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Olena Seminog

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UNAM Universidad Nacional Autónoma de México

National Scientific and Technical Research Council

National Institute Of Technology Kurukshetra

Politecnico di Milano

Antônio Waldir Cunha Da Silva

UFPR

Universidad Politécnica de Valencia

Arani Ilankuberan

Goldsmiths, University of London

André dos S. Domingues

UTFPR - UNIVERSIDADE TECNOLOGICA FEDERAL DO PARANÁ

Hœs Sam Båğhďæď

Université de JIJEL

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Papers by Olena Seminog

COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

The Lancet Digital Health

National record-linkage study of hospital admissions for schizophrenia in childhood and adolescence in England

European Child & Adolescent Psychiatry, 2021

Background There is a lack of information on changes in hospital admission rates for childhood-on... more Background There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was ...

Abstract T P138: Time Trends over Five Decades in Rates of Hospital Admission for Any Stroke and Stroke Subtypes in England

Stroke, 2014

Aim: To study 43 year trends in England in the rates of hospital admission for any stroke, and fo... more Aim: To study 43 year trends in England in the rates of hospital admission for any stroke, and for stroke subtypes divided into stroke that was coded as haemorrhagic, ischaemic or of undefined etiology. Methods: We analysed routine hospital statistics from the Hospital In-Patient Enquiry and Hospital Episode Statistics to estimate trends in hospital admissions for any stroke and the three stroke subtypes in England from 1968 to 2011. The rates were age-standardised and expressed per 100 000 population. Results: The study included 2 555 180 admissions for stroke. Annual admission rates for any stroke increased from 169.79 (95% CI 165.61-173.97) in 1968 to 272.4 (270.86-273.93) in 1993; and then started to decline to reach 196.58 (195.38-197.79) in 2011. Admission rates for haemorrhagic stroke declined from 30.40 (28.61-32.19) in 1968 to 15.07 (13.80-16. 34) in 1982, and then steadily increased to 44.65 (44.07-45.24) in 2011. Admission rates for ischaemic stroke halved between 1968 an...

Gout in patients with multiple sclerosis, Parkinson's disease and motor neurone disease: record-linkage studies

Sex difference in mortality rates for stroke and stroke subtypes in England 1995-2011

40-year perspective on trends in the risk of acute ischaemic stroke in patients hospitalised with atrial fibrillation: English record linkage studies

Cerebrovascular Diseases, 2013

Reflections on running an International Public Health Film Competition during the COVID-19 pandemic and implications for future film festivals

Journal of Communication in Healthcare, 2021

ABSTRACT The COVID-19 pandemic has had a substantial impact on the film industry in 2020. Films t... more ABSTRACT The COVID-19 pandemic has had a substantial impact on the film industry in 2020. Films that tell the story of the pandemic by giving independent commentaries are important to our understanding of life during these rare public health events. However, it is unclear what effects the pandemic would have on the production of these films. In this Letter we describe a unique global collaboration that saw the launch of an International Public Health Film Competition during the first wave of the pandemic in early 2020 to collect the ‘best health-related’ stories told through film. We reflect on the process followed for this competition and provide insights for future film competitions/ festivals.

Linked electronic health records for research on a nationwide cohort including over 54 million people in England

ABSTRACTObjectivesDescribe a new England-wide electronic health record (EHR) resource enabling wh... more ABSTRACTObjectivesDescribe a new England-wide electronic health record (EHR) resource enabling whole population research on Covid-19 and cardiovascular disease whilst ensuring data security and privacy and maintaining public trust.DesignCohort comprising linked person-level records from national healthcare settings for the English population accessible within NHS Digital’s new Trusted Research Environment.SettingEHRs from primary care, hospital episodes, death registry, Covid-19 laboratory test results and community dispensing data, with further enrichment planned from specialist intensive care, cardiovascular and Covid-19 vaccination data.Participants54.4 million people alive on 1st January 2020 and registered with an NHS general practitioner in England.Main measures of interestConfirmed and suspected Covid-19 diagnoses, exemplar cardiovascular conditions (incident stroke or transient ischaemic attack (TIA) and incident myocardial infarction (MI)) and all-cause mortality between 1s...

Age-specific risk of breast cancer in women with neurofibromatosis type 1

British Journal of Cancer, 2015

Background: Young women with neurofibromatosis type 1 (NF1) are reported to have a higher risk of... more Background: Young women with neurofibromatosis type 1 (NF1) are reported to have a higher risk of breast cancer than others, and this might have implications for screening programmes. Our aim was to calculate this risk. Methods: An all-England linked data set of hospital admissions and deaths was analysed to determine age-specific rates of breast cancer in women with NF1 and controls. The age-specific excess risk of breast cancer, comparing the NF1 cohort with the control cohort, was elevated 6.5-fold (95% confidence interval 2.6-13.5) in women aged 30-39 years. There was a 4.4 (2.5-7.0) times higher risk among women aged 40-49. Conclusions: Women with NF1 develop breast cancer at younger ages than the general population. We have previously reported on the risk of a wide range of cancer types in individuals with type 1 neurofibromatosis (NF1) in England . Among other findings of elevated risks of site-specific cancers, the study demonstrated high risk of breast cancer among women with NF1. We sought to provide a more detailed breakdown of the results by age at which women with NF1 were diagnosed with breast cancer. This information could be used to guide the development of clinical recommendations about an appropriate age at which to start inviting women with NF1 for breast cancer screening.

OP79 Trends over time in risk of ischaemic stroke and ischaemic heart disease in patients with diabetes mellitus in England

Journal of Epidemiology and Community Health, 2014

ABSTRACT Background Ischaemic stroke and ischaemic heart disease (IHD) are well known complicatio... more ABSTRACT Background Ischaemic stroke and ischaemic heart disease (IHD) are well known complications of diabetes mellitus (DM). It is assumed that better control of blood glycaemia would decrease the occurrence of these complications. In the general population of England the prevalence of DM is increasing and the incidence of stroke and IHD is declining. We were interested in determining whether the excess risk of ischaemic stroke and IHD in people with DM has declined over time. Methods We used English national linked Hospital Episode Statistics for 1999–2011. The outcomes of interest were hospitalisation and death from ischaemic stroke and IHD. We compared the rates of ischaemic stroke and IHD in the cohort of patients with DM with the rates in a diabetes-free control cohort. Results were expressed as a rate ratio (RR) standardised for age and for a range of other variables. RRs were calculated for each of the successive 4-year intervals. We selected cases based on ICD codes. The ICD 10 codes were E10-E14 for DM, I63 for ischaemic stroke, and I20-I25 for IHD. Only patients with a primary diagnosis of DM were included, to avoid case mix bias that might potentially arise from other co-morbidities. Results In total there were 5666 and 32,409 patients with a primary diagnosis of DM who developed ischaemic stroke or IHD, respectively. The RRs for subsequent ischaemic stroke in people with DM were 2.43 (95% CI 2.35–2.51) in 1999–2002, 2.38 (2.25–2.51) in 2003–2006, and 2.34 (2.14–2.54) in 2007–2011. RRs for IHD in people with DM were 2.63 (2.59–2.66) in 1999–2002, 2.37 (2.31–2.42) in 2003–2006, and 2.37 (2.28–2.47) in 2007–2011. Conclusion There was no decline in the excess risk, when compared to the control population, of ischaemic stroke in patients with DM over the last 13 years. A modest decline was observed in the excess risk of IHD between 1999–2002 and 2003–2006, but this improvement has not continued in recent years. These findings show that diabetes remains an important risk factor for stroke and IHD. They suggest that there were no major improvements in preventing these complications of DM at a population level in England.

First International Public Health Film Competition 2016-reflections on the development and use of competition judging criteria

Journal of public health (Oxford, England), Jan 25, 2017

Film competitions can be a helpful method to understand issues of quality in health films. In thi... more Film competitions can be a helpful method to understand issues of quality in health films. In this paper, we describe the development and use of explicit quality criteria to identify the 'best' films for the first ever international public health film competition. A film selection committee encompassing a range of stakeholders was compiled. The committee drew up 10 explicit quality criteria to judge films drawing upon other film festival's selection criteria. These criteria were then applied to a broad range of health-related films entered into a film competition to select the 'best' film to screen. Eighty-four films from 20 different countries were submitted to the public health film competition. The originality of the subject covered by the film, the public health importance of the issue and story-telling approach in the film were found to be the most discriminatory criteria to select films. Selection of health films for festivals can be undertaken using explic...

Risk of individual malignant neoplasms in patients with sickle cell disease: English national record linkage study

Journal of the Royal Society of Medicine, 2016

Objective Case reports suggest that there may be an increased risk of some cancers associated wit... more Objective Case reports suggest that there may be an increased risk of some cancers associated with sickle cell disease. However, population-based studies are scarce and there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this. Design We used an English national dataset of linked statistical records of hospital admissions and deaths from 1999 to 2011 to undertake a retrospective cohort study. Setting England. Participants Records of all hospital admissions in England with SCD or with conditions included in the control cohort. Main outcome measures Rate ratios were calculated comparing rates of cancer in a sickle cell disease cohort and a control cohort, confining the analyses to people whose ethnicity was recorded as Black. Results Comparing the sickle cell disease cohort with the cohort without sickle cell disease, the rate ratio for all cancers combined was 2.1 (95% confidence interval 1.7–2.5). There were signi...

Clinical associations between gout and multiple sclerosis, Parkinson's disease and motor neuron disease: record-linkage studies

BMC neurology, Jan 28, 2015

Uric acid has antioxidant effects on neurons. Abnormally high levels of uric acid are, however, a... more Uric acid has antioxidant effects on neurons. Abnormally high levels of uric acid are, however, associated with gout. Previous studies have suggested that high levels of uric acid (and the presence of gout) may exert a protective effect against the risk of developing some neurological diseases. We aimed to investigate this hypothesis in a large database of hospital admissions in England. We analysed a database of linked statistical records of hospital admissions and death registrations in England (1999-2012). A cohort of people with gout was constructed and followed for development of multiple sclerosis (MS), Parkinson's disease (PD) or motor neuron disease (MND). Then, conversely, cohorts of all people in the database with MS, PD or MND were constructed and followed for subsequent gout. Rate ratios (RRs) were determined, comparing these cohorts with people in a reference cohort. In the gout cohort, we observed a modest elevation of the overall risk of subsequent MS, PD and MND ...

Associations between Klinefelter's syndrome and autoimmune diseases: English national record linkage studies

Autoimmunity, 2015

There are reports suggesting that people with Klinefelter's syndrome (KS) may be at increased... more There are reports suggesting that people with Klinefelter's syndrome (KS) may be at increased risk of some autoimmune diseases, but the evidence is not substantial. We wanted to add to the evidence by systematically assessing the risk of autoimmune diseases in a national cohort of people with KS. We selected records of all people with KS in a record-linked dataset of all hospital day cases and inpatient admissions in England, 1999-2011; and we followed them up by electronic record linkage to identify the occurrence of autoimmune diseases. We compared their occurrence in the KS cohort with a control cohort, studied in the same way, and expressed the results as rate ratios (RR). Of 30 autoimmune diseases studied in people with KS, there were significantly increased risks of seven-Addison's disease (RR 11.7, 95% confidence interval 2.4-34.4), diabetes mellitus type 1 (6.1, 4.4-8.3), multiple sclerosis (4.3, 1.2-11.0), acquired hypothyroidism (2.7, 1.8-4.0), rheumatoid arthritis...

Risk of benign tumours of nervous system, and of malignant neoplasms, in people with neurofibromatosis: population-based record-linkage study

British journal of cancer, Jan 15, 2013

The neurofibromatoses (NF) are genetic disorders. Increased risks of some cancers in people with ... more The neurofibromatoses (NF) are genetic disorders. Increased risks of some cancers in people with NF are well recognised, but there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this. A linked data set of hospital admissions and deaths in England was used to compare rates of tumours in an NF cohort with rates in a comparison cohort, with results expressed as rate ratios (RR). The RR for all cancers combined, in people with both types of NF combined, was 4.3 (95% confidence interval (CI): 4.0-4.6), based on 769 cases of cancer in 8003 people with NF. Considering only people with presumed NF1 (as defined in the main article), the RR for all cancers excluding nervous system malignancies remained elevated (2.7, 95% CI: 2.4-2.9); and risks were significantly high for cancer of the oesophagus (3.3), stomach (2.8), colon (2.0), liver (3.8), lung (3.0), bone (19.6), thyroid (4.9), malignant melanoma (3.6), non-Hodgkin&#39...

Risk of venous thromboembolism after hospitalisation with cancer: record linkage study

Thrombosis Research, 2012

Gout as a risk factor for myocardial infarction and stroke in England: evidence from record linkage studies

Rheumatology, 2013

Objective. Some studies suggest that gout is a risk factor for cardiovascular disease. There is m... more Objective. Some studies suggest that gout is a risk factor for cardiovascular disease. There is more evidence about the association between gout and acute myocardial infarction (MI) than about gout and stroke, and only limited information about risks by age group and sex. We aimed to study MI and stroke following gout, including types of stroke, by age group and comparing men and women. Methods. We analysed an all-England national linked dataset of hospital admissions and death records from 1999 to 2011, and a similar dataset in the Oxford Record Linkage Study spanning 196398. The occurrence of MI and stroke was estimated in cohorts of patients admitted to hospital with gout, compared with MI and stroke in control cohorts, and the comparisons were expressed as rate ratios (RRs). Results. The risk of MI and stroke was elevated, and similar, in both datasets. In the all-England dataset, which included 202 033 hospital patients with gout, the RR for MI following gout was 1.82 (95% CI 1.78, 1.85), for all stroke 1.71 (1.68, 1.75), ischaemic stroke 1.68 (1.64, 1.73), haemorrhagic stroke 1.69 (1.61, 1.77) and stroke of unspecified type 2.00 (1.95, 2.06). Associations were stronger in younger than older age groups, and in the younger were stronger in women than men. Gout was associated with increased risk of stroke as well as MI. These findings should be considered by clinicians and may have implications for preventive management of circulatory disease risks in people with gout.

Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage

Journal of the Royal Society of Medicine, 2014

BackgroundPsychiatric illnesses are known risk factors for self-harm but associations between sel... more BackgroundPsychiatric illnesses are known risk factors for self-harm but associations between self-harm and physical illnesses are less well established. We aimed to stratify selected chronic physical and psychiatric illnesses according to their relative risk of self-harm.DesignRetrospective cohort studies using a linked dataset of Hospital Episode Statistics (HES) for 1999–2011.ParticipantsIndividuals with selected psychiatric or physical conditions were compared with a reference cohort constructed from patients admitted for a variety of other conditions and procedures.SettingAll admissions and day cases in National Health Service (NHS) hospitals in England.Main outcome measuresHospital episodes of self-harm. Rate ratios (RRs) were derived by comparing admission for self-harm between cohorts.ResultsThe psychiatric illnesses studied (depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia and substance abuse) all had very high RRs (> 5) for...

The Effect of Hospital Admission Day on Mortality from Myocardial Infarction in England: A National Record Linkage Study

Journal of the American College of Cardiology, 2014

background: There are concerns that quality of medical care and availability of medical procedure... more background: There are concerns that quality of medical care and availability of medical procedures may vary between weekdays and weekends. Acute myocardial infarction (AMI) is a life-threatening condition, which requires urgent specialized care and, potentially, invasive procedures. The specialized care and invasive procedures may not be equivalently available on weekends and weekdays, which may affect mortality from AMI. We tested the hypothesis that case fatality rates (CFRs) within 30 days from hospital admission for AMI did not differ between weekend and weekday admissions. methods: The National Health Service (NHS) provides health-care for all residents of England. We used datasets of English National Hospital Episode Statistics (HES) and mortality records supplied by, respectively, the NHS Information Centre and the Office for National Statistics. Linkage between the datasets was done using encrypted values of the unique HES identifier and of the unique NHS number supplemented with encrypted values of the patients' date of birth and postcode. We used the hospital admission and mortality data for England from 2001 to 2011 to calculate 30-day CFRs. We used chi-squared statistics to compare categorical variables and to test for statistical significance. We set the level of statistical significance at 0.01. Logistic regression analysis was used to quantify the effects of age, year of admission and day of the week of admission on the CFR. Statistical tests were carried out in SPSS Statistics version 20 for Windows. The study comprised 633 388 people. In patients admitted with AMI, CFRs for weekday and weekend admissions did not differ significantly: they were 13.3% (62 088/468 433) on weekdays and 13.4% (22 070/164 955) on weekends, P-value=0.2. CFR on weekdays and weekends did not differ by year of admission. Conclusions: Overall, there was no evidence of a "weekend effect" on CFRs in patients hospitalized with AMI in England in 2001-2011. This indicates that the delivery of NHS care, at least in respect of CFRs for AMI in the period studied, was as effective for weekend as for weekday admissions.

OP28 Trends in Mortality from Stroke, and Stroke Subtypes, in the Oxford Region 1979-2011

Journal of Epidemiology & Community Health, 2013

Background A decline in mortality rates from stroke has been observed in many industrialised coun... more Background A decline in mortality rates from stroke has been observed in many industrialised countries in recent decades. We were interested in whether any of the observed decline in stroke, and its subtypes, might be artefactual rather than real. In particular, we wanted to determine whether any of the trends over time might be attributable to shifts in death certification practice between underlying cause and contributory cause, and/or shifts over time between certification of specific subtypes (haemorrhagic and ischaemic stroke) and stroke without specification of type. Methods We analysed mortality data from the former Oxford NHS region 1979–2011. This has a longer run of multiple-cause coded mortality data than all-England mortality (though findings from the latter will also be shown). We calculated age-standardised rates, presented as mortality rates per million population, in each year from 1979–2011 and in grouped years for periods defined by national changes to the rules for selection of underlying cause (the rules changed in 1984, 1992 and 2001). Results Mortality rates based on any mention of stroke on the death certificate, and on underlying cause, showed broadly similar trends. Mortality rates for each code for stroke – ischaemic, haemorrhagic and ‘unspecified’ – and for stroke overall fell at a broadly similar rate between 1979–1992. Thereafter, trends diverged. The average annual rate for mortality in men from ischaemic stroke in 2001–2011, at 72.7 per million, was 11% lower than that in 1993–2000 at 84.2. The corresponding rates for haemorrhagic stroke were 93.6 and 92.7, i.e. they did not fall at all. By contrast, the average annual rate for stroke ‘unspecified’ in men was 355.9 in 2001–11 which was 56% lower than the rate of 600.8 in 1993–2000. Stroke mortality, overall, fell from 768.1 to 504.5 between 1993–2000 and 2001–2011. In recent years, when national multiple-cause coding data were available, national trends were similar to those in Oxford in these respects. Rates for women will also be shown (they exhibited the same pattern). Conclusion There have been substantial changes in certification practice with a shift in recent years away from specifying stroke type. Studies of trends in mortality from ischaemic stroke alone, or haemorrhagic stroke alone, without being put into the broader context of all stroke, would be seriously misleading. They would suggest a levelling off of the decline in ischaemic and haemorrhagic stroke mortality in recent years which is, in fact, an artefact of certification and coding practice.

COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

The Lancet Digital Health

National record-linkage study of hospital admissions for schizophrenia in childhood and adolescence in England

European Child & Adolescent Psychiatry, 2021

Background There is a lack of information on changes in hospital admission rates for childhood-on... more Background There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was ...

Abstract T P138: Time Trends over Five Decades in Rates of Hospital Admission for Any Stroke and Stroke Subtypes in England

Stroke, 2014

Aim: To study 43 year trends in England in the rates of hospital admission for any stroke, and fo... more Aim: To study 43 year trends in England in the rates of hospital admission for any stroke, and for stroke subtypes divided into stroke that was coded as haemorrhagic, ischaemic or of undefined etiology. Methods: We analysed routine hospital statistics from the Hospital In-Patient Enquiry and Hospital Episode Statistics to estimate trends in hospital admissions for any stroke and the three stroke subtypes in England from 1968 to 2011. The rates were age-standardised and expressed per 100 000 population. Results: The study included 2 555 180 admissions for stroke. Annual admission rates for any stroke increased from 169.79 (95% CI 165.61-173.97) in 1968 to 272.4 (270.86-273.93) in 1993; and then started to decline to reach 196.58 (195.38-197.79) in 2011. Admission rates for haemorrhagic stroke declined from 30.40 (28.61-32.19) in 1968 to 15.07 (13.80-16. 34) in 1982, and then steadily increased to 44.65 (44.07-45.24) in 2011. Admission rates for ischaemic stroke halved between 1968 an...

Gout in patients with multiple sclerosis, Parkinson's disease and motor neurone disease: record-linkage studies

Sex difference in mortality rates for stroke and stroke subtypes in England 1995-2011

40-year perspective on trends in the risk of acute ischaemic stroke in patients hospitalised with atrial fibrillation: English record linkage studies

Cerebrovascular Diseases, 2013

Reflections on running an International Public Health Film Competition during the COVID-19 pandemic and implications for future film festivals

Journal of Communication in Healthcare, 2021

ABSTRACT The COVID-19 pandemic has had a substantial impact on the film industry in 2020. Films t... more ABSTRACT The COVID-19 pandemic has had a substantial impact on the film industry in 2020. Films that tell the story of the pandemic by giving independent commentaries are important to our understanding of life during these rare public health events. However, it is unclear what effects the pandemic would have on the production of these films. In this Letter we describe a unique global collaboration that saw the launch of an International Public Health Film Competition during the first wave of the pandemic in early 2020 to collect the ‘best health-related’ stories told through film. We reflect on the process followed for this competition and provide insights for future film competitions/ festivals.

Linked electronic health records for research on a nationwide cohort including over 54 million people in England

ABSTRACTObjectivesDescribe a new England-wide electronic health record (EHR) resource enabling wh... more ABSTRACTObjectivesDescribe a new England-wide electronic health record (EHR) resource enabling whole population research on Covid-19 and cardiovascular disease whilst ensuring data security and privacy and maintaining public trust.DesignCohort comprising linked person-level records from national healthcare settings for the English population accessible within NHS Digital’s new Trusted Research Environment.SettingEHRs from primary care, hospital episodes, death registry, Covid-19 laboratory test results and community dispensing data, with further enrichment planned from specialist intensive care, cardiovascular and Covid-19 vaccination data.Participants54.4 million people alive on 1st January 2020 and registered with an NHS general practitioner in England.Main measures of interestConfirmed and suspected Covid-19 diagnoses, exemplar cardiovascular conditions (incident stroke or transient ischaemic attack (TIA) and incident myocardial infarction (MI)) and all-cause mortality between 1s...

Age-specific risk of breast cancer in women with neurofibromatosis type 1

British Journal of Cancer, 2015

Background: Young women with neurofibromatosis type 1 (NF1) are reported to have a higher risk of... more Background: Young women with neurofibromatosis type 1 (NF1) are reported to have a higher risk of breast cancer than others, and this might have implications for screening programmes. Our aim was to calculate this risk. Methods: An all-England linked data set of hospital admissions and deaths was analysed to determine age-specific rates of breast cancer in women with NF1 and controls. The age-specific excess risk of breast cancer, comparing the NF1 cohort with the control cohort, was elevated 6.5-fold (95% confidence interval 2.6-13.5) in women aged 30-39 years. There was a 4.4 (2.5-7.0) times higher risk among women aged 40-49. Conclusions: Women with NF1 develop breast cancer at younger ages than the general population. We have previously reported on the risk of a wide range of cancer types in individuals with type 1 neurofibromatosis (NF1) in England . Among other findings of elevated risks of site-specific cancers, the study demonstrated high risk of breast cancer among women with NF1. We sought to provide a more detailed breakdown of the results by age at which women with NF1 were diagnosed with breast cancer. This information could be used to guide the development of clinical recommendations about an appropriate age at which to start inviting women with NF1 for breast cancer screening.

OP79 Trends over time in risk of ischaemic stroke and ischaemic heart disease in patients with diabetes mellitus in England

Journal of Epidemiology and Community Health, 2014

ABSTRACT Background Ischaemic stroke and ischaemic heart disease (IHD) are well known complicatio... more ABSTRACT Background Ischaemic stroke and ischaemic heart disease (IHD) are well known complications of diabetes mellitus (DM). It is assumed that better control of blood glycaemia would decrease the occurrence of these complications. In the general population of England the prevalence of DM is increasing and the incidence of stroke and IHD is declining. We were interested in determining whether the excess risk of ischaemic stroke and IHD in people with DM has declined over time. Methods We used English national linked Hospital Episode Statistics for 1999–2011. The outcomes of interest were hospitalisation and death from ischaemic stroke and IHD. We compared the rates of ischaemic stroke and IHD in the cohort of patients with DM with the rates in a diabetes-free control cohort. Results were expressed as a rate ratio (RR) standardised for age and for a range of other variables. RRs were calculated for each of the successive 4-year intervals. We selected cases based on ICD codes. The ICD 10 codes were E10-E14 for DM, I63 for ischaemic stroke, and I20-I25 for IHD. Only patients with a primary diagnosis of DM were included, to avoid case mix bias that might potentially arise from other co-morbidities. Results In total there were 5666 and 32,409 patients with a primary diagnosis of DM who developed ischaemic stroke or IHD, respectively. The RRs for subsequent ischaemic stroke in people with DM were 2.43 (95% CI 2.35–2.51) in 1999–2002, 2.38 (2.25–2.51) in 2003–2006, and 2.34 (2.14–2.54) in 2007–2011. RRs for IHD in people with DM were 2.63 (2.59–2.66) in 1999–2002, 2.37 (2.31–2.42) in 2003–2006, and 2.37 (2.28–2.47) in 2007–2011. Conclusion There was no decline in the excess risk, when compared to the control population, of ischaemic stroke in patients with DM over the last 13 years. A modest decline was observed in the excess risk of IHD between 1999–2002 and 2003–2006, but this improvement has not continued in recent years. These findings show that diabetes remains an important risk factor for stroke and IHD. They suggest that there were no major improvements in preventing these complications of DM at a population level in England.

First International Public Health Film Competition 2016-reflections on the development and use of competition judging criteria

Journal of public health (Oxford, England), Jan 25, 2017

Film competitions can be a helpful method to understand issues of quality in health films. In thi... more Film competitions can be a helpful method to understand issues of quality in health films. In this paper, we describe the development and use of explicit quality criteria to identify the 'best' films for the first ever international public health film competition. A film selection committee encompassing a range of stakeholders was compiled. The committee drew up 10 explicit quality criteria to judge films drawing upon other film festival's selection criteria. These criteria were then applied to a broad range of health-related films entered into a film competition to select the 'best' film to screen. Eighty-four films from 20 different countries were submitted to the public health film competition. The originality of the subject covered by the film, the public health importance of the issue and story-telling approach in the film were found to be the most discriminatory criteria to select films. Selection of health films for festivals can be undertaken using explic...

Risk of individual malignant neoplasms in patients with sickle cell disease: English national record linkage study

Journal of the Royal Society of Medicine, 2016

Objective Case reports suggest that there may be an increased risk of some cancers associated wit... more Objective Case reports suggest that there may be an increased risk of some cancers associated with sickle cell disease. However, population-based studies are scarce and there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this. Design We used an English national dataset of linked statistical records of hospital admissions and deaths from 1999 to 2011 to undertake a retrospective cohort study. Setting England. Participants Records of all hospital admissions in England with SCD or with conditions included in the control cohort. Main outcome measures Rate ratios were calculated comparing rates of cancer in a sickle cell disease cohort and a control cohort, confining the analyses to people whose ethnicity was recorded as Black. Results Comparing the sickle cell disease cohort with the cohort without sickle cell disease, the rate ratio for all cancers combined was 2.1 (95% confidence interval 1.7–2.5). There were signi...

Clinical associations between gout and multiple sclerosis, Parkinson's disease and motor neuron disease: record-linkage studies

BMC neurology, Jan 28, 2015

Uric acid has antioxidant effects on neurons. Abnormally high levels of uric acid are, however, a... more Uric acid has antioxidant effects on neurons. Abnormally high levels of uric acid are, however, associated with gout. Previous studies have suggested that high levels of uric acid (and the presence of gout) may exert a protective effect against the risk of developing some neurological diseases. We aimed to investigate this hypothesis in a large database of hospital admissions in England. We analysed a database of linked statistical records of hospital admissions and death registrations in England (1999-2012). A cohort of people with gout was constructed and followed for development of multiple sclerosis (MS), Parkinson's disease (PD) or motor neuron disease (MND). Then, conversely, cohorts of all people in the database with MS, PD or MND were constructed and followed for subsequent gout. Rate ratios (RRs) were determined, comparing these cohorts with people in a reference cohort. In the gout cohort, we observed a modest elevation of the overall risk of subsequent MS, PD and MND ...

Associations between Klinefelter's syndrome and autoimmune diseases: English national record linkage studies

Autoimmunity, 2015

There are reports suggesting that people with Klinefelter's syndrome (KS) may be at increased... more There are reports suggesting that people with Klinefelter's syndrome (KS) may be at increased risk of some autoimmune diseases, but the evidence is not substantial. We wanted to add to the evidence by systematically assessing the risk of autoimmune diseases in a national cohort of people with KS. We selected records of all people with KS in a record-linked dataset of all hospital day cases and inpatient admissions in England, 1999-2011; and we followed them up by electronic record linkage to identify the occurrence of autoimmune diseases. We compared their occurrence in the KS cohort with a control cohort, studied in the same way, and expressed the results as rate ratios (RR). Of 30 autoimmune diseases studied in people with KS, there were significantly increased risks of seven-Addison's disease (RR 11.7, 95% confidence interval 2.4-34.4), diabetes mellitus type 1 (6.1, 4.4-8.3), multiple sclerosis (4.3, 1.2-11.0), acquired hypothyroidism (2.7, 1.8-4.0), rheumatoid arthritis...

Risk of benign tumours of nervous system, and of malignant neoplasms, in people with neurofibromatosis: population-based record-linkage study

British journal of cancer, Jan 15, 2013

The neurofibromatoses (NF) are genetic disorders. Increased risks of some cancers in people with ... more The neurofibromatoses (NF) are genetic disorders. Increased risks of some cancers in people with NF are well recognised, but there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this. A linked data set of hospital admissions and deaths in England was used to compare rates of tumours in an NF cohort with rates in a comparison cohort, with results expressed as rate ratios (RR). The RR for all cancers combined, in people with both types of NF combined, was 4.3 (95% confidence interval (CI): 4.0-4.6), based on 769 cases of cancer in 8003 people with NF. Considering only people with presumed NF1 (as defined in the main article), the RR for all cancers excluding nervous system malignancies remained elevated (2.7, 95% CI: 2.4-2.9); and risks were significantly high for cancer of the oesophagus (3.3), stomach (2.8), colon (2.0), liver (3.8), lung (3.0), bone (19.6), thyroid (4.9), malignant melanoma (3.6), non-Hodgkin&#39...

Risk of venous thromboembolism after hospitalisation with cancer: record linkage study

Thrombosis Research, 2012

Gout as a risk factor for myocardial infarction and stroke in England: evidence from record linkage studies

Rheumatology, 2013

Objective. Some studies suggest that gout is a risk factor for cardiovascular disease. There is m... more Objective. Some studies suggest that gout is a risk factor for cardiovascular disease. There is more evidence about the association between gout and acute myocardial infarction (MI) than about gout and stroke, and only limited information about risks by age group and sex. We aimed to study MI and stroke following gout, including types of stroke, by age group and comparing men and women. Methods. We analysed an all-England national linked dataset of hospital admissions and death records from 1999 to 2011, and a similar dataset in the Oxford Record Linkage Study spanning 196398. The occurrence of MI and stroke was estimated in cohorts of patients admitted to hospital with gout, compared with MI and stroke in control cohorts, and the comparisons were expressed as rate ratios (RRs). Results. The risk of MI and stroke was elevated, and similar, in both datasets. In the all-England dataset, which included 202 033 hospital patients with gout, the RR for MI following gout was 1.82 (95% CI 1.78, 1.85), for all stroke 1.71 (1.68, 1.75), ischaemic stroke 1.68 (1.64, 1.73), haemorrhagic stroke 1.69 (1.61, 1.77) and stroke of unspecified type 2.00 (1.95, 2.06). Associations were stronger in younger than older age groups, and in the younger were stronger in women than men. Gout was associated with increased risk of stroke as well as MI. These findings should be considered by clinicians and may have implications for preventive management of circulatory disease risks in people with gout.

Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage

Journal of the Royal Society of Medicine, 2014

BackgroundPsychiatric illnesses are known risk factors for self-harm but associations between sel... more BackgroundPsychiatric illnesses are known risk factors for self-harm but associations between self-harm and physical illnesses are less well established. We aimed to stratify selected chronic physical and psychiatric illnesses according to their relative risk of self-harm.DesignRetrospective cohort studies using a linked dataset of Hospital Episode Statistics (HES) for 1999–2011.ParticipantsIndividuals with selected psychiatric or physical conditions were compared with a reference cohort constructed from patients admitted for a variety of other conditions and procedures.SettingAll admissions and day cases in National Health Service (NHS) hospitals in England.Main outcome measuresHospital episodes of self-harm. Rate ratios (RRs) were derived by comparing admission for self-harm between cohorts.ResultsThe psychiatric illnesses studied (depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia and substance abuse) all had very high RRs (> 5) for...

The Effect of Hospital Admission Day on Mortality from Myocardial Infarction in England: A National Record Linkage Study

Journal of the American College of Cardiology, 2014

background: There are concerns that quality of medical care and availability of medical procedure... more background: There are concerns that quality of medical care and availability of medical procedures may vary between weekdays and weekends. Acute myocardial infarction (AMI) is a life-threatening condition, which requires urgent specialized care and, potentially, invasive procedures. The specialized care and invasive procedures may not be equivalently available on weekends and weekdays, which may affect mortality from AMI. We tested the hypothesis that case fatality rates (CFRs) within 30 days from hospital admission for AMI did not differ between weekend and weekday admissions. methods: The National Health Service (NHS) provides health-care for all residents of England. We used datasets of English National Hospital Episode Statistics (HES) and mortality records supplied by, respectively, the NHS Information Centre and the Office for National Statistics. Linkage between the datasets was done using encrypted values of the unique HES identifier and of the unique NHS number supplemented with encrypted values of the patients' date of birth and postcode. We used the hospital admission and mortality data for England from 2001 to 2011 to calculate 30-day CFRs. We used chi-squared statistics to compare categorical variables and to test for statistical significance. We set the level of statistical significance at 0.01. Logistic regression analysis was used to quantify the effects of age, year of admission and day of the week of admission on the CFR. Statistical tests were carried out in SPSS Statistics version 20 for Windows. The study comprised 633 388 people. In patients admitted with AMI, CFRs for weekday and weekend admissions did not differ significantly: they were 13.3% (62 088/468 433) on weekdays and 13.4% (22 070/164 955) on weekends, P-value=0.2. CFR on weekdays and weekends did not differ by year of admission. Conclusions: Overall, there was no evidence of a "weekend effect" on CFRs in patients hospitalized with AMI in England in 2001-2011. This indicates that the delivery of NHS care, at least in respect of CFRs for AMI in the period studied, was as effective for weekend as for weekday admissions.

OP28 Trends in Mortality from Stroke, and Stroke Subtypes, in the Oxford Region 1979-2011

Journal of Epidemiology & Community Health, 2013

Background A decline in mortality rates from stroke has been observed in many industrialised coun... more Background A decline in mortality rates from stroke has been observed in many industrialised countries in recent decades. We were interested in whether any of the observed decline in stroke, and its subtypes, might be artefactual rather than real. In particular, we wanted to determine whether any of the trends over time might be attributable to shifts in death certification practice between underlying cause and contributory cause, and/or shifts over time between certification of specific subtypes (haemorrhagic and ischaemic stroke) and stroke without specification of type. Methods We analysed mortality data from the former Oxford NHS region 1979–2011. This has a longer run of multiple-cause coded mortality data than all-England mortality (though findings from the latter will also be shown). We calculated age-standardised rates, presented as mortality rates per million population, in each year from 1979–2011 and in grouped years for periods defined by national changes to the rules for selection of underlying cause (the rules changed in 1984, 1992 and 2001). Results Mortality rates based on any mention of stroke on the death certificate, and on underlying cause, showed broadly similar trends. Mortality rates for each code for stroke – ischaemic, haemorrhagic and ‘unspecified’ – and for stroke overall fell at a broadly similar rate between 1979–1992. Thereafter, trends diverged. The average annual rate for mortality in men from ischaemic stroke in 2001–2011, at 72.7 per million, was 11% lower than that in 1993–2000 at 84.2. The corresponding rates for haemorrhagic stroke were 93.6 and 92.7, i.e. they did not fall at all. By contrast, the average annual rate for stroke ‘unspecified’ in men was 355.9 in 2001–11 which was 56% lower than the rate of 600.8 in 1993–2000. Stroke mortality, overall, fell from 768.1 to 504.5 between 1993–2000 and 2001–2011. In recent years, when national multiple-cause coding data were available, national trends were similar to those in Oxford in these respects. Rates for women will also be shown (they exhibited the same pattern). Conclusion There have been substantial changes in certification practice with a shift in recent years away from specifying stroke type. Studies of trends in mortality from ischaemic stroke alone, or haemorrhagic stroke alone, without being put into the broader context of all stroke, would be seriously misleading. They would suggest a levelling off of the decline in ischaemic and haemorrhagic stroke mortality in recent years which is, in fact, an artefact of certification and coding practice.