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1. Clinical coding of long COVID in primary care 2020–2023 in a cohort of 19 million adults: an OpenSAFELY analysis

Author

Walker, Alex, Green, Amelia, Mehrkar, Amir, Schaffer, Andrea, Brown, Andrew, Goldacre, Ben, Butler-Cole, Ben, MacKenna, Brian, Morton, Caroline, Walters, Caroline, Stables, Catherine, Cunningham, Christine, Wood, Christopher, Andrews, Colm, Evans, David, Hickman, George, Curtis, Helen, Drysdale, Henry, Dillingham, Iain, Morley, Jessica, Massey, Jon, Nab, Linda, Hopcroft, Lisa, Fisher, Louis, Bridges, Lucy, Wiedemann, Milan, DeVito, Nicholas, Macdonald, Orla, Inglesby, Peter, Smith, Rebecca, Croker, Richard, Park, Robin, Higgins, Rose, Bacon, Sebastian, Davy, Simon, Maude, Steven, O'Dwyer, Thomas, Ward, Tom, Speed, Victoria, Hulme, William, Hart, Liam, Stokes, Pete, Bhaskaran, Krishnan, Costello, Ruth, Cowling, Thomas, Douglas, Ian, Eggo, Rosalind, Evans, Stephen, Forbes, Harriet, Grieve, Richard, Grint, Daniel, Herrett, Emily, Langan, Sinead, Mahalingasivam, Viyaasan, Mansfield, Kathryn, Mathur, Rohini, McDonald, Helen, Parker, Edward, Rentsch, Christopher, Schultze, Anna, Smeeth, Liam, Tazare, John, Tomlinson, Laurie, Walker, Jemma, Williamson, Elizabeth, Wing, Kevin, Wong, Angel, Zheng, Bang, Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O'Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Griffiths, Paul, Fowles, Aaron, Parkes, Nasreen, Perera, Rafael, Harrison, David, Khunti, Kamlesh, Sterne, Jonathan, Quint, Jennifer, Henderson, Alasdair D., Butler-Cole, Ben FC., Tomlinson, Laurie A., Marks, Michael, Jit, Mark, Briggs, Andrew, Lin, Liang-Yu, Carlile, Oliver, Bates, Chris, Bacon, Sebastian CJ., Dennison, William A., Costello, Ruth E., Wei, Yinghui, Walker, Alex J., and Eggo, Rosalind M.

Published
2024
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2. Impact of long COVID on health-related quality-of-life: an OpenSAFELY population cohort study using patient-reported outcome measures (OpenPROMPT)

Author

Walker, Alex, Green, Amelia, Mehrkar, Amir, Schaffer, Andrea, Brown, Andrew, Goldacre, Ben, Butler-Cole, Ben, MacKenna, Brian, Morton, Caroline, Walters, Caroline, Stables, Catherine, Cunningham, Christine, Wood, Christopher, Andrews, Colm, Evans, David, Hickman, George, Curtis, Helen, Drysdale, Henry, Dillingham, Iain, Morley, Jessica, Massey, Jon, Nab, Linda, Hopcroft, Lisa, Fisher, Louis, Bridges, Lucy, Wiedemann, Milan, DeVito, Nicholas, Macdonald, Orla, Inglesby, Peter, Smith, Rebecca, Croker, Richard, Park, Robin, Higgins, Rose, Bacon, Sebastian, Davy, Simon, Maude, Steven, O'Dwyer, Thomas, Ward, Tom, Speed, Victoria, Hulme, William, Hart, Liam, Stokes, Pete, Bhaskaran, Krishnan, Costello, Ruth, Cowling, Thomas, Douglas, Ian, Eggo, Rosalind, Evans, Stephen, Forbes, Harriet, Grieve, Richard, Grint, Daniel, Herrett, Emily, Langan, Sinead, Mahalingasivam, Viyaasan, Mansfield, Kathryn, Mathur, Rohini, McDonald, Helen, Parker, Edward, Rentsch, Christopher, Schultze, Anna, Smeeth, Liam, Tazare, John, Tomlinson, Laurie, Walker, Jemma, Williamson, Elizabeth, Wing, Kevin, Wong, Angel, Zheng, Bang, Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O'Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Griffiths, Paul, Fowles, Aaron, Parkes, Nasreen, Perera, Rafael, Harrison, David, Khunti, Kamlesh, Sterne, Jonathan, Quint, Jennifer, Carlile, Oliver, Briggs, Andrew, Henderson, Alasdair D., Butler-Cole, Ben F.C., Tomlinson, Laurie A., Marks, Michael, Jit, Mark, Lin, Liang-Yu, Bates, Chris, Bacon, Sebastian C.J., Dennison, William A., Costello, Ruth E., Walker, Alex J., and Eggo, Rosalind M.

Published
2024
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3. Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people

Author

Al Arab, Marwa, Almaghrabi, Fatima, Andrews, Colm, Badrick, Ellena, Baz, Sarah, Beckford, Chelsea, Berman, Samantha, Bolton, Tom, Booth, Charlotte, Bowyer, Ruth, Boyd, Andy, Bridger-Staatz, Charis, Brophy, Sinead, Campbell, Archie, Campbell, Kirsteen C, Carnemolla, Alisia, Carpentieri, Jd, Cezard, Genevieve, Chaturvedi, Nishi, Cheetham, Nathan, Costello, Ruth, Cowling, Thomas, Crane, Matthew, Cuitun Coronado, Jose Ignacio, Curtis, Helen, Denaxas, Spiros, Denholm, Rachel, Di Gessa, Giorgio, Dobson, Richard, Douglas, Ian, Evans, Katharine M, Fang, Chao, Ferreira, Vanessa, Finnigan, Lucy, Fisher, Louis, Flaig, Robin, Folarin, Amos, Forbes, Harriet, Foster, Diane, Fox, Laura, Freydin, Maxim, Garcia, Paz, Gibson, Andy, Glen, Fiona, Goldacre, Ben, Goncalves Soares, Ana, Greaves, Felix, Green, Amelia, Green, Mark, Green, Michael, Griffith, Gareth, Hamill Howes, Lee, Hamilton, Olivia, Herbet, Annie, Herrett, Emily, Hopcroft, Lisa, Horne, Elsie, Hou, Bo, Hughes, Alun, Hulme, William, Huntley, Lizzie, Ip, Samantha, Jacques, Wels, Jezzard, Peter, Jones, Louise, Kanagaratnam, Arun, Karthikeyan Suseeladevi, Arun, Katikireddi, Vittal, Kellas, John, Kennedy, Jonathan I, Kibble, Milla, Knight, Rochelle, Knueppel, Anika, Kopasker, Daniel, Kromydas, Theocharis, Kwong, Alex, Langan, Sinead, Lemanska, Agnieszka, Lukaschuk, Elena, Mackenna, Brain, Macleod, John, Maddock, Jane, Mahalingasivam, Viyaasan, Mansfield, Kathryn, McArdle, Fintan, McCartney, Daniel, McEachan, Rosie, McElroy, Eoin, McLachlan, Stela, Mitchell, Ruth, Moltrecht, Bettina, Morley, Jess, Nab, Linda, Neubauer, Stefan, Nigrelli, Lidia, North, Teri, Northstone, Kate, Oakley, Jacqui, Palmer, Tom, Park, Chloe, Parker, Michael, Parsons, Sam, Patalay, Praveetha, Patel, Kishan, Perez-Reche, Francisco, Piechnik, Stefan, Piehlmaier, Dominik, Ploubidis, George, Rafeti, Elena, Raman, Betty, Ranjan, Yatharth, Rapala, Alicja, Rhead, Rebecca, Roberts, Amy, Sampri, Alexia, Sanders, Zeena-Britt, Santorelli, Gillian, Saunders, Laura C, Shah, Anoop, Shah, Syed Ahmar, Sharp, Steve, Shaw, Richard, Sheard, Laura, Sheikh, Aziz, Silverwood, Richard, Smeeth, Liam, Smith, Stephen, Stafford, Jean, Steptoe, Andrew, Sterne, Jonathan, Steves, Claire, Stewart, Callum, Taylor, Kurt, Tazare, John, Teece, Lucy, Thomas, Richard, Thompson, Ellen, Tilling, Kate, Timpson, Nicholas, Tomlinson, Laurie, Toms, Renin, Tunnicliffe, Elizabeth, Turner, Emma L, Walker, Alex, Walker, Venexia, Walter, Scott, Wang, Kevin, Wei, Yinghui, Whitehorn, Rebecca, Wielgoszewska, Bozena, Wild, James M, Willan, Kathryn, Willans, Robert, Williams, Dylan, Wong, Andrew, Wood, Angela, Woodward, Hannah, Wright, John, Yang, Tiffany, Zaninotto, Paola, Zheng, Bang, Zhu, Jingmin, Eastwood, Sophie, Horne, Elsie M F, Massey, Jon, Hopcroft, Lisa E M, Cuitun Coronado, Jose, Davy, Simon, Dillingham, Iain, Morton, Caroline, and Sterne, Jonathan A C

Published
2024
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4. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

Author

Strangfeld, Anja, Schäfer, Martin, Gianfrancesco, Milena A, Lawson-Tovey, Saskia, Liew, Jean W, Ljung, Lotta, Mateus, Elsa F, Richez, Christophe, Santos, Maria J, Schmajuk, Gabriela, Scirè, Carlo A, Sirotich, Emily, Sparks, Jeffrey A, Sufka, Paul, Thomas, Thierry, Trupin, Laura, Wallace, Zachary S, Al-Adely, Sarah, Bachiller-Corral, Javier, Bhana, Suleman, Cacoub, Patrice, Carmona, Loreto, Costello, Ruth, Costello, Wendy, Gossec, Laure, Grainger, Rebecca, Hachulla, Eric, Hasseli, Rebecca, Hausmann, Jonathan S, Hyrich, Kimme L, Izadi, Zara, Jacobsohn, Lindsay, Katz, Patricia, Kearsley-Fleet, Lianne, Robinson, Philip C, Yazdany, Jinoos, Machado, Pedro M, Dahou, Brahim, Pinheiro, Marcelo, Ribeiro, Francinne M, Chassin-Trubert, Anne-Marie, Ibáñez, Sebastián, Dong, Lingli, Cajas, Lui, Hamoud, Hesham, Avouac, Jérôme, Belin, Véronique, Borie, Raphaël, Chazerain, Pascal, Chevalier, Xavier, Claudepierre, Pascal, Clavel, Gaëlle, Colette-Cedoz, Marie-Eve, Combe, Bernard, Constant, Elodie, Costedoat-Chalumeau, Nathalie, Desmurs, Marie, Devauchelle-Pensec, Valérie, Devaux, Mathilde, Dhote, Robin, Dieudonné, Yannick, Domont, Fanny, Duret, Pierre-Marie, Ebbo, Mikaël, Ebstein, Esther, Mahou, Soumaya El, Fautrel, Bruno, Felten, Renaud, Flipo, René-Marc, Foltz, Violaine, Froissart, Antoine, Galland, Joris, Gaud-Listrat, Véronique, Georgin-Lavialle, Sophie, Giraud-Morelet, Aude, Quitrec, Jeanine S Giraudet-Le, Goupille, Philippe, Govindaraju-Audouard, Sophie, Grados, Franck, Guillaume-Czitrom, Séverine, Hermet, Marion, Hittinger-Roux, Ambre, Hudry, Christophe, Kone-Paut, Isabelle, La Batide Alanore, Sylvain, Lafforgue, Pierre, Lahalle, Sophie, Lambrecht, Isabelle, Langlois, Vincent, Larbre, Jean-Paul, Ledoult, Emmanuel, Leroux, Christophe, Liote, Frédéric, Maria, Alexandre TJ, Marotte, Hubert, Mekinian, Arsène, Melki, Isabelle, Messer, Laurent, Michel, Catherine, and Morel, Gauthier

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Infectious Diseases, Autoimmune Disease, Arthritis, Coronaviruses, Emerging Infectious Diseases, Cardiovascular, Inflammatory and immune system, Good Health and Well Being, Aged, Antirheumatic Agents, COVID-19, Comorbidity, Female, Global Health, Glucocorticoids, Humans, Male, Middle Aged, Odds Ratio, Registries, Rheumatic Diseases, Rheumatology, SARS-CoV-2, antirheumatic agents, autoimmune diseases, epidemiology, glucocorticoids, outcome assessment, health care, COVID-19 Global Rheumatology Alliance, Immunology, Public Health and Health Services, Arthritis & Rheumatology, Clinical sciences
Abstract

ObjectivesTo determine factors associated with COVID-19-related death in people with rheumatic diseases.MethodsPhysician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.ResultsOf 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.ConclusionAmong people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Published
2021

5. The use of digital data to investigate the management of rheumatoid arthritis

Author

Costello, Ruth, Dixon, William, and Humphreys, Jennifer

Abstract

Increasingly there are large amounts of digital data that can be harnessed for epidemiological research. The theme of this thesis is to describe how digital data, in particular electronic health records (EHR) and data collected through an online health community, can be used to answer questions about the management of rheumatoid arthritis (RA). These two data sources have different strengths - EHRs produce large longitudinal datasets representing the whole of the UK and can be linked to other administrative datasets. For bespoke surveys, collecting data through an online health community is a quick and efficient method to identify issues important to patients. Both have limitations that need addressing through careful use of epidemiological techniques. This thesis presents seven studies that highlight these methodological challenges focused on two interventions used to manage RA: vaccinations and glucocorticoids. Primary care EHR data was used to estimate influenza and pneumococcal vaccination uptake the UK (publication 1) and timing of pneumococcal vaccination in relation to starting disease-modifying anti-rheumatic drugs (publication 2), where the main challenges addressed were related to misclassification. EHR data was used to answer questions related to adverse outcomes associated with glucocorticoids: mortality, overall (publication 3) and in people with comorbid type 2 diabetes mellitus (publication 4), and hypertension (publication 5). These studies required careful preparation of drug data to correctly attribute risk and consideration of biases such as peri-mortal bias and surveillance bias. Data collected through an online health community measured patient perspectives of glucocorticoid side effects (publication 6) and the challenge of representativeness of responders was directly addressed through capturing the characteristics of patients with RA and comparing them to patients with RA identified using EHR data to understand the representativeness of online health community responders (publication 7). The studies highlighted important clinical issues: 1) vaccination uptake was not occurring as guidelines recommend, 2) glucocorticoid use was associated with increased risk of mortality and hypertension, 3) the glucocorticoid side effects of importance to patients are not frequently researched and 4) patients recruited through online health communities represent a younger and more diverse RA population. The thesis shows how digital data can be used, to successfully address a variety of previously unanswered questions, related to different aspects of RA management, using methods applicable to the investigation of other chronic diseases.

Published
2021

6. Comparative effectiveness of nirmatrelvir/ritonavir versus sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in non-hospitalised high-risk patients during Omicron waves: observational cohort study using the OpenSAFELY platform

Author

Zheng, Bang, Tazare, John, Nab, Linda, Green, Amelia CA., Curtis, Helen J., Mahalingasivam, Viyaasan, Herrett, Emily L., Costello, Ruth E., Eggo, Rosalind M., Speed, Victoria, Bacon, Sebastian CJ., Bates, Christopher, Parry, John, Cockburn, Jonathan, Hester, Frank, Harper, Sam, Schaffer, Andrea L., Hulme, William J., Mehrkar, Amir, Evans, Stephen JW., MacKenna, Brian, Goldacre, Ben, Douglas, Ian J., and Tomlinson, Laurie A.

Published
2023
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7. Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform

Author

Chaturvedi, Nishi, Park, Chloe, Carnemolla, Alisia, Williams, Dylan, Knueppel, Anika, Boyd, Andy, Turner, Emma L., Evans, Katharine M., Thomas, Richard, Berman, Samantha, McLachlan, Stela, Crane, Matthew, Whitehorn, Rebecca, Oakley, Jacqui, Foster, Diane, Woodward, Hannah, Campbell, Kirsteen C., Timpson, Nicholas, Kwong, Alex, Soares, Ana Goncalves, Griffith, Gareth, Toms, Renin, Jones, Louise, Annie, Herbert, Mitchell, Ruth, Palmer, Tom, Sterne, Jonathan, Walker, Venexia, Huntley, Lizzie, Fox, Laura, Denholm, Rachel, Knight, Rochelle, Northstone, Kate, Kanagaratnam, Arun, Horne, Elsie, Forbes, Harriet, North, Teri, Taylor, Kurt, Arab, Marwa A.L., Walker, Scott, Coronado, Jose I.C., Karthikeyan, Arun S., Ploubidis, George, Moltrecht, Bettina, Booth, Charlotte, Parsons, Sam, Wielgoszewska, Bozena, Bridger-Staatz, Charis, Steves, Claire, Thompson, Ellen, Garcia, Paz, Cheetham, Nathan, Bowyer, Ruth, Freydin, Maxim, Roberts, Amy, Goldacre, Ben, Walker, Alex, Morley, Jess, Hulme, William, Nab, Linda, Fisher, Louis, MacKenna, Brian, Andrews, Colm, Curtis, Helen, Hopcroft, Lisa, Green, Amelia, Patalay, Praveetha, Maddock, Jane, Patel, Kishan, Stafford, Jean, Jacques, Wels, Tilling, Kate, Macleod, John, McElroy, Eoin, Shah, Anoop, Silverwood, Richard, Denaxas, Spiros, Flaig, Robin, McCartney, Daniel, Campbell, Archie, Tomlinson, Laurie, Tazare, John, Zheng, Bang, Smeeth, Liam, Herrett, Emily, Cowling, Thomas, Mansfield, Kate, Costello, Ruth E., Wang, Kevin, Mansfield, Kathryn, Mahalingasivam, Viyaasan, Douglas, Ian, Langan, Sinead, Brophy, Sinead, Parker, Michael, Kennedy, Jonathan, McEachan, Rosie, Wright, John, Willan, Kathryn, Badrick, Ellena, Santorelli, Gillian, Yang, Tiffany, Hou, Bo, Steptoe, Andrew, Giorgio, Di Gessa, Zhu, Jingmin, Zaninotto, Paola, Wood, Angela, Cezard, Genevieve, Ip, Samantha, Bolton, Tom, Sampri, Alexia, Rafeti, Elena, Almaghrabi, Fatima, Sheikh, Aziz, Shah, Syed A., Katikireddi, Vittal, Shaw, Richard, Hamilton, Olivia, Green, Michael, Kromydas, Theocharis, Kopasker, Daniel, Greaves, Felix, Willans, Robert, Glen, Fiona, Sharp, Steve, Hughes, Alun, Wong, Andrew, Howes, Lee Hamill, Rapala, Alicja, Nigrelli, Lidia, McArdle, Fintan, Beckford, Chelsea, Raman, Betty, Dobson, Richard, Folarin, Amos, Stewart, Callum, Ranjan, Yatharth, Carpentieri, Jd, Sheard, Laura, Fang, Chao, Baz, Sarah, Gibson, Andy, Kellas, John, Neubauer, Stefan, Piechnik, Stefan, Lukaschuk, Elena, Saunders, Laura C., Wild, James M., Smith, Stephen, Jezzard, Peter, Tunnicliffe, Elizabeth, Sanders, Zeena-Britt, Finnigan, Lucy, Ferreira, Vanessa, Green, Mark, Rhead, Rebecca, Kibble, Milla, Wei, Yinghui, Lemanska, Agnieszka, Perez-Reche, Francisco, Piehlmaier, Dominik, Teece, Lucy, Parker, Edward, Walker, Alex J., Inglesby, Peter, Curtis, Helen J., Morton, Caroline E., Morley, Jessica, Mehrkar, Amir, Bacon, Sebastian C.J., Hickman, George, Croker, Richard, Evans, David, Ward, Tom, DeVito, Nicholas J., Green, Amelia C.A., Massey, Jon, Smith, Rebecca M., Hulme, William J., Davy, Simon, Andrews, Colm D., Hopcroft, Lisa E.M., Drysdale, Henry, Dillingham, Iain, Park, Robin Y., Higgins, Rose, Cunningham, Christine, Wiedemann, Milan, Maude, Steven, Macdonald, Orla, Butler-Cole, Ben F.C., O'Dwyer, Thomas, Stables, Catherine L., Wood, Christopher, Brown, Andrew D., Speed, Victoria, Bridges, Lucy, Schaffer, Andrea L., Walters, Caroline E., Rentsch, Christopher T., Bhaskaran, Krishnan, Schultze, Anna, Williamson, Elizabeth J., McDonald, Helen I., Tomlinson, Laurie A., Mathur, Rohini, Eggo, Rosalind M., Wing, Kevin, Wong, Angel Y.S., Grieve, Richard, Grint, Daniel J., Mansfield, Kathryn E., Douglas, Ian J., Evans, Stephen J.W., Walker, Jemma L., Cowling, Thomas E., Herrett, Emily L., Parker, Edward P.K., Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O'Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Griffiths, Paul, Fowles, Aaron, Parkes, Nasreen, Nicholson, Brian, Perera, Rafael, Harrison, David, Khunti, Kamlesh, Sterne, Jonathan AC., Quint, Jennifer, Henderson, Alasdair D., Carreira, Helena, Bidulka, Patrick, Warren-Gash, Charlotte, Hayes, Joseph F., Quint, Jennifer K., Katikireddi, Srinivasa Vittal, and Langan, Sinéad M.

Published
2023
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8. Impacts of the COVID-19 pandemic on deprivation-level differences in cardiovascular hospitalisations: A comparison of England and Denmark using the OpenSAFELY platform and National Registry Data

Author

Costello, Ruth, primary, Henderson, Alasdair, additional, Tazare, John, additional, Pedersen, Lars, additional, Toft Sorensen, Henrik, additional, Vandenbroucke, Jan, additional, Mansfield, Kathryn E, additional, Mahalingasivam, Viyaasan, additional, Zheng, Bang, additional, Carreira, Helena, additional, Bidulka, Patrick, additional, Piehlmaier, Dominik, additional, Wong, Angel, additional, Warren-Gash, Charlotte, additional, Hayes, Joseph F, additional, Quint, Jennifer K, additional, Katikireddi, Srinivasa Vittal, additional, MacKenna, Brian, additional, Mehrkar, Amir, additional, Bacon, Sebastian, additional, Goldacre, Ben, additional, Tomlinson, Laurie, additional, Langan, Sinead, additional, and Mathur, Rohini, additional

Published
2024
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10. Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people

Author

Taylor, Kurt, Eastwood, Sophie, Walker, Venexia, Cezard, Genevieve, Knight, Rochelle, Al Arab, Marwa, Wei, Yinghui, Horne, Elsie M F, Teece, Lucy, Forbes, Harriet, Walker, Alex, Fisher, Louis, Massey, Jon, Hopcroft, Lisa E M, Palmer, Tom, Cuitun Coronado, Jose, Ip, Samantha, Davy, Simon, Dillingham, Iain, Morton, Caroline, Greaves, Felix, Macleod, John, Goldacre, Ben, Wood, Angela, Chaturvedi, Nishi, Sterne, Jonathan A C, Denholm, Rachel, Al Arab, Marwa, Almaghrabi, Fatima, Andrews, Colm, Badrick, Ellena, Baz, Sarah, Beckford, Chelsea, Berman, Samantha, Bolton, Tom, Booth, Charlotte, Bowyer, Ruth, Boyd, Andy, Bridger-Staatz, Charis, Brophy, Sinead, Campbell, Archie, Campbell, Kirsteen C, Carnemolla, Alisia, Carpentieri, Jd, Cezard, Genevieve, Chaturvedi, Nishi, Cheetham, Nathan, Costello, Ruth, Cowling, Thomas, Crane, Matthew, Cuitun Coronado, Jose Ignacio, Curtis, Helen, Denaxas, Spiros, Denholm, Rachel, Di Gessa, Giorgio, Dobson, Richard, Douglas, Ian, Evans, Katharine M, Fang, Chao, Ferreira, Vanessa, Finnigan, Lucy, Fisher, Louis, Flaig, Robin, Folarin, Amos, Forbes, Harriet, Foster, Diane, Fox, Laura, Freydin, Maxim, Garcia, Paz, Gibson, Andy, Glen, Fiona, Goldacre, Ben, Goncalves Soares, Ana, Greaves, Felix, Green, Amelia, Green, Mark, Green, Michael, Griffith, Gareth, Hamill Howes, Lee, Hamilton, Olivia, Herbet, Annie, Herrett, Emily, Hopcroft, Lisa, Horne, Elsie, Hou, Bo, Hughes, Alun, Hulme, William, Huntley, Lizzie, Ip, Samantha, Jacques, Wels, Jezzard, Peter, Jones, Louise, Kanagaratnam, Arun, Karthikeyan Suseeladevi, Arun, Katikireddi, Vittal, Kellas, John, Kennedy, Jonathan I, Kibble, Milla, Knight, Rochelle, Knueppel, Anika, Kopasker, Daniel, Kromydas, Theocharis, Kwong, Alex, Langan, Sinead, Lemanska, Agnieszka, Lukaschuk, Elena, Mackenna, Brain, Macleod, John, Maddock, Jane, Mahalingasivam, Viyaasan, Mansfield, Kathryn, McArdle, Fintan, McCartney, Daniel, McEachan, Rosie, McElroy, Eoin, McLachlan, Stela, Mitchell, Ruth, Moltrecht, Bettina, Morley, Jess, Nab, Linda, Neubauer, Stefan, Nigrelli, Lidia, North, Teri, Northstone, Kate, Oakley, Jacqui, Palmer, Tom, Park, Chloe, Parker, Michael, Parsons, Sam, Patalay, Praveetha, Patel, Kishan, Perez-Reche, Francisco, Piechnik, Stefan, Piehlmaier, Dominik, Ploubidis, George, Rafeti, Elena, Raman, Betty, Ranjan, Yatharth, Rapala, Alicja, Rhead, Rebecca, Roberts, Amy, Sampri, Alexia, Sanders, Zeena-Britt, Santorelli, Gillian, Saunders, Laura C, Shah, Anoop, Shah, Syed Ahmar, Sharp, Steve, Shaw, Richard, Sheard, Laura, Sheikh, Aziz, Silverwood, Richard, Smeeth, Liam, Smith, Stephen, Stafford, Jean, Steptoe, Andrew, Sterne, Jonathan, Steves, Claire, Stewart, Callum, Taylor, Kurt, Tazare, John, Teece, Lucy, Thomas, Richard, Thompson, Ellen, Tilling, Kate, Timpson, Nicholas, Tomlinson, Laurie, Toms, Renin, Tunnicliffe, Elizabeth, Turner, Emma L, Walker, Alex, Walker, Venexia, Walter, Scott, Wang, Kevin, Wei, Yinghui, Whitehorn, Rebecca, Wielgoszewska, Bozena, Wild, James M, Willan, Kathryn, Willans, Robert, Williams, Dylan, Wong, Andrew, Wood, Angela, Woodward, Hannah, Wright, John, Yang, Tiffany, Zaninotto, Paola, Zheng, Bang, and Zhu, Jingmin

Abstract

Some studies have shown that the incidence of type 2 diabetes increases after a diagnosis of COVID-19, although the evidence is not conclusive. However, the effects of the COVID-19 vaccine on this association, or the effect on other diabetes subtypes, are not clear. We aimed to investigate the association between COVID-19 and incidence of type 2, type 1, gestational and non-specific diabetes, and the effect of COVID- 19 vaccination, up to 52 weeks after diagnosis.

Published
2024
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11. Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform

Author

Costello, Ruth E., primary, Tazare, John, additional, Piehlmaier, Dominik, additional, Herrett, Emily, additional, Parker, Edward P.K., additional, Zheng, Bang, additional, Mansfield, Kathryn E., additional, Henderson, Alasdair D., additional, Carreira, Helena, additional, Bidulka, Patrick, additional, Wong, Angel Y.S., additional, Warren-Gash, Charlotte, additional, Hayes, Joseph F., additional, Quint, Jennifer K., additional, MacKenna, Brian, additional, Mehrkar, Amir, additional, Eggo, Rosalind M., additional, Katikireddi, Srinivasa Vittal, additional, Tomlinson, Laurie, additional, Langan, Sinéad M., additional, Mathur, Rohini, additional, Chaturvedi, Nishi, additional, Park, Chloe, additional, Carnemolla, Alisia, additional, Williams, Dylan, additional, Knueppel, Anika, additional, Boyd, Andy, additional, Turner, Emma L., additional, Evans, Katharine M., additional, Thomas, Richard, additional, Berman, Samantha, additional, McLachlan, Stela, additional, Crane, Matthew, additional, Whitehorn, Rebecca, additional, Oakley, Jacqui, additional, Foster, Diane, additional, Woodward, Hannah, additional, Campbell, Kirsteen C., additional, Timpson, Nicholas, additional, Kwong, Alex, additional, Soares, Ana Goncalves, additional, Griffith, Gareth, additional, Toms, Renin, additional, Jones, Louise, additional, Annie, Herbert, additional, Mitchell, Ruth, additional, Palmer, Tom, additional, Sterne, Jonathan, additional, Walker, Venexia, additional, Huntley, Lizzie, additional, Fox, Laura, additional, Denholm, Rachel, additional, Knight, Rochelle, additional, Northstone, Kate, additional, Kanagaratnam, Arun, additional, Horne, Elsie, additional, Forbes, Harriet, additional, North, Teri, additional, Taylor, Kurt, additional, Arab, Marwa A.L., additional, Walker, Scott, additional, Coronado, Jose I.C., additional, Karthikeyan, Arun S., additional, Ploubidis, George, additional, Moltrecht, Bettina, additional, Booth, Charlotte, additional, Parsons, Sam, additional, Wielgoszewska, Bozena, additional, Bridger-Staatz, Charis, additional, Steves, Claire, additional, Thompson, Ellen, additional, Garcia, Paz, additional, Cheetham, Nathan, additional, Bowyer, Ruth, additional, Freydin, Maxim, additional, Roberts, Amy, additional, Goldacre, Ben, additional, Walker, Alex, additional, Morley, Jess, additional, Hulme, William, additional, Nab, Linda, additional, Fisher, Louis, additional, Andrews, Colm, additional, Curtis, Helen, additional, Hopcroft, Lisa, additional, Green, Amelia, additional, Patalay, Praveetha, additional, Maddock, Jane, additional, Patel, Kishan, additional, Stafford, Jean, additional, Jacques, Wels, additional, Tilling, Kate, additional, Macleod, John, additional, McElroy, Eoin, additional, Shah, Anoop, additional, Silverwood, Richard, additional, Denaxas, Spiros, additional, Flaig, Robin, additional, McCartney, Daniel, additional, Campbell, Archie, additional, Smeeth, Liam, additional, Cowling, Thomas, additional, Mansfield, Kate, additional, Costello, Ruth E., additional, Wang, Kevin, additional, Mansfield, Kathryn, additional, Mahalingasivam, Viyaasan, additional, Douglas, Ian, additional, Langan, Sinead, additional, Brophy, Sinead, additional, Parker, Michael, additional, Kennedy, Jonathan, additional, McEachan, Rosie, additional, Wright, John, additional, Willan, Kathryn, additional, Badrick, Ellena, additional, Santorelli, Gillian, additional, Yang, Tiffany, additional, Hou, Bo, additional, Steptoe, Andrew, additional, Giorgio, Di Gessa, additional, Zhu, Jingmin, additional, Zaninotto, Paola, additional, Wood, Angela, additional, Cezard, Genevieve, additional, Ip, Samantha, additional, Bolton, Tom, additional, Sampri, Alexia, additional, Rafeti, Elena, additional, Almaghrabi, Fatima, additional, Sheikh, Aziz, additional, Shah, Syed A., additional, Katikireddi, Vittal, additional, Shaw, Richard, additional, Hamilton, Olivia, additional, Green, Michael, additional, Kromydas, Theocharis, additional, Kopasker, Daniel, additional, Greaves, Felix, additional, Willans, Robert, additional, Glen, Fiona, additional, Sharp, Steve, additional, Hughes, Alun, additional, Wong, Andrew, additional, Howes, Lee Hamill, additional, Rapala, Alicja, additional, Nigrelli, Lidia, additional, McArdle, Fintan, additional, Beckford, Chelsea, additional, Raman, Betty, additional, Dobson, Richard, additional, Folarin, Amos, additional, Stewart, Callum, additional, Ranjan, Yatharth, additional, Carpentieri, Jd, additional, Sheard, Laura, additional, Fang, Chao, additional, Baz, Sarah, additional, Gibson, Andy, additional, Kellas, John, additional, Neubauer, Stefan, additional, Piechnik, Stefan, additional, Lukaschuk, Elena, additional, Saunders, Laura C., additional, Wild, James M., additional, Smith, Stephen, additional, Jezzard, Peter, additional, Tunnicliffe, Elizabeth, additional, Sanders, Zeena-Britt, additional, Finnigan, Lucy, additional, Ferreira, Vanessa, additional, Green, Mark, additional, Rhead, Rebecca, additional, Kibble, Milla, additional, Wei, Yinghui, additional, Lemanska, Agnieszka, additional, Perez-Reche, Francisco, additional, Teece, Lucy, additional, Parker, Edward, additional, Walker, Alex J., additional, Inglesby, Peter, additional, Curtis, Helen J., additional, Morton, Caroline E., additional, Morley, Jessica, additional, Bacon, Sebastian C.J., additional, Hickman, George, additional, Croker, Richard, additional, Evans, David, additional, Ward, Tom, additional, DeVito, Nicholas J., additional, Green, Amelia C.A., additional, Massey, Jon, additional, Smith, Rebecca M., additional, Hulme, William J., additional, Davy, Simon, additional, Andrews, Colm D., additional, Hopcroft, Lisa E.M., additional, Drysdale, Henry, additional, Dillingham, Iain, additional, Park, Robin Y., additional, Higgins, Rose, additional, Cunningham, Christine, additional, Wiedemann, Milan, additional, Maude, Steven, additional, Macdonald, Orla, additional, Butler-Cole, Ben F.C., additional, O'Dwyer, Thomas, additional, Stables, Catherine L., additional, Wood, Christopher, additional, Brown, Andrew D., additional, Speed, Victoria, additional, Bridges, Lucy, additional, Schaffer, Andrea L., additional, Walters, Caroline E., additional, Rentsch, Christopher T., additional, Bhaskaran, Krishnan, additional, Schultze, Anna, additional, Williamson, Elizabeth J., additional, McDonald, Helen I., additional, Tomlinson, Laurie A., additional, Wing, Kevin, additional, Grieve, Richard, additional, Grint, Daniel J., additional, Douglas, Ian J., additional, Evans, Stephen J.W., additional, Walker, Jemma L., additional, Cowling, Thomas E., additional, Herrett, Emily L., additional, Bates, Christopher, additional, Cockburn, Jonathan, additional, Parry, John, additional, Hester, Frank, additional, Harper, Sam, additional, O'Hanlon, Shaun, additional, Eavis, Alex, additional, Jarvis, Richard, additional, Avramov, Dima, additional, Griffiths, Paul, additional, Fowles, Aaron, additional, Parkes, Nasreen, additional, Nicholson, Brian, additional, Perera, Rafael, additional, Harrison, David, additional, Khunti, Kamlesh, additional, Sterne, Jonathan AC., additional, and Quint, Jennifer, additional

Published
2023
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12. Ursodeoxycholic acid and severe COVID-19 outcomes in people with liver disease: a cohort study using the OpenSAFELY platform

Author

Costello, Ruth E, primary, Waller, Karen MJ, additional, Smith, Rachel, additional, Mells, George F, additional, Wong, Angel YS, additional, Schultze, Anna, additional, Mahalingasivam, Viyaasan, additional, Herrett, Emily, additional, Zheng, Bang, additional, Lin, Liang-Yu, additional, Mehrkar, Amir, additional, Bacon, Sebastian CJ, additional, Goldacre, Ben, additional, Tomlinson, Laurie A, additional, Tazare, John, additional, and Rentsch, Christopher T., additional

Published
2023
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13. Clinical coding of long COVID in primary care 2020-2023 in a cohort of 19 million adults: an OpenSAFELY analysis

Author

Henderson, Alasdair D, primary, Butler-Cole, Ben FC, additional, Tazare, John, additional, Tomlinson, Laurie A, additional, Marks, Michael, additional, Jit, Mark, additional, Briggs, Andrew, additional, Lin, Liang-Yu, additional, Carlile, Oliver, additional, Bates, Christopher, additional, Parry, John, additional, Bacon, Sebastian CJ, additional, Dillingham, Iain, additional, Dennison, William A, additional, Costello, Ruth E, additional, Wei, Yinghui, additional, Walker, Alex J, additional, Hulme, William, additional, Goldacre, Ben, additional, Mehrkar, Amir, additional, MacKenna, Brian, additional, Collaborative, The OpenSAFELY, additional, Herrett, Emily, additional, and Eggo, Rosalind M, additional

Published
2023
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15. Opioid use, postoperative complications, and implant survival after unicompartmental versus total knee replacement: a population-based network study

Author

Burn, Edward, Weaver, James, Morales, Daniel, Prats-Uribe, Albert, Delmestri, Antonella, Strauss, Victoria Y, He, Ying, Robinson, Danielle E, Pinedo-Villanueva, Rafael, Kolovos, Spyros, Duarte-Salles, Talita, Sproviero, William, Yu, Dahai, Van Speybroeck, Michel, Williams, Ross, John, Luis H, Hughes, Nigel, Sena, Anthony G, Costello, Ruth, Birlie, Belay, Culliford, David, O'Leary, Caroline, Morgan, Henry, Burkard, Theresa, Prieto-Alhambra, Daniel, and Ryan, Patrick

Published
2019
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22. Continuing specialist care into adulthood in young people with juvenile idiopathic arthritis: a retrospective cohort study using electronic health records in England.

Author

Costello, Ruth E, Kearsley-Fleet, Lianne, McDonagh, Janet E, Hyrich, Kimme L, and Humphreys, Jenny H

Subjects
*TRANSITION to adulthood, *HEALTH services accessibility, *JUVENILE idiopathic arthritis, *RETROSPECTIVE studies, *UVEITIS, *CONTINUUM of care, *DESCRIPTIVE statistics, *ADOLESCENT medicine, *RESEARCH funding, *ELECTRONIC health records, *ADULTS
Abstract

Objectives This study aimed to measure (1) the proportion of children who continue to receive specialist care (rheumatology/ophthalmology) as adults, (2) the characteristics associated with continuing specialist care, and (3) the frequency of specialist care appointments in both paediatric and adult services. Methods A retrospective cohort of young people with JIA was identified from UK primary care electronic health records (Clinical Practice Research Datalink) between 1 April 2003 and 31 December 2018. To be included in the study, cases needed to have at least 1 year of registration at their general practice beyond age 18 and linkage to Hospital Episodes Statistics data for secondary care information. All specialist care outpatient visits were identified from Hospital Episodes Statistics outpatient data. Results There were 666 young people included in the study. Of these, 427 (64%) received specialist care beyond age 18, 90 (13%) had their last recorded contact at 16–17 years and 149 (22%) did not continue after 16 years. Older age at diagnosis, female gender, less deprivation and a childhood diagnosis of uveitis were associated with continuing specialist care beyond age 18. Of those continuing beyond 18, 35% (n  = 153) were subsequently discharged by the study end date. Of all those discharged, 32% had a missed appointment recorded after the last attended visit, suggesting failure to attend. Conclusions Two-thirds of young people with JIA continue to receive specialist care beyond age 18. This is useful information for children and young people with JIA and their families planning for their future, and for clinicians planning health-care services. [ABSTRACT FROM AUTHOR]

Published
2023
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26. Outcomes of SARS-CoV-2 infection among children and young people with pre-existing rheumatic and musculoskeletal diseases

Author

Kearsley-Fleet, Lianne, Chang, Min-Lee, Lawson-Tovey, Saskia, Costello, Ruth, Fingerhutová, Šárka, Švestková, Natálie, Belot, Alexandre, Aeschlimann, Florence A, Melki, Isabelle, Koné-Paut, Isabelle, Eulert, Sascha, Kallinich, Tilmann, Berkun, Yackov, Uziel, Yosef, Raffeiner, Bernd, Oliveira Ramos, Filipa, Clemente, Daniel, Dackhammar, Christina, Wulffraat, Nico M, Waite, Helen, Strangfeld, Anja, Mateus, Elsa F, Machado, Pedro M, CARRA Registry Investigators, COVID-19 Global Pediatric Rheumatology Database Investigators, Natter, Marc, and Hyrich, Kimme L

Abstract

OBJECTIVES: Some adults with rheumatic and musculoskeletal diseases (RMDs) are at increased risk of COVID-19-related death. Excluding post-COVID-19 multisystem inflammatory syndrome of children, children and young people (CYP) are overall less prone to severe COVID-19 and most experience a mild or asymptomatic course. However, it is unknown if CYP with RMDs are more likely to have more severe COVID-19. This analysis aims to describe outcomes among CYP with underlying RMDs with COVID-19. METHODS: Using the European Alliance of Associations for Rheumatology COVID-19 Registry, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, and the CARRA-sponsored COVID-19 Global Paediatric Rheumatology Database, we obtained data on CYP with RMDs who reported SARS-CoV-2 infection (presumptive or confirmed). Patient characteristics and illness severity were described, and factors associated with COVID-19 hospitalisation were investigated. RESULTS: 607 CYP with RMDs

Published
2022

30. Incidence and prevalence of juvenile idiopathic arthritis in the United Kingdom, 2000–2018: results from the Clinical Practice Research Datalink.

Author

Costello, Ruth, McDonagh, Janet, Hyrich, Kimme L, and Humphreys, Jenny H

Subjects
*CONFIDENCE intervals, *JUVENILE idiopathic arthritis, *DISEASE incidence, *ACQUISITION of data, *PRIMARY health care, *DISEASE prevalence, *MEDICAL records, *DESCRIPTIVE statistics, *ELECTRONIC health records, *LONGITUDINAL method
Abstract

Objective The incidence and prevalence of JIA was last estimated in the UK in 1994. Since then the disease has been reclassified, the specialty of paediatric rheumatology has evolved and there has been a significant shift in disease management with new advanced therapies. This study aimed to provide up-to-date national estimates of this disease. Methods Children and young people (CYP) with JIA were identified in the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, which source data from the two most commonly used primary care electronic health record systems in the UK. These databases were combined and the cohort was identified (2000–18) using predefined code lists. Validation was performed through linkage to the England Hospital Episode Statistics. Annual incidence and prevalence rates were calculated and stratified by gender, age group and nation of the UK. Direct standardization to the UK population was performed and 5 year incidence rates were calculated between 2003 and 2018. Results The age-standardized incidence rate was 5.61 per 100 000 population. The age-standardized prevalence rate in 2018 was 43.5 per 100 000. Rates were higher in Scotland compared with England: incidence rate ratio 1.27 (95% CI 1.11, 1.46). The 5 year incidence rates did not change significantly over time. Conclusions This study has provided the first contemporaneous estimates of occurrence of JIA in the UK in 25 years. These data provide important estimates to inform resource allocation and health service development for management of JIA. [ABSTRACT FROM AUTHOR]

Published
2022
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31. SMM902179 Supplemental Material - Supplemental material for Modeling of cumulative effects of time-varying drug exposures on within-subject changes in a continuous outcome

Author

Danieli, Coraline, Sheppard, Therese, Costello, Ruth, Dixon, William G, and Abrahamowicz, Michal

Subjects
111099 Nursing not elsewhere classified, 111708 Health and Community Services, 160807 Sociological Methodology and Research Methods, FOS: Health sciences, FOS: Sociology
Abstract

Supplemental material, SMM902179 Supplemental Material for Modeling of cumulative effects of time-varying drug exposures on within-subject changes in a continuous outcome by Coraline Danieli, Therese Sheppard, Ruth Costello, William G Dixon and Michal Abrahamowicz in Statistical Methods in Medical Research

Published
2020
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32. Development and validation of patient-level prediction models for adverse outcomes following total knee arthroplasty

Author

Williams, Ross, primary, Reps, Jenna, additional, Sena, Anthony, additional, Burn, Edward, additional, Ying, Helen, additional, Morales, Daniel, additional, Culliford, David, additional, Yu, Dahai, additional, Strauss, Victoria, additional, Duarte-Salles, Talita, additional, Prats-Uribe, Albert, additional, Delmestri, Antonella, additional, Weaver, James, additional, Sproviero, William, additional, Robinson, Danielle, additional, Morgan-Stewart, Henry, additional, Birlie, Belay, additional, Pinedo-Villanueva, Rafael, additional, Kolovos, Spyros, additional, John, Luis, additional, Costello, Ruth, additional, van Speybroeck, Michel, additional, O'Leary, Caroline, additional, Minty, Evan, additional, Falconer, Thomas, additional, Bourke, Alison, additional, Pfohl, Stephen, additional, Burkard, Theresa, additional, Lane, Jennifer, additional, Rijnbeek, Peter, additional, Ryan, Patrick, additional, and Prieto-Alhambra, Daniel, additional

Published
2020
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39. Associations between patterns of online engagement with an online health community and changes in patient activation and health care utilisation: longitudinal web-based survey

Author

Costello, Ruth, Anand, A., Jameson Evans, M., and Dixon, William

Subjects
Self-management, sense organs, health information exchanges, chronic disease
Abstract

Background: Online health communities (OHC) are widely used in the UK. They allow patients to share experiences of living with disease and self-management, but it is unknown whether use improves health outcomes. Objectives: The aims of this study were: 1) to determine change in activation over three months in new users of an OHC, 2) to describe patterns of engagement with an OHC, 3) to examine whether patient characteristics at baseline were associated with subsequent patterns of engagement, and 4) to determine if patterns of engagement during the three months were associated with changes in patient activation, healthcare utilisation and health status. Methods: Active new OHC users on HealthUnlocked (HU) were surveyed to measure demographics, levels of “patient activation” (describing a person’s confidence in managing their own health; scale 0-100 with four categories), healthcare utilisation and health status using a web-based survey at baseline and three months. Patient activation at baseline and three months was compared (Aim 1). Alongside, for a sample of HU users and survey responders, daily OHC website usage data was automatically captured indicating whether or not a user interacted with HU. This was used to identify clusters of engagement with HU (Aim 2). For survey responders, baseline characteristics, patient activation, healthcare utilisation and health status was compared at baseline and three months, overall and between engagement clusters using t-tests and chi-squared tests (Aims 3 & 4). Results: In 329 people who completed both the baseline and follow-up surveys, baseline activation was most frequently ‘level 3’, described as “taking action but still lacking confidence”. At follow-up a change of 2.6 points was seen, with the greatest change seen in those at lowest baseline activation levels. Four clusters of engagement were identified - low, medium, high and very high - who were active on HU for a mean of 4, 12, 29 and 59 days, respectively. Survey responders were more commonly high or very high engagers. Baseline activation was highest in low and very high engagers. Overall activation increased over time in all engagement groups. Very high engagers had the greatest improvement in activation (5 points), although the average change was not above what is considered clinically meaningful for any group. Accident and emergency visits at follow-up were lower with higher engagement, though this trend was not seen for other healthcare utilisation measures. There was no change in health status at three months. Conclusions: This observational study provides some insight into how patterns of engagement with OHCs are associated with changes in patient activation, healthcare utilisation and health status. Over three months overall the change in activation was not clinically significant, there were some indications that OHCs may be of benefit to particular groups. However, the study limitations prevent firm conclusions about causal relationships.

Published
2019

45. Glucocorticoid use is associated with an increased risk of hypertension.

Author

Costello, Ruth E, Yimer, Belay B, Roads, Polly, Jani, Meghna, and Dixon, William G

Subjects
*BLOOD pressure measurement, *CARDIOVASCULAR diseases risk factors, *CONFIDENCE intervals, *DRUG utilization, *DRUG prescribing, *GLUCOCORTICOIDS, *HYPERTENSION, *ANTIHYPERTENSIVE agents, *IMMUNOSUPPRESSIVE agents, *MEDICAL records, *PRIMARY health care, *REGRESSION analysis, *RHEUMATOID arthritis, *RHEUMATOLOGISTS, *RISK assessment, *PHYSICIAN practice patterns, *DISEASE incidence, *PROPORTIONAL hazards models, *RETROSPECTIVE studies, *ELECTRONIC health records, *DESCRIPTIVE statistics, *ACQUISITION of data methodology
Abstract

Objectives Patients with RA are frequently treated with glucocorticoids (GCs), but evidence is conflicting about whether GCs are associated with hypertension. The aim of this study was to determine whether GCs are associated with incident hypertension in patients with RA. Methods A retrospective cohort of patients with incident RA and without hypertension was identified from UK primary care electronic medical records (Clinical Practice Research Datalink). GC prescriptions were used to determine time-varying GC use, dose and cumulative dose, with a 3 month attribution window. Hypertension was identified through either: blood pressure measurements >140/90 mmHg, or antihypertensive prescriptions and a Read code for hypertension. Unadjusted and adjusted Cox proportional hazards regression models were fitted to determine whether there was an association between GC use and incident hypertension. Results There were 17 760 patients in the cohort. A total of 7421 (42%) were prescribed GCs during follow-up. The incident rate of hypertension was 64.1 per 1000 person years (95% CI: 62.5, 65.7). The Cox proportional hazards model indicated that recent GC use was associated with a 17% increased hazard of hypertension (hazard ratio 1.17; 95% CI: 1.10, 1.24). When categorized by dose, only doses above 7.5 mg were significantly associated with hypertension. Cumulative dose did not indicate a clear pattern. Conclusion Recent GC use was associated with incident hypertension in patients with RA, in particular doses ≥7.5 mg were associated with hypertension. Clinicians need to consider cardiovascular risk when prescribing GCs, and ensure blood pressure is regularly monitored and treated where necessary. [ABSTRACT FROM AUTHOR]

Published
2021
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46. Patient perceptions of glucocorticoid side effects: a cross-sectional survey of users in an online health community

Author

Costello, Ruth, Patel, Rikesh, Humphreys, Jennifer, Mcbeth, John, and Dixon, William

Abstract

ObjectivesTo identify the side effects most important to glucocorticoid (GC) users through a survey of a UK online health community (Healthunlocked.com).DesignOnline cross-sectional survey.SettingParticipants were recruited through Healthunlocked.com, an online social network for health. ParticipantsAdults who were currently taking GCs, or had taken GCs in the past month.MethodResponders scored the importance of listed side effects from one to ten, with ten being of high importance to them. For each side effect, histograms were plotted, and the median rating and inter-quartile range (IQR) was determined. Side effects were ranked by median ranking (largest to smallest) and then IQR (smallest to largest). The scores were categorised as low (scores 1-3), medium (scores 4-7) and high (scores 8-10) importance. Results 604 responders completed the survey. Histograms of side effect scores showed a skew towards high importance for weight gain, a U-shaped distribution for CVD, diabetes, eye disease and infections, and a skew towards low importance for acne. When ranked the side effect of most importance to responders was weight gain (median score=9, IQR 6, 10) followed by insomnia and moon face with equal median score (8) and IQR (5, 10). Three serious side effects: cardiovascular disease, diabetes and infections, were ranked of lower importance overall but had wide ranging scores (median score=8, IQR 1, 10). ConclusionsThe three most highly rated side effects were not clinically serious but remained important to patients, perhaps reflecting their impact on quality of life and high prevalence. This should be taken into consideration when discussing treatment options and planning future GC safety studies.Keywords: Steroids, Side effects, Patient beliefs

Published
2017

48. Influenza and Pneumococcal Vaccination Uptake in Patients with Rheumatoid Arthritis Treated with Immunosuppressive Therapy in the UK: A Retrospective Cohort Study Using Data from the Clinical Practice Research Datalink

Author

Costello, Ruth, Winthrop, Kevin, Pye, Stephen R, Brown, Benjamin, and Dixon, William G

Subjects
lcsh:R, lcsh:Medicine, lcsh:Q, lcsh:Science
Abstract

Guidelines for the management of rheumatoid arthritis (RA) recommend using influenza and pneumococcal vaccinations to mitigate infection risk. The level of adherence to these guidelines is not well known in the UK. The aims of this study were to describe the uptake of influenza and pneumococcal vaccinations in patients with RA in the UK, to compare the characteristics of those vaccinated to those not vaccinated and to compare vaccination rates across regions of the UK.A retrospective cohort study of adults diagnosed with incident RA and treated with non-biologic immunosuppressive therapy, using data from a large primary care database. For the influenza vaccination, patients were considered unvaccinated on 1st September each year and upon vaccination their status changed to vaccinated. For pneumococcal vaccination, patients were considered vaccinated after their first vaccination until the end of follow-up. Patients were stratified by age 65 at the start of follow-up, given differences in vaccination guidelines for the general population.Overall (N=15,724), 80% patients received at least one influenza vaccination, and 50% patients received a pneumococcal vaccination, during follow-up (mean 5.3 years). Of those aged below 65 years (N=9,969), 73% patients had received at least one influenza vaccination, and 43% patients received at least one pneumococcal vaccination. Of those aged over 65 years (N=5,755), 91% patients received at least one influenza vaccination, and 61% patients had received at least one pneumococcal vaccination. Those vaccinated were older, had more comorbidity and visited the GP more often. Regional differences in vaccination rates were seen with the highest rates in Northern Ireland, and the lowest rates in London.One in five patients received no influenza vaccinations and one in two patients received no pneumonia vaccine over five years of follow-up. There remains significant scope to improve uptake of vaccinations in patients with RA.

Published
2016

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