73.6
n/a
52.1
11.0
28.3
n/a
140.0
4.3
7.3
NDM
15,617
69.6
46.9
39.2
n/a
26.3
25.8
139.3
4.9
5.8
DM
1,363
72.1
39.0
49.1
11.2
29.0
29.5
137.4
4.3
7.3
NDM
12,666
70.1
38.6
68.5
n/a
25.1
24.9
138.3
4.8
6.2
DM
891
72.1
36.1
78.0
8.6
28.4
29.2
135.3
4.2
7.5
NDM
7,076
70.7
27.7
52.2
n/a
26.1
25.8
142.3
4.9
6.1
DM
716
72.4
18.8
62.7
11.4
28.7
28.7
140.9
4.5
7.5
NDM
5,625
63.6
100.0
27.6
n/a
n/a
27.3
140.6
5.5
5.8
DM
424
67.5
100.0
31.0
10.4
n/a
32.7
141.1
4.7
7.4
NDM
2,125
70.8
53.8
41.4
n/a
25.8
25.5
140.1
5.1
6.2
DM
375
71.2
44.5
56.0
5.6
28.2
28.3
135.3
4.4
8.5
NDM
1,334
68.8
47.9
43.6
n/a
26.5
26.2
137.9
5.0
5.7
DM
252
69.8
29.8
60.7
9.0
29.4
31.0
136.2
4.3
7.3
13.9
1.3
30.7
14.4
6.1
0.9
23.3
13.8
19.9
1.5
34.3
14.5
15.4
1.6
30.4
16.3
21.5
1.5
40.3
14.0
19.9
1.7
34.6
12.4
8.2
1.0
20.0
12.0
16.2
1.8
25.9
11.2
17.6
1.7
32.9
20.2
1.8
99.1
0.0
0.9
3.3
92.9
4.6
2.5
1.1
99.7
0.0
0.3
3.1
95.6
2.8
1.5
1.9
98.6
0.0
1.4
3.0
91.1
5.7
3.2
2.2
99.2
0.0
0.7
3.4
93.1
4.2
2.7
2.4
99.1
0.0
0.9
4.0
91.0
7.0
2.0
2.2
98.4
0.0
1.6
2.1
92.2
5.3
2.5
1.4
99.4
0.0
0.6
3.3
94.8
3.5
1.6
2.6
99.1
0.0
0.9
2.4
95.2
3.0
1.8
2.6
99.1
0.1
0.8
3.2
94.8
2.8
2.4
4.7
2.5
6.5
610,856
6.9
4.2
10.9
28,722
3.8
2.2
4.9
198,581
6.5
3.9
9.2
5,211
5.3
2.5
6.9
65,183
7.0
4.1
10.3
4,972
5.0
2.4
6.6
61,308
6.9
4.2
10.6
4,178
5.3
2.8
8.7
13,171
7.2
4.5
12.4
940
5.2
2.5
7.0
32,675
6.8
4.0
10.2
2,685
4.3
2.3
7.0
25,343
6.2
3.9
9.9
1,451
5.2
2.5
9.0
1,484
6.6
3.9
13.7
255
5.1
2.7
8.8
1,502
7.3
4.7
14.0
272
Incident cancers by DM treatment
Diabetes by treatment in the first three months following cancer diagnosis
All non-diabetes
Patients – n; %
140,141
All type 2
diabetes
9,890
71.4
9.7
Sulf mono
Insulin mono
Met + Sulf
Met + Insulin
1,635
16.5
1,844
18.6
753
7.6
1,295
13.1
320
3.2
70.2
9.8
73.6
9.3
70.2
9.3
71.7
9.0
67.4
9.0
Age – years (mean; sd)
65.7
Sex – % women
53.3
41.0
44.1
40.3
41.3
39.1
Smoking – % ever smoked
42.4
52.1
53.8
47.8
54.2
51.5
Diabetes duration – years (mean; median)
15.0
Met mono
43.7
58.1
n/a
n/a
10.4
8.9
8.1
6.8
9.9
8.7
15.3
14.3
12.2
10.8
15.5
14.4
26.0
3.7
28.6
4.3
29.8
4.3
27.3
3.9
28.2
4.4
28.7
4.3
30.2
4.2
25.8
4.8
30.4
5.9
32.1
5.6
28.3
5.3
29.9
5.9
30.6
5.6
33.6
5.9
139.5
20.2
139.0
19.5
137.7
18.2
141.4
21.4
139.6
19.9
139.5
18.2
138
17.9
Total cholesterol – mmol/l (mean; sd)
5.0
1.2
4.4
1.1
4.3
1.1
4.5
1.2
4.3
1.1
4.3
1.1
4.1
1.0
HbA1c in year prior – % (mean; sd)
5.8
0.9
7.4
1.5
7.1
1.3
7.4
1.6
8.3
1.6
7.7
1.5
8.3
1.5
2
BMI males – kg/m (mean; sd)
2
BMI females – kg/m (mean; sd)
Systolic blood pressure – mmHg (mean; sd)
Prior vascular disease – %
Large vessel disease
13.9
30.7
27.4
32.7
39.6
31.0
35.9
Eye problems (some)
1.3
14.4
10.9
11.0
30.5
16.7
25.6
Eye problems (severe visual loss/blindness)
1.8
3.3
2.0
4.2
4.9
3.0
5.6
No renal disease
99.1
92.9
94.4
92.6
88.4
93.9
91.6
Mild renal disease
0.0
4.6
4.8
4.0
6.2
4.9
7.5
Moderate/severe renal disease
0.9
2.5
0.8
3.4
5.3
1.2
0.9
General morbidity:
Charlson index,adjusted (mean; sd)
4.7
1.8
Charlson index, unadjusted (mean; sd)
2.5
GP contacts in previous year (mean; median)
6.5
Total observation time – years
6.9
1.8
0.9
4.2
5
10.9
610,856
6.5
1.7
1.4
3.9
9
10.6
28,722
7.1
1.9
1.2
4.2
9
10.2
4,564
7.4
2.0
1.5
4.9
8
13.4
5,754
6.9
1.7
1.7
4.2
10
10.7
2,054
6.8
1.8
1.3
4.5
1.5
9
13.4
11
3,950
690
Cancers – n; %
Breast
30,901
22.0
1,286
13.0
276
16.9
233
12.6
87
11.6
184
14.2
51
15.9
Prostate
16,872
12.0
1,475
14.9
274
16.7
259
14.0
89
11.8
234
18.1
48
15.0
Colorectal
15,617
11.1
1,363
13.8
213
13.0
249
13.5
97
12.9
181
14.0
43
13.4
All cancers
Breast
Ovarian &
Endometrium
Colorectal
Bladder
Prostate
Liver
Lung
Type 2 diabetes
3.3 3.2
2.6 2.6
Non-diabetes
Type 2 diabetes
Non-diabetes
5
Type 2 diabetes
7.9
Non-diabetes
7.7
Type 2 diabetes
11.0
Non-diabetes
8.8
Type 2 diabetes
14.2
Non-diabetes
7.5
Type 2 diabetes
15
Non-diabetes
17.4
Type 2 diabetes
20
Non-diabetes
Type 2 diabetes
Non-diabetes
10
Type 2 diabetes
Non-diabetes
Mean survival by Ca. site (years)
30
26.9
25
18.2
13.6
10.5
8.4
1.7 1.4
0
Pancreas
Δ mean survival by Ca. site (years)
18
15.9
16
14
12
10
9.9
9.4
8
6.4
6
5.7
4
2.1
2
0
All cancers
Breast
Ovarian & Colorectal
Endometrium
Bladder
Prostate
0.1
0.1
0.3
Liver
Lung
Pancreas
Cumulative mortality (crude)
DM
Non-DM
Cumulative mortality (adjusted)
DM
Non-DM
Adjusted: age, sex, smoking, morbidity
HR DM vs-N-DM (Cox)
Model #
Model specification
HR
Model 1
Age at Ca. diagnosis
1.067
1.024
1.113
0.00229
Model 2
Model 1, plus sex
1.040
0.997
1.084
0.06579
Model 3
Model 2, plus smoking status
1.129
1.082
1.176
0.00000
Model 4
Model 3, plus baseline morbidity*
0.969
0.928
1.011
0.14448
Model 5
Model 4, plus cancer site
0.904
0.860
0.951
0.00009
Model 6
Model 5, plus year of Ca. Diagnosis**
0.890
0.843
0.939
0.00002
Model 7
Model 6, plus no post-Ca. exposure to metformin
1.167
1.076
1.266
0.00018
Key: *, number of GP contacts in the year prior; **, after 1994 only
95% CI
p-value
adjHR: DM vs N-DM (=1) by treatment
1.15
1.12
1.10
1.10
1.05
1.00
0.95
Sulfonylurea
Insulin
Met+Insulin
Met+Sulf
Metfromin
monotherapy monotherpy combination combination monotherapy
0.94
0.90
0.85
0.87
0.80
0.79
0.75
Cum-mortality: ± metformin (adjusted)
Met-
MetMet+
Exposed anytime aft Ca. diag
HR=0.72; 0.68-0.76; p<0.00001
Met+
Exposed in first 3 months
HR=0.83; 0.78-0.89; p<0.00001
Cancer site
Cases
Events
HR
95% CI
p-value
Cases
Met+ vs Met- (<3 mths) Model A
All cancers
Events
HR
95% CI
p-value
Met+ vs Met- (<3 mths) Model B
130,270
51,468
0.975
0.918
1.037
0.42163
127,869
50,328
0.835
0.784
Breast
31,720
6,459
1.125
0.918
1.379
0.25766
31,365
6,378
0.997
0.809
1.229
0.97808
Prostate
17,762
5,943
1.147
0.978
1.345
0.09195
17,426
5,834
1.034
0.877
1.218
0.69206
Colorectal
16,368
6,905
0.900
0.761
1.065
0.22008
16,043
6,766
0.783
0.659
0.931
0.00564
Lung
13,083
9,798
0.695
0.597
0.808 0.00000
12,697
9,499
0.626
0.537
Bladder
7,497
2,893
1.107
0.876
0.39296
7,356
2,823
0.958
0.756
Ovarian and Endomeytrial
5,882
2,165
0.585
0.419
0.817 0.00168
5,747
2,103
0.550
0.390
0.777 0.00069
Pancreas
2,314
1,788
0.712
0.550
0.923 0.01022
2,250
1,737
0.655
0.503
0.853 0.00169
Liver
1,452
1,010
0.705
0.503
0.987 0.04184
1,411
978
0.673
0.475
0.955 0.02636
1.399
Met+ vs Met- (>3 mths) Model A
0.888 0.00000
0.730 0.00000
1.216
0.72644
Met+ vs Met- (>3 mths) Model B
130,270
51,468
0.834
0.787
127,869
50,328
0.717
0.675
Breast
31,720
6,459
1.063
0.891
1.268
0.49931
31,365
6,378
0.927
0.773
1.112
0.41267
Prostate
17,762
5,943
1.061
0.920
1.225
0.41555
17,426
5,834
0.960
0.829
1.112
0.58756
Colorectal
16,368
6,905
0.804
0.688
0.940 0.00611
16,043
6,766
0.709
0.604
0.831 0.00002
Lung
13,083
9,798
0.626
0.533
0.735 0.00000
12,697
9,499
0.562
0.477
0.663 0.00000
Bladder
7,497
2,893
0.929
0.748
0.50314
7,356
2,823
0.818
0.655
Ovarian and Endomeytrial
5,882
2,165
0.607
0.453
0.813 0.00083
5,747
2,103
0.579
0.429
0.781 0.00035
Pancreas
2,314
1,788
0.626
0.466
0.840 0.00180
2,250
1,737
0.582
0.432
0.785 0.00038
Liver
1,452
1,010
0.569
0.398
0.813 0.00195
1,411
978
0.557
0.385
0.807 0.00198
All cancers
0.885 0.00000
1.153
Model A = age + sex + smoking + metformin parameter; Model B = age + sex + smoking + baseline morbidity + metformin parameter
0.761 0.00000
1.020
0.07486