Amrita Bandyopadhyay

Estimating the incidence, prevalence and true cost of asthma in the UK: secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales—a study protocol

Introduction Asthma is now one of the most common long-term conditions in the UK. It is therefore important to develop a comprehensive appreciation of the healthcare and societal costs in order to inform decisions on care provision and planning. We plan to build on our earlier estimates of national prevalence and costs from asthma by filling the data gaps previously identified in relation to healthcare and broadening the field of enquiry to include societal costs. This work will provide the first UK-wide estimates of the costs of asthma. In the context of asthma for the UK and its member countries (ie, England, Northern Ireland, Scotland and Wales), we seek to: (1) produce a detailed overview of estimates of incidence, prevalence and healthcare utilisation; (2) estimate health and societal costs; (3) identify any remaining information gaps and explore the feasibility of filling these and (4) provide insights into future research that has the potential to inform changes in policy leading to the provision of more cost-effective care. Methods and analysis Secondary analyses of data from national health surveys, primary care, prescribing, emergency care, hospital, mortality and administrative data sources will be undertaken to estimate prevalence, healthcare utilisation and outcomes from asthma. Data linkages and economic modelling will be undertaken in an attempt to populate data gaps and estimate costs. Separate prevalence and cost estimates will be calculated for each of the UK-member countries and these will then be aggregated to generate UK-wide estimates. Ethics and dissemination Approvals have been obtained from the NHS Scotland Information Services Divisions Privacy Advisory Committee, the Secure Anonymised Information Linkage Collaboration Review System, the NHS South-East Scotland Research Ethics Service and The University of Edinburghs Centre for Population Health Sciences Research Ethics Committee. We will produce a report for Asthma-UK, submit papers to peer-reviewed journals and construct an interactive map.

Childhood asthma prevalence: cross-sectional record linkage study comparing parent-reported wheeze with general practitioner-recorded asthma diagnoses from primary care electronic health records in Wales

Introduction Electronic health records (EHRs) are increasingly used to estimate the prevalence of childhood asthma. The relation of these estimates to those obtained from parent-reported wheezing suggestive of asthma is unclear. We hypothesised that parent-reported wheezing would be more prevalent than general practitioner (GP)-recorded asthma diagnoses in preschool-aged children. Methods 1529 of 1840 (83%) Millennium Cohort Study children registered with GPs in the Welsh Secure Anonymised Information Linkage databank were linked. Prevalences of parent-reported wheezing and GP-recorded asthma diagnoses in the previous 12 months were estimated, respectively, from parent report at ages 3, 5, 7 and 11 years, and from Read codes for asthma diagnoses and prescriptions based on GP EHRs over the same time period. Prevalences were weighted to account for clustered survey design and non-response. Cohen’s kappa statistics were used to assess agreement. Results Parent-reported wheezing was more prevalent than GP-recorded asthma diagnoses at 3 and 5 years. Both diminished with age: by age 11, prevalences of parent-reported wheezing and GP-recorded asthma diagnosis were 12.9% (95% CI 10.6 to 15.4) and 10.9% (8.8 to 13.3), respectively (difference: 2% (−0.5 to 4.5)). Other GP-recorded respiratory diagnoses accounted for 45.7% (95% CI 37.7 to 53.9) and 44.8% (33.9 to 56.2) of the excess in parent-reported wheezing at ages 3 and 5 years, respectively. Conclusion Parent-reported wheezing is more prevalent than GP-recorded asthma diagnoses in the preschool years, and this difference diminishes in primary school-aged children. Further research is needed to evaluate the implications of these differences for the characterisation of longitudinal childhood asthma phenotypes from EHRs.

Challenges of harmonising data from UK national health surveys: a case study of attempts to estimate the UK prevalence of asthma.

Bright I Nwaru, Mome Mukherjee, Ramyani P Gupta, Angela Farr, Martin Heaven, Andrew Stoddart, Amrita Bandyopadhyay, Deborah Fitzsimmons, Michael Shields, Ceri Phillips, George Chamberlain, Colin Fischbacher, Christopher Dibben, Chantelle Aftab, Colin R Simpson, Ronan Lyons, David Strachan, Gwyneth A Davies, Brian McKinstry and Aziz Sheikh Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH8 9AG, UK Edinburgh Health Services Research Unit, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK Population Health Research Institute, St George’s, University of London, UK Swansea Centre for Health Economics (SCHE), College of Human and Health Science, Swansea University, UK CIPHER – Centre for the Improvement of Population Health through e-Records Research, Centre for Health Information, Research and Evaluation (CHIRAL), College of Medicine, Institute of Life Science 2 (ILS2), Swansea University, UK Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Health Sciences Building, Queen’s University Belfast, UK Information Services Division (ISD), NHS National Services Scotland, Edinburgh, UK School of Geography & Geosciences, Department of Geography & Sustainable Development, The University of Edinburgh, UK Asthma & Allergy Group, Institute of Life Science, College of Medicine, Swansea University, UK Corresponding author: Aziz Sheikh. Email: aziz.sheikh@ed.ac.uk

Risk of emergency hospital admission in children associated with mental disorders and alcohol misuse in the household: an electronic birth cohort study

Summary Background Mental disorders and alcohol misuse are common in families but their effects on the physical health of children are not known. We investigated the risk of emergency hospital admissions during childhood associated with living with an adult who has a mental health disorder, or who had an alcohol-related hospital admission. Methods We did this cohort study in a total population electronic child cohort in Wales, UK, which includes all children who live in Wales or with a mother who is resident in Wales. We used Cox regression to model time to first emergency hospital admission during the first 14 years of life associated with living with an adult who has a mental health disorder, or who had an alcohol-related hospital admission. We adjusted our results for social deprivation and perinatal risk factors. Findings We included data for 253 717 children with 1 015 614 child-years of follow-up. Living with an adult with a mental disorder was associated with an increased risk of emergency admission for all causes (adjusted hazard ratio [aHR] 1·17, 95% CI 1·16–1·19), for injuries and external causes (1·14, 1·11–1·18), and childhood victimisation (1·55, 1·44–1·67). Children living with a household member who had an alcohol-related hospital admission had a significantly higher risk of emergency admissions for injuries and external causes (aHR 1·13, 95% CI 1·01–1 ·26) and victimisation (1·39, 1·00–1·94), but not for all-cause emergency admissions (1·01, 0·93–1·09). Interpretation The increased risk of emergency admissions in children associated with mental disorders and alcohol misuse in the household supports the need for policy measures to provide support to families that are affected. Funding Economic and Social Research Council, Medical Research Council, Alcohol Research UK, Public Health Wales.

Measuring the timeliness of childhood vaccinations: Using cohort data and routine health records to evaluate quality of immunisation services

Highlights • Most children received the first dose of primary vaccines on time.• Timeliness of vaccination decreased with vaccine dose.• Most children had appropriate intervals between doses; marked variation occurred.• The quality of routine vaccination records in Wales is high.• Parental report of MMR status is reliable.

Educational Attainment at Age 10–11 Years Predicts Health Risk Behaviors and Injury Risk During Adolescence

Purpose To examine the effect of educational attainment in primary school on later adolescent health. Methods Education data attainments at age 7 and 11 were linked with (1) primary and secondary care injury consultation/admissions and (2) the Health Behaviour in School-aged Children survey. Cox regression was carried out to examine if attainment in primary school predicts time to injury in adolescence. Results Pupils that achieve attainment at age 7 but not at age 11 (i.e., declining attainment over time in primary school) are more likely to have an injury during adolescence. These children are also more likely to self-report drinking in adolescence. Conclusions Interventions aimed at children with declining attainment in primary school could help to improve adolescent health.

P218 The epidemiological, healthcare and societal burden and costs of asthma in the UK and member nations: analyses of national databases

Background Developing a comprehensive picture of the burden of asthma in the UK will enable informed national decisions about care provision and planning. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma. Methods We undertook analyses of national health surveys, routine healthcare and administrative datasets over the period 2010–12. Economic modelling was carried out to estimate costs. Estimates were calculated for each nation and the UK as a whole. Results The UK lifetime prevalence of patient-reported symptoms suggestive of asthma in 2010–11 was 30.7% (95% Confidence Intervals [CI] 29.2–32.2; equivalent to [~] 18,949,516 people), lifetime prevalence of patient-reported physician-diagnosed asthma was 15.9% (95% CI 14.7–17.1; ~10,841,030 people), annual prevalence of patient-reported physician-diagnosed-and-treated asthma was 9.1% (95% CI 8.0–10.2; ~5,765,237 people), annual prevalence of GP reported-and-diagnosed asthma was 8.2% (95% CI 8.2–8.2; ~5,215,607 people) and annual prevalence of GP reported-and-diagnosed-and-treated asthma was 6.0% (95% CI 6.0–6.0; ~3,946,796 people). In 2011–12, asthma resulted in an estimated: 6,392,670 primary-care consultations; 93,916 inpatient-care episodes; 1,864 (317 paediatric and 1,547 adult) intensive-care unit episodes; 36,800 disability living allowance (DLA) claims; and 1,160 deaths. The estimated cost of asthma in the UK was at least £1.1billion in 2011–12: 75% of this was for primary-care (60% prescribing and 15% consultations), 13% for DLA claims, and 10% for hospital care. Conclusions We found that asthma is very common, affecting at least 3.95 million people, and that it is responsible for substantial morbidity, healthcare and societal costs in the UK. Setting ambitious targets for improving asthma outcomes is paramount and resources should be targeted to improving community-based prescribing decisions and reducing the risk of asthma exacerbations and associated hospitalisations and deaths. Funding Asthma UK, with additional support from the Edinburgh Health Services Research Unit and Farr Institute, UK.