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Objectives Having multiple long term health conditions (MLTCs), also known as multimorbidity, is becoming increasingly common as populations age. Understanding how clusters of diseases are likely to lead to other diseases and the effect of multimorbidity on healthcare resource use (HRU) will be of great importance as this trend continues. Approach Graph-based approaches, also called network analysis in the literature, have been used previously to study multimorbidity. The use of hypergraphs, which are generalisations of graphs where edges can connect to any number of nodes, and their application to the problem of understanding multimorbidity will be discussed. Analysis using hypergraphs was carried out using a population-scale cohort of people in the Secure Anonymised Information Linkage (SAIL) Databank to find the diseases and disease sets which are most important based on a measure of prevalence and measures of healthcare resource utilisation in secondary care. Results The most important sets of diseases based on the centrality of a hypergraph weighted by a measure of prevalence featured hypertension, and the most important was hypertension and diabetes. The most important sets of diseases based on the centrality of a hypergraph weighted by a measure of unplanned inpatient HRU were arrhythmia, heart failure and hypertension while for a measure of outpatient HRU the most important set of diseases was diabetes and hypertension. Conclusion Hypergraphs are very flexible and general mathematical objects and there is still a great deal of development that can be done to make them more useful in epidemiological settings and beyond.

ABSTRACT Objectives The secondary use of health data for public and private good raises complex questions of privacy and governance. Such questions are ill-suited to opinion polling where citizens must choose quickly with little information between multiple choice answers. This project aims to extend our knowledge about what control informed citizens would seek over health records after participating in a deliberative process. Approach Two citizens’ juries, of 17 citizens each, were convened; each jury was chosen to reflect national demographics, from a pool of almost 400 volunteers. Juries met separately over three days, to address the charge “To what extent should patients control access to patient records for secondary use?” Citizens heard from and questioned five expert witnesses (chosen either to inform the jury, or to air arguments for and against the secondary use of data), interspersed with opportunities to deliberate amongst themselves, using a range of tools including facilitated discussion and guided role-play. Jurors voted on a series of questions associated with the jury charge, giving their rationale. Individual views were polled at the beginning and end of the process against the jury charge. Results Thirty-three out of 34 jurors voted in support of the secondary use of data, with 24 wanting individuals to be able to opt-out and 6 favouring opt-in. Many jurors changed their opinion about who should get access to these records, with more people supporting wider information sharing by the end of day 3. When considering who should get access to data, the two juries had very similar rationales. Both thought that public benefit was a key justification for access. Jury 1 was more strongly supportive of sharing patient records for public benefit, whilst jury 2 was more cautious and sought to give patients more control. The questionnaire results suggest that over the course of three days a few people moved towards more patient control over patient records, but overall more people moved towards enabling greater sharing of health data for public benefit. Despite our endeavours to ensure otherwise, bias was reported by a few jurors, particularly regarding the impartiality of information from expert witnesses. Conclusion These findings illustrate that citizens often change their minds about complex policy questions when they become more informed about a public policy problem. It may also suggest that many, but not all, people become less sceptical about health data sharing as they become better informed of its benefits and risks.

ABSTRACT Objectives Electronic Health Records (EHRs) contain a wealth of routinely-collected data that could potentially be used to inform clinical decisions such as the choice between competing treatment regimens. Apart from structured data about diagnoses and biomarkers, these records often include unstructured data such as free-text medication prescriptions. Disjoint toolsets exist for structured and unstructured data, making it difficult to analyse datasets that comprise both structured and unstructured data. Representing free-text items in a structured and standardised format would enable their statistical analysis. The aim of this study was to develop a generic, analytical pipeline that integrates different tools for text analytics and statistical modelling, and to apply it to data from the UK Renal Registry (UKRR) to answer specific clinical and epidemiological questions on kidney transplant immune suppression. Approach The UKRR database comprises data from all renal units in England, Wales and Northern Ireland and consists of both structured and semi-structured data. Our workflow starts by using rules to extract medication regimen from free-text prescriptions, which is then automatically combined with structured patient's record. The data is then analysed for patterns of transplant immune suppression prescribing by specific centres across the UK. Results We have developed an analytical pipeline for improving concordance between unstructured and structured medical records, combining new and established text analysis and subsequence analysis tools. Results of the study are underway and will be presented at the conference. Conclusions We have developed new framework that integrates tools for text analytics and statistical modelling, to facilitate the analysis of mixed structured and unstructured data. Our analysis of the UKRR data will help to compare immune suppressive treatment regimens, identify best practice, and explore the associations between transplant medication and transplant outcomes.