Ashley Akbari

Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study

Aliment Pharmacol Ther 2011; 33: 64–76

The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors

The incidence of acute pancreatitis has increased sharply in many European countries and the USA in recent years.

Review article: the prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe.

There is little up‐to‐date review evidence on the prevalence of Helicobacter pylori across Europe.

Survey of digestive health across Europe: Final report. Part 1: The burden of gastrointestinal diseases and the organisation and delivery of gastroenterology services across Europe

United European Gastroenterology (UEG) which represents gastroenterology and hepatology and its sub-disciplines across Europe relies on accurate and up to date information on the burden of gastrointestinal diseases in Europe, the availability and quality of diagnostic and therapeutic services and the economic impact of these diseases across the member countries of the European Union to inform its strategy in advising relevant agencies on future clinical services and research priorities. Determining the trajectory of the morbidity and mortality of digestive diseases is vital in planning health services for the future and in making the case for investment in research where there are clear gaps in knowledge. In addition there are marked economic differences across the member nations in Europe and this is reflected in the funding available to support health services, making it highly likely that there are important disparities in the accessibility to high-quality healthcare. In September 2012 the UEG Council accepted a proposal from the UEG Future Trends Committee to commission a detailed survey of digestive health across Europe. The Future Trends Committee developed an outline framework for the study, following which there was an open, competitive process across Europe to identify a competent research group to undertake the project. The contract was awarded to an experienced group within the College of Medicine, Swansea University, United Kingdom, and the project was formally initiated in April 2013. The research group at Swansea has worked closely with the Committee, including an interim update meeting with the Committee in October 2013. The Committee also had the opportunity to make specific comments on a draft final report submitted in May 2014; a final report, Survey of Digestive Health Across Europe was received in August 2014. The final report is organised into two parts: Part 1, The burden of gastrointestinal diseases and the organisation and delivery of gastroenterology services across Europe and Part 2, The economic impact and burden of digestive disorders. We present here the executive summaries of the two parts of the survey, but the full report can be found on the UEG journal website. It is anticipated that several shorter publications will follow, focusing on some specific topics of particular importance and interest. Michael Farthing President United European Gastroenterology

Mortality following Stroke, the Weekend Effect and Related Factors: Record Linkage Study.

Background Increased mortality following hospitalisation for stroke has been reported from many but not all studies that have investigated a ‘weekend effect’ for stroke. However, it is not known whether the weekend effect is affected by factors including hospital size, season and patient distance from hospital. Objective To assess changes over time in mortality following hospitalisation for stroke and how any increased mortality for admissions on weekends is related to factors including the size of the hospital, seasonal factors and distance from hospital. Methods A population study using person linked inpatient, mortality and primary care data for stroke from 2004 to 2012. The outcome measures were, firstly, mortality at seven days and secondly, mortality at 30 days and one year. Results Overall mortality for 37 888 people hospitalised following stroke was 11.6% at seven days, 21.4% at 30 days and 37.7% at one year. Mortality at seven and 30 days fell significantly by 1.7% and 3.1% per annum respectively from 2004 to 2012. When compared with week days, mortality at seven days was increased significantly by 19% for admissions on weekends, although the admission rate was 21% lower on weekends. Although not significant, there were indications of increased mortality at seven days for weekend admissions during winter months (31%), in community (81%) rather than large hospitals (8%) and for patients resident furthest from hospital (32% for distances of >20 kilometres). The weekend effect was significantly increased (by 39%) for strokes of ‘unspecified’ subtype. Conclusions Mortality following stroke has fallen over time. Mortality was increased for admissions at weekends, when compared with normal week days, but may be influenced by a higher stroke severity threshold for admission on weekends. Other than for unspecified strokes, we found no significant variation in the weekend effect for hospital size, season and distance from hospital.

Weekend emergency admissions and mortality in England and Wales.

Increased mortality for hospital admissions at weekends has been reported for emergency admissions overall and for specific disorders, although the size of this effect varies across reports. No evidence exists that compares a wide range of emergency disorders or, for confirmatory purposes, is based on two independent information sources. Further evidence is needed to defi ne which disorders are susceptible to the weekend effect. A Wellcome Trust project of mortality after emergency admissions across England and Wales was used to investigate disorder susceptibility to the weekend effect across two different health-care systems and two independent information sources. Systematic record linkage of national administrative inpatient and mortality data was used for emergency admissions to all public hospitals across England and Wales. Mortality at 30 days was established for admissions on weekends, and compared with admissions on weekdays, for emergency disorders overall and for 15 major circulatory, gastrointestinal, respiratory, and trauma disorders from Jan 1, 2004, to Dec 31, 2012. Logistic regression modelling was used to adjust mortality for patient age, sex, and comorbidities (table, appendix). Overall mortality at 30 days after emergency admissions in England was slightly lower than in Wales (5·59% vs 5·64%). The increased mortality for weekend admissions compared with weekdays was similar in England and Wales. Mortality was higher in England than in Wales in 2004–06, similar in 2007–08, and lower in England than in Wales in 2009–10 and 2011–12. The sizes of the weekend eff ects on mortality in England and Wales were consistent for all 15 disorders and the Pearson’s correlation for each disorder across the two countries was 0·57. The weekend eff ect was strongest for abdominal aortic aneurysm followed by other disorders with very high mortality during the acute phase; pulmonary embolism, stroke, and subarachnoid haemorrhage. Little or no weekend eff ect was observed for acute myocardial infarction and less acute disorders; chronic obstructive pulmonary disease, pneumonia, hip fracture, acute pancreatitis, and inflammatory bowel disease. No signifi cant variation was observed in the weekend effect over time or across patient age groups. These data provide new evidence as to the emergency disorders that are most strongly affected by the weekend effect and show that findings are quite consistent across two health-care systems. The weekend eff ect is most apparent for disorders with very high mortality that often require access to specialist investigation and care during critical acute phases. We declare no competing interests. We acknowledge support from the Wellcome Trust (093564/Z/10/Z). We thank Judy Williams for clerical assistance, Alan Watkins for statistical advice, and the Health Information Research Unit (Swansea, UK) for access to the Secure Anonymised Information Linkage databank.

Influence of social deprivation and air pollutants on serious asthma

To the Editors: Asthma is an important disorder worldwide, as a major cause of hospital admissions, medical consultations, prescriptions and impaired quality of life. The precise causes of asthma, although largely unknown, are multifactorial and involve a complex interaction of genetic and environmental factors. Although hospital admission rates are often increased for people in lower socioeconomic groups [1], little has been reported specifically for serious asthma ( i.e. prolonged admissions and/or death within 30 days). Evidence about the effects of air pollutants on the occurrence of serious asthma is also unclear [2]. We aimed to establish the hospital admission rate and case fatality for serious asthma, and whether admissions are associated more strongly with social deprivation or air pollutants. We used medical record linkage of inpatient data from the Patient Episode Database for Wales (PEDW) and mortality data from the National Health Service (NHS) Welsh Administrative Register. PEDW covers inpatient admissions to all NHS hospitals across 22 local health authorities in Wales, UK (population three million) and has been used as the basis of many previous published studies. We included all emergency admissions from April 1, 1999 to March 31, 2007 where asthma (ICD-10 codes J45 and J46) was the principal diagnosis at discharge. Patients of all ages with admissions lasting ≥3 days, or who died (from any cause) within 30 days, were classified as “serious” cases. We included all first “serious” admissions during the study period, and subsequent serious admissions providing they occurred >30 days after the preceding serious admission. We measured social deprivation and its seven domains using the Welsh Index of Multiple Deprivation 2005 [3]. Social deprivation scores were assigned to 1,896 lower super output areas (LSOAs) across Wales (average LSOA population 1,560) [3]. The LSOAs were ranked according to …

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.

Colectomy rates in patients with ulcerative colitis following treatment with infliximab or ciclosporin: a systematic literature review.

This review aimed to compile all available published data on colectomy rates following treatment using infliximab or ciclosporin in adult ulcerative colitis patients and to analyse colectomy rates, timing to colectomy and postcolectomy mortality for each treatment. We systematically reviewed the literature after 1990 reporting colectomy rates in ulcerative colitis patients treated with infliximab or ciclosporin, excluding articles on paediatric patients, patients with indeterminate colitis or Crohn’s disease and bowel surgery not related to ulcerative colitis. We presented weighted mean colectomy rates and mortality rates. Cox’s regression was used to assess time to colectomy adjusting for colitis severity, patient age and sex. We tabulated 78 studies reporting on ciclosporin and/or infliximab and colectomy rates or postcolectomy mortality rates. Not all studies reported data in a standardized manner. Infliximab had a significantly lower colectomy rate than ciclosporin at 36 months when analysing all studies, studies directly comparing infliximab and ciclosporin and studies using severe colitis patients, but not at 3, 12 or 24 months. Severity and age were key indicators in the likelihood of undergoing colectomy after treatment. Postcolectomy mortality rates were less than 1.5% for both drugs. This review indicates that long-term colectomy rates following infliximab are significantly lower than ciclosporin in the longer term, and that postcolectomy mortality following infliximab and ciclosporin is very low. However, many key data items were missing from research articles, reducing our ability to establish with more confidence the actual impact of these two drugs on colectomy rates and postcolectomy mortality rates.

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.