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2. Health outcomes 3 months and 6 months after molnupiravir treatment for COVID-19 for people at higher risk in the community (PANORAMIC): a randomised controlled trial

Author

Moftah, Areej, Goodman, Anna, Halifax, Rob, Turnbull, Chris, Sundaralingam, Anand, Agyeman, Akosua, Shah, Divya, Brown, Julianne, Thalasselis, Chris, Woodall, Maximillian N J, Yongblah, Francis, Howell, Aleksandra, Patel, Kavil, Hussain, Iqbal, Penfold, Ruth, Hutchinson, Simon, Poonian, Satveer, Imlach, Marie, Popoola, Olajide, Irving, Greg, Pora, Alexander, Jacobsen, Nicholas, Prasad, Vibhore, Kennard, James, Prasad, Rishabh, Khan, Umar, Razzaq, Omair, Knox, Kyle, Richardson, Scot, Krasucki, Christopher, Royal, Simon, Law, Tom, Safa, Afsana, Lee, Rem, Sehdev, Satash, Lester, Nicola, Sevenoaks, Tamsin, Lewis, David, Sheikh, Aadil, Lunn, James, Short, Vanessa, Mackintosh, Claire, Singh Sidhu, Baljinder, Mathukia, Mehul, Singh, Ivor, Moore, Patrick, Soni, Yusuf, Morton, Seb, Wilson, Pete, Murphy, Daniel, Wingfield, David, Nally, Rhiannon, Wong, Michael, Ndukauba, Chinonso, Wooding, Nick, Ogundapo, Olufunto, Woods, Sharon, Okeke, Henry, Yong, Joanna, Ahmed, Tanveer, Allcock, Damien, Atherton, George, Beltran-Martinez, Adrian, Benedict, Oluseye Emmanuel, Bird, Nigel, Brennan, Laura, Burns, Gerard, Butler, Mike, Butler, Daniel, Carson-Stevens, Andrew, Cheng, Zelda, Danson, Ruth, De Kare-Silver, Nigel, Dhasmana, Devesh, Dickson, Jon, Engamba, Serge, Fisher, Stacey, Fox, Robin, Frost, Eve, Gaunt, Richard, Ghosh, Sarit, Gilkar, Ishtiaq, Granier, Steve, Packham, Alice, Dowsell, Sarah, Gulati, Radhika, Patel, Amit, Harris, Victoria, Holmes, Jane, Gbinigie-Thompson, Oghenekome, Rahman, Najib M, Richards, Duncan B, Hayward, Gail, Dorward, Jienchi, Lowe, David M, Standing, Joseph F, Breuer, Judith, Khoo, Saye, Petrou, Stavros, Hood, Kerenza, Ahmed, Haroon, Nguyen-Van-Tam, Jonathan S, Patel, Mahendra G, Saville, Benjamin R, Francis, Nick, Thomas, Nicholas P B, Evans, Philip, Dobson, Melissa, Png, May Ee, Lown, Mark, van Hecke, Oliver, Jani, Bhautesh D, Hart, Nigel D, Cureton, Lucy, Patil, Meena, Andersson, Monique, Coates, Maria, Bateman, Clare, Davies, Jennifer C, Raymundo-Wood, Ivy, Ustianowski, Andrew, Yu, Ly-Mee, Hobbs, F D Richard, Little, Paul, and Butler, Christopher C

Published
2025
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3. Maternal and pregnancy factors contributing to the association between area deprivation and infant mortality in England: a retrospective cohort study

Author

Ho, Frederick K., Allan, Max, Shao, Hui, Man, Kenneth K.C., Jani, Bhautesh D., Lyall, Donald, Hastie, Claire, Fleming, Michael, Mackay, Daniel, Cleland, John G.F., Delles, Christian, Dundas, Ruth, Lewsey, Jim, Ip, Patrick, Wong, Ian, Welsh, Paul, Pearce, Anna, Wright, Charlotte M., Minnis, Helen, Katikireddi, S Vittal, and Pell, Jill P.

Published
2024
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4. Evidence for exercise-based interventions across 45 different long-term conditions: an overview of systematic reviews

Author

Begum, Samina, DeBarros, Clara, Davies, Firoza, Sterniczuk, Kamil, Kumar, Rashmi, Longley, Rebecca, Freeman, Andrew, Lalseta, Jagruti, Ashby, Paul, Van Grieken, Marc, Grace Elder, Dorothy, Dibben, Grace O., Gardiner, Lucy, Young, Hannah M.L., Wells, Valerie, Evans, Rachael A., Ahmed, Zahira, Barber, Shaun, Dean, Sarah, Doherty, Patrick, Gardiner, Nikki, Greaves, Colin, Ibbotson, Tracy, Jani, Bhautesh D., Jolly, Kate, Mair, Frances S., McIntosh, Emma, Ormandy, Paula, Simpson, Sharon A., Ahmed, Sayem, Krauth, Stefanie J., Steell, Lewis, Singh, Sally J., and Taylor, Rod S.

Published
2024
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8. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Author

Agyeman, Akosua A, Ahmed, Tanveer, Allcock, Damien, Beltran-Martinez, Adrian, Benedict, Oluseye E, Bird, Nigel, Brennan, Laura, Brown, Julianne, Burns, Gerard, Butler, Mike, Cheng, Zelda, Danson, Ruth, de Kare-Silver, Nigel, Dhasmana, Devesh, Dickson, Jon, Engamba, Serge, Fisher, Stacey, Fox, Robin, Frost, Eve, Gaunt, Richard, Ghosh, Sarit, Gilkar, Ishtiaq, Goodman, Anna, Granier, Steve, Howell, Aleksandra, Hussain, Iqbal, Hutchinson, Simon, Imlach, Marie, Irving, Greg, Jacobsen, Nicholas, Kennard, James, Khan, Umar, Knox, Kyle, Krasucki, Christopher, Law, Tom, Lee, Rem, Lester, Nicola, Lewis, David, Lunn, James, Mackintosh, Claire I., Mathukia, Mehul, Moore, Patrick, Morton, Seb, Murphy, Daniel, Nally, Rhiannon, Ndukauba, Chinonso, Ogundapo, Olufunto, Okeke, Henry, Patel, Amit, Patel, Kavil, Penfold, Ruth, Poonian, Satveer, Popoola, Olajide, Pora, Alexander, Prasad, Vibhore, Prasad, Rishabh, Razzaq, Omair, Richardson, Scot, Royal, Simon, Safa, Afsana, Sehdev, Satash, Sevenoaks, Tamsin, Shah, Divya, Sheikh, Aadil, Short, Vanessa, Sidhu, Baljinder S, Singh, Ivor, Soni, Yusuf, Thalasselis, Chris, Wilson, Pete, Wingfield, David, Wong, Michael, Woodall, Maximillian N J, Wooding, Nick, Woods, Sharon, Yong, Joanna, Yongblah, Francis, Zafar, Azhar, Butler, Christopher C, Hobbs, F D Richard, Gbinigie, Oghenekome A, Rahman, Najib M, Hayward, Gail, Richards, Duncan B, Dorward, Jienchi, Lowe, David M, Standing, Joseph F, Breuer, Judith, Khoo, Saye, Petrou, Stavros, Hood, Kerenza, Nguyen-Van-Tam, Jonathan S, Patel, Mahendra G, Saville, Benjamin R, Marion, Joe, Ogburn, Emma, Allen, Julie, Rutter, Heather, Francis, Nick, Thomas, Nicholas P B, Evans, Philip, Dobson, Melissa, Madden, Tracie-Ann, Holmes, Jane, Harris, Victoria, Png, May Ee, Lown, Mark, van Hecke, Oliver, Detry, Michelle A, Saunders, Christina T, Fitzgerald, Mark, Berry, Nicholas S, Mwandigha, Lazaro, Galal, Ushma, Mort, Sam, Jani, Bhautesh D, Hart, Nigel D, Ahmed, Haroon, Butler, Daniel, McKenna, Micheal, Chalk, Jem, Lavallee, Layla, Hadley, Elizabeth, Cureton, Lucy, Benysek, Magdalena, Andersson, Monique, Coates, Maria, Barrett, Sarah, Bateman, Clare, Davies, Jennifer C, Raymundo-Wood, Ivy, Ustianowski, Andrew, Carson-Stevens, Andrew, Yu, Ly-Mee, and Little, Paul

Published
2023
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11. Sex differences in cancer outcomes across the range of eGFR.

Author

Shemilt, Richard, Sullivan, Michael K, Hanlon, Peter, Jani, Bhautesh D, Mata, Nicole De La, Rosales, Brenda, Elyan, Benjamin M P, Hedley, James A, Cutting, Rachel B, Wyld, Melanie, McAllister, David A, Webster, Angela C, Mark, Patrick B, and Lees, Jennifer S

Subjects
PROPORTIONAL hazards models, GENITALIA, KIDNEY function tests, CHRONIC kidney failure, RENAL cancer
Abstract

Background People with chronic kidney disease (CKD) have increased incidence and mortality of most cancer types. We hypothesized that the odds of presenting with advanced cancer may vary according to differences in estimated glomerular filtration rate (eGFR), that this could contribute to increased all-cause mortality and that sex differences may exist. Methods Data were from Secure Anonymised Information Linkage Databank, including people with de novo cancer diagnosis (2011–17) and two kidney function tests within 2 years prior to diagnosis to determine baseline eGFR (mL/min/1.73 m2). Logistic regression models determined the odds of presenting with advanced cancer by baseline eGFR. Cox proportional hazards models tested associations between baseline eGFRCr and all-cause mortality. Results eGFR <30 was associated with higher odds of presenting with advanced cancer of prostate, breast and female genital organs, but not other cancer sites. Compared with eGFR >75–90, eGFR <30 was associated with greater hazards of all-cause mortality in both sexes, but the association was stronger in females [female: hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.56–1.88; male versus female comparison: HR 0.88, 95% CI 0.78–0.99]. Conclusions Lower or higher eGFR was not associated with substantially higher odds of presenting with advanced cancer across most cancer sites, but was associated with reduced survival. A stronger association with all-cause mortality in females compared with males with eGFR <30 is concerning and warrants further scrutiny. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Vitamin D concentrations and COVID-19 infection in UK Biobank

Author

Hastie, Claire E., Mackay, Daniel F., Ho, Frederick, Celis-Morales, Carlos A., Katikireddi, Srinivasa Vittal, Niedzwiedz, Claire L., Jani, Bhautesh D., Welsh, Paul, Mair, Frances S., Gray, Stuart R., O’Donnell, Catherine A., Gill, Jason MR., Sattar, Naveed, and Pell, Jill P.

Published
2020
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14. Evidence for exercise-based interventions across 45 different long-term conditions: an overview of systematic reviews

Author

Dibben, Grace O., primary, Gardiner, Lucy, additional, Young, Hannah M.L., additional, Wells, Valerie, additional, Evans, Rachael A., additional, Ahmed, Zahira, additional, Barber, Shaun, additional, Dean, Sarah, additional, Doherty, Patrick, additional, Gardiner, Nikki, additional, Greaves, Colin, additional, Ibbotson, Tracy, additional, Jani, Bhautesh D., additional, Jolly, Kate, additional, Mair, Frances S., additional, McIntosh, Emma, additional, Ormandy, Paula, additional, Simpson, Sharon A., additional, Ahmed, Sayem, additional, Krauth, Stefanie J., additional, Steell, Lewis, additional, Singh, Sally J., additional, Taylor, Rod S., additional, Begum, Samina, additional, DeBarros, Clara, additional, Davies, Firoza, additional, Sterniczuk, Kamil, additional, Kumar, Rashmi, additional, Longley, Rebecca, additional, Freeman, Andrew, additional, Lalseta, Jagruti, additional, Ashby, Paul, additional, Van Grieken, Marc, additional, and Grace Elder, Dorothy, additional

Published
2024
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18. Cost-utility analysis of molnupiravir for high-risk, community-based adults with COVID-19: an economic evaluation of the PANORAMIC trial.

Author

Png, May Ee, Harris, Victoria, Grabey, Jenna, Hart, Nigel D, Jani, Bhautesh D, Butler, Daniel, Carson-Stevens, Andrew, Coates, Maria, Cureton, Lucy, Dobson, Melissa, Dorward, Jienchi, Evans, Philip, Francis, Nick, Gbinigie, Oghenekome A, Hayward, Gail, Holmes, Jane, Hood, Kerenza, Khoo, Saye, Ahmed, Haroon, and Lown, Mark

Subjects
COVID-19, COST benefit analysis, COST effectiveness, QUALITY-adjusted life years, MOLNUPIRAVIR
Abstract

Background: The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. Aim: To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months. Design and setting: An economic evaluation of the PANORAMIC trial in the UK. Method: A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement. Results: In the base-case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold. Conclusion: At the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Associations between multimorbidity and adverse health outcomes in UK Biobank and the SAIL Databank: A comparison of longitudinal cohort studies

Author

Hanlon, Peter, Jani, Bhautesh D., Nicholl, Barbara, Lewsey, Jim, McAllister, David A., and Mair, Frances S.

Subjects
Comorbidity -- Risk factors, Chronic diseases -- Development and progression -- Patient outcomes, Biological sciences
Abstract

Background Cohorts such as UK Biobank are increasingly used to study multimorbidity; however, there are concerns that lack of representativeness may lead to biased results. This study aims to compare associations between multimorbidity and adverse health outcomes in UK Biobank and a nationally representative sample. Methods and findings These are observational analyses of cohorts identified from linked routine healthcare data from UK Biobank participants (n = 211,597 from England, Scotland, and Wales with linked primary care data, age 40 to 70, mean age 56.5 years, 54.6% women, baseline assessment 2006 to 2010) and from the Secure Anonymised Information Linkage (SAIL) databank (n = 852,055 from Wales, age 40 to 70, mean age 54.2, 50.0% women, baseline January 2011). Multimorbidity (n = 40 long-term conditions [LTCs]) was identified from primary care Read codes and quantified using a simple count and a weighted score. Individual LTCs and LTC combinations were also assessed. Associations with all-cause mortality, unscheduled hospitalisation, and major adverse cardiovascular events (MACEs) were assessed using Weibull or negative binomial models adjusted for age, sex, and socioeconomic status, over 7.5 years follow-up for both datasets. Multimorbidity was less common in UK Biobank than SAIL (26.9% and 33.0% with [greater than or equal to]2 LTCs in UK Biobank and SAIL, respectively). This difference was attenuated, but persisted, after standardising by age, sex, and socioeconomic status. The association between increasing multimorbidity count and mortality, hospitalisation, and MACE was similar between both datasets at LTC counts of [less than or equal to]3; however, above this level, UK Biobank underestimated the risk associated with multimorbidity (e.g., mortality hazard ratio for 2 LTCs 1.62 (95% confidence interval 1.57 to 1.68) in SAIL and 1.51 (1.43 to 1.59) in UK Biobank, hazard ratio for 5 LTCs was 3.46 (3.31 to 3.61) in SAIL and 2.88 (2.63 to 3.15) in UK Biobank). Absolute risk of mortality, hospitalisation, and MACE, at all levels of multimorbidity, was lower in UK Biobank than SAIL (adjusting for age, sex, and socioeconomic status). Both cohorts produced similar hazard ratios for some LTCs (e.g., hypertension and coronary heart disease), but UK Biobank underestimated the risk for others (e.g., alcohol-related disorders or mental health conditions). Hazard ratios for some LTC combinations were similar between the cohorts (e.g., cardiovascular conditions); however, UK Biobank underestimated the risk for combinations including other conditions (e.g., mental health conditions). The main limitations are that SAIL databank represents only part of the UK (Wales only) and that in both cohorts we lacked data on severity of the LTCs included. Conclusions In this study, we observed that UK Biobank accurately estimates relative risk of mortality, unscheduled hospitalisation, and MACE associated with LTC counts [less than or equal to]3. However, for counts [greater than or equal to]4, and for some LTC combinations, estimates of magnitude of association from UK Biobank are likely to be conservative. Researchers should be mindful of these limitations of UK Biobank when conducting and interpreting analyses of multimorbidity. Nonetheless, the richness of data available in UK Biobank does offers opportunities to better understand multimorbidity, particularly where complementary data sources less susceptible to selection bias can be used to inform and qualify analyses of UK Biobank., Author(s): Peter Hanlon 1, Bhautesh D. Jani 1, Barbara Nicholl 1, Jim Lewsey 2, David A. McAllister 3, Frances S. Mair 1,* Introduction Multimorbidity, the coexistence of multiple long-term conditions [...]

Published
2022
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21. Comparison of two different frailty measurements and risk of hospitalisation or death from COVID-19: findings from UK Biobank

Author

Petermann-Rocha, Fanny, Hanlon, Peter, Gray, Stuart R., Welsh, Paul, Gill, Jason M. R., Foster, Hamish, Katikireddi, S. Vittal, Lyall, Donald, Mackay, Daniel F., O’Donnell, Catherine A., Sattar, Naveed, Nicholl, Barbara I., Pell, Jill P., Jani, Bhautesh D., Ho, Frederick K., Mair, Frances S., and Celis-Morales, Carlos

Published
2020
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24. Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada.

Author

Nguyen, Tu N., Kalia, Sumeet, Hanlon, Peter, Jani, Bhautesh D., Nicholl, Barbara I., Christie, Chelsea D., Aliarzadeh, Babak, Moineddin, Rahim, Harrison, Christopher, Chow, Clara, Fortin, Martin, Mair, Frances S., and Greiver, Michelle

Subjects
HYPERTENSION, RESEARCH, OBESITY, DIURETICS, ANTIHYPERTENSIVE agents, STRUCTURAL equation modeling, CONFIDENCE intervals, SYSTOLIC blood pressure, CHRONIC diseases, MYOCARDIAL ischemia, SCHIZOPHRENIA, CALCIUM antagonists, DIABETES, ACE inhibitors, PRIMARY health care, DIASTOLIC blood pressure, LEANNESS, ADRENERGIC beta blockers, PEARSON correlation (Statistics), COMPARATIVE studies, T-test (Statistics), MENTAL depression, DEMENTIA, OSTEOARTHRITIS, CHI-squared test, STATISTICAL correlation, LOGISTIC regression analysis, ODDS ratio, ANXIETY, SMOKING, ANGIOTENSIN receptors, COMORBIDITY, HEART failure
Abstract

Background: There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control. Methods: This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019. Uncontrolled BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. A list of 11 a priori selected chronic conditions was used to define multimorbidity. Multimorbidity was defined as having ≥1 long-term condition in addition to hypertension. Logistic regression models were used to estimate the association between multimorbidity (or individual long-term conditions) with uncontrolled BP. Results: A total of 67 385 patients with hypertension were included. They had a mean age of 70, 53.1% were female, 80.6% had multimorbidity, and 35.7% had uncontrolled BP. Patients with multimorbidity had lower odds of uncontrolled BP than those without multimorbidity (adjusted OR = 0.72, 95% CI 0.68-0.76). Among the long-term conditions, diabetes (aOR = 0.73, 95%CI 0.70-0.77), heart failure (aOR = 0.81, 95%CI 0.73-0.91), ischemic heart disease (aOR = 0.74, 95%CI 0.69-0.79), schizophrenia (aOR = 0.79, 95%CI 0.65-0.97), depression/anxiety (aOR = 0.91, 95%CI 0.86-0.95), dementia (aOR = 0.87, 95%CI 0.80-0.95), and osteoarthritis (aOR = 0.89, 95%CI 0.85-0.93) were associated with a lower likelihood of uncontrolled BP. Conclusion: We found that multimorbidity was associated with better BP control. Several conditions were associated with better control, including diabetes, heart failure, ischemic heart disease, schizophrenia, depression/anxiety, dementia, and osteoarthritis. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Supplemental Material - Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study

Author

McLoone, Philip, Jani, Bhautesh D, Siebert, Stefan, Morton, Fraser R, Canning, Jordan, Macdonald, Sara, Mair, Frances S, and Nicholl, Barbara I

Subjects
Medicine
Abstract

Supplemental Material for Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study by Philip McLoone, BSc, Bhautesh D Jani, MD, PhD, Stefan Siebert, MD, PhD, Fraser R Morton, MRes, Jordan Canning, MRes, Sara Macdonald, PhD, Frances S Mair, MD, DRCOG, FRCGP and Barbara I Nichol, PhD in Journal of Multimorbidity and Comorbidity

Published
2023
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27. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Author

Butler, Christopher C, primary, Hobbs, F D Richard, additional, Gbinigie, Oghenekome A, additional, Rahman, Najib M, additional, Hayward, Gail, additional, Richards, Duncan B, additional, Dorward, Jienchi, additional, Lowe, David M, additional, Standing, Joseph F, additional, Breuer, Judith, additional, Khoo, Saye, additional, Petrou, Stavros, additional, Hood, Kerenza, additional, Nguyen-Van-Tam, Jonathan S, additional, Patel, Mahendra G, additional, Saville, Benjamin R, additional, Marion, Joe, additional, Ogburn, Emma, additional, Allen, Julie, additional, Rutter, Heather, additional, Francis, Nick, additional, Thomas, Nicholas P B, additional, Evans, Philip, additional, Dobson, Melissa, additional, Madden, Tracie-Ann, additional, Holmes, Jane, additional, Harris, Victoria, additional, Png, May Ee, additional, Lown, Mark, additional, van Hecke, Oliver, additional, Detry, Michelle A, additional, Saunders, Christina T, additional, Fitzgerald, Mark, additional, Berry, Nicholas S, additional, Mwandigha, Lazaro, additional, Galal, Ushma, additional, Mort, Sam, additional, Jani, Bhautesh D, additional, Hart, Nigel D, additional, Ahmed, Haroon, additional, Butler, Daniel, additional, McKenna, Micheal, additional, Chalk, Jem, additional, Lavallee, Layla, additional, Hadley, Elizabeth, additional, Cureton, Lucy, additional, Benysek, Magdalena, additional, Andersson, Monique, additional, Coates, Maria, additional, Barrett, Sarah, additional, Bateman, Clare, additional, Davies, Jennifer C, additional, Raymundo-Wood, Ivy, additional, Ustianowski, Andrew, additional, Carson-Stevens, Andrew, additional, Yu, Ly-Mee, additional, Little, Paul, additional, Agyeman, Akosua A, additional, Ahmed, Tanveer, additional, Allcock, Damien, additional, Beltran-Martinez, Adrian, additional, Benedict, Oluseye E, additional, Bird, Nigel, additional, Brennan, Laura, additional, Brown, Julianne, additional, Burns, Gerard, additional, Butler, Mike, additional, Cheng, Zelda, additional, Danson, Ruth, additional, de Kare-Silver, Nigel, additional, Dhasmana, Devesh, additional, Dickson, Jon, additional, Engamba, Serge, additional, Fisher, Stacey, additional, Fox, Robin, additional, Frost, Eve, additional, Gaunt, Richard, additional, Ghosh, Sarit, additional, Gilkar, Ishtiaq, additional, Goodman, Anna, additional, Granier, Steve, additional, Howell, Aleksandra, additional, Hussain, Iqbal, additional, Hutchinson, Simon, additional, Imlach, Marie, additional, Irving, Greg, additional, Jacobsen, Nicholas, additional, Kennard, James, additional, Khan, Umar, additional, Knox, Kyle, additional, Krasucki, Christopher, additional, Law, Tom, additional, Lee, Rem, additional, Lester, Nicola, additional, Lewis, David, additional, Lunn, James, additional, Mackintosh, Claire I., additional, Mathukia, Mehul, additional, Moore, Patrick, additional, Morton, Seb, additional, Murphy, Daniel, additional, Nally, Rhiannon, additional, Ndukauba, Chinonso, additional, Ogundapo, Olufunto, additional, Okeke, Henry, additional, Patel, Amit, additional, Patel, Kavil, additional, Penfold, Ruth, additional, Poonian, Satveer, additional, Popoola, Olajide, additional, Pora, Alexander, additional, Prasad, Vibhore, additional, Prasad, Rishabh, additional, Razzaq, Omair, additional, Richardson, Scot, additional, Royal, Simon, additional, Safa, Afsana, additional, Sehdev, Satash, additional, Sevenoaks, Tamsin, additional, Shah, Divya, additional, Sheikh, Aadil, additional, Short, Vanessa, additional, Sidhu, Baljinder S, additional, Singh, Ivor, additional, Soni, Yusuf, additional, Thalasselis, Chris, additional, Wilson, Pete, additional, Wingfield, David, additional, Wong, Michael, additional, Woodall, Maximillian N J, additional, Wooding, Nick, additional, Woods, Sharon, additional, Yong, Joanna, additional, Yongblah, Francis, additional, and Zafar, Azhar, additional

Published
2023
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31. Rates, causes and predictors of all-cause and avoidable mortality in 163 686 children and young people with and without intellectual disabilities: a record linkage national cohort study

Author

Hughes-McCormack, Laura Anne, primary, Rydzewska, Ewelina, additional, Cooper, Sally-Ann, additional, Fleming, Michael, additional, Mackay, Daniel, additional, Dunn, Kirsty, additional, Ward, Laura, additional, Sosenko, Filip, additional, Barlow, Fiona, additional, Miller, Jenny, additional, Symonds, Joseph D, additional, Jani, Bhautesh D, additional, Truesdale, Maria, additional, Cairns, Deborah, additional, Pell, Jill, additional, Henderson, Angela, additional, and Melville, Craig, additional

Published
2022
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32. Rates, causes and predictors of all-cause and avoidable mortality in 163,686 children and young people with and without intellectual disabilities: A record linkage national cohort study

Author

Hughes-McCormack, Laura, primary, Rydzewska, Ewelina, additional, Cooper, Sally-Ann, additional, Fleming, Michael, additional, Mackay, Daniel, additional, Dunn, Kirsty, additional, Ward, Laura, additional, Sosenko, Filip, additional, Barlow, Fiona, additional, Miller, Jenny, additional, Symonds, Joseph D, additional, Jani, Bhautesh D, additional, Truesdale, Maria, additional, Kinnear, Deborah, additional, Pell, Jill, additional, Henderson, Angela, additional, and Melville, Craig, additional

Published
2022
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34. Experiences of multimorbidity in urban and rural Malawi: an interview study of burdens of treatment and lack of treatment

Author

Chikumbu, Edith F., Bunn, Christopher, Kasenda, Stephen, Dube, Albert, Phiri-Makwakwa, Enita, Jani, Bhautesh D., Jobe, Modu, Wyke, Sally, Seeley, Janet, Crampin, Amelia C., and Mair, Frances S.

Subjects
H1, R1, RA
Abstract

Multimorbidity (presence of ≥2 long term conditions (LTCs)) is a growing global health challenge, yet we know little about the experiences of those living with multimorbidity in low- and middle-income countries (LMICs). We therefore explore: 1) experiences of men and women living with multimorbidity in urban and rural Malawi including their experiences of burden of treatment and 2) examine the utility of Normalization Process Theory (NPT) and Burden of Treatment Theory (BOTT) for structuring analytical accounts of these experiences. We conducted in depth, semi-structured interviews with 32 people in rural (n = 16) and urban settings (n = 16); 16 males, 16 females; 15 under 50 years; and 17 over 50 years. Data were analysed thematically and then conceptualised through the lens of NPT and BOTT. Key elements of burden of treatment identified included: coming to terms with and gaining an understanding of life with multimorbidity; dealing with resulting disruptions to family life; the work of seeking family and community support; navigating healthcare systems; coping with lack of continuity of care; enacting self-management advice; negotiating medical advice; appraising treatments; and importantly, dealing with the burden of lack of treatments/services. Poverty and inadequate healthcare provision constrained capacity to deal with treatment burden while supportive social and community networks were important enabling features. Greater access to health information/education would lessen treatment burden as would better resourced healthcare systems and improved standards of living. Our work demonstrates the utility of NPT and BOTT for aiding conceptualisation of treatment burden issues in LMICs but our findings highlight that ‘lack’ of access to treatments or services is an important additional burden which must be integrated in accounts of treatment burden in LMICs.

Published
2022

38. Associations between multimorbidity and adverse health outcomes in UK Biobank and the SAIL Databank: A comparison of longitudinal cohort studies

Author

Hanlon, Peter, Jani, Bhautesh D., Nicholl, Barbara, Lewsey, Jim, McAllister, David A., and Mair, Frances S.

Subjects
Adult, Cohort Studies, Male, Scotland, Outcome Assessment, Health Care, Humans, Multimorbidity, Female, General Medicine, Longitudinal Studies, Middle Aged, Aged, Biological Specimen Banks
Abstract

Background Cohorts such as UK Biobank are increasingly used to study multimorbidity; however, there are concerns that lack of representativeness may lead to biased results. This study aims to compare associations between multimorbidity and adverse health outcomes in UK Biobank and a nationally representative sample. Methods and findings These are observational analyses of cohorts identified from linked routine healthcare data from UK Biobank participants (n = 211,597 from England, Scotland, and Wales with linked primary care data, age 40 to 70, mean age 56.5 years, 54.6% women, baseline assessment 2006 to 2010) and from the Secure Anonymised Information Linkage (SAIL) databank (n = 852,055 from Wales, age 40 to 70, mean age 54.2, 50.0% women, baseline January 2011). Multimorbidity (n = 40 long-term conditions [LTCs]) was identified from primary care Read codes and quantified using a simple count and a weighted score. Individual LTCs and LTC combinations were also assessed. Associations with all-cause mortality, unscheduled hospitalisation, and major adverse cardiovascular events (MACEs) were assessed using Weibull or negative binomial models adjusted for age, sex, and socioeconomic status, over 7.5 years follow-up for both datasets. Multimorbidity was less common in UK Biobank than SAIL (26.9% and 33.0% with ≥2 LTCs in UK Biobank and SAIL, respectively). This difference was attenuated, but persisted, after standardising by age, sex, and socioeconomic status. The association between increasing multimorbidity count and mortality, hospitalisation, and MACE was similar between both datasets at LTC counts of ≤3; however, above this level, UK Biobank underestimated the risk associated with multimorbidity (e.g., mortality hazard ratio for 2 LTCs 1.62 (95% confidence interval 1.57 to 1.68) in SAIL and 1.51 (1.43 to 1.59) in UK Biobank, hazard ratio for 5 LTCs was 3.46 (3.31 to 3.61) in SAIL and 2.88 (2.63 to 3.15) in UK Biobank). Absolute risk of mortality, hospitalisation, and MACE, at all levels of multimorbidity, was lower in UK Biobank than SAIL (adjusting for age, sex, and socioeconomic status). Both cohorts produced similar hazard ratios for some LTCs (e.g., hypertension and coronary heart disease), but UK Biobank underestimated the risk for others (e.g., alcohol-related disorders or mental health conditions). Hazard ratios for some LTC combinations were similar between the cohorts (e.g., cardiovascular conditions); however, UK Biobank underestimated the risk for combinations including other conditions (e.g., mental health conditions). The main limitations are that SAIL databank represents only part of the UK (Wales only) and that in both cohorts we lacked data on severity of the LTCs included. Conclusions In this study, we observed that UK Biobank accurately estimates relative risk of mortality, unscheduled hospitalisation, and MACE associated with LTC counts ≤3. However, for counts ≥4, and for some LTC combinations, estimates of magnitude of association from UK Biobank are likely to be conservative. Researchers should be mindful of these limitations of UK Biobank when conducting and interpreting analyses of multimorbidity. Nonetheless, the richness of data available in UK Biobank does offers opportunities to better understand multimorbidity, particularly where complementary data sources less susceptible to selection bias can be used to inform and qualify analyses of UK Biobank.

Published
2021

40. Multimorbidity clusters and their associations with health-related quality of life in two UK cohorts

Author

Steell, Lewis, Krauth, Stefanie J., Ahmed, Sayem, Dibben, Grace O., McIntosh, Emma, Hanlon, Peter, Lewsey, Jim, Nicholl, Barbara I., McAllister, David A., Smith, Susan M., Evans, Rachael, Ahmed, Zahira, Dean, Sarah, Greaves, Colin, Barber, Shaun, Doherty, Patrick, Gardiner, Nikki, Ibbotson, Tracy, Jolly, Kate, Ormandy, Paula, Simpson, Sharon A., Taylor, Rod S., Singh, Sally J., Mair, Frances S., and Jani, Bhautesh D.

Published
2025
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41. Correction: Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort

Author

McQueenie, Ross, primary, Foster, Hamish M. E., additional, Jani, Bhautesh D., additional, Katikireddi, Srinivasa Vittal, additional, Sattar, Naveed, additional, Pell, Jill P, additional, Ho, Frederick K., additional, Niedzwiedz, Claire L., additional, Hastie, Claire E., additional, Anderson, Jana, additional, Mark, Patrick B., additional, Sullivan, Michael, additional, O’Donnell, Catherine A., additional, Mair, Frances S., additional, and Nicholl, Barbara I., additional

Published
2021
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44. Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants

Author

Ho, Frederick K., primary, Petermann-Rocha, Fanny, additional, Gray, Stuart R., additional, Jani, Bhautesh D., additional, Katikireddi, S. Vittal, additional, Niedzwiedz, Claire L., additional, Foster, Hamish, additional, Hastie, Claire E., additional, Mackay, Daniel F., additional, Gill, Jason M. R., additional, O'Donnell, Catherine, additional, Welsh, Paul, additional, Mair, Frances, additional, Sattar, Naveed, additional, Celis-Morales, Carlos A., additional, and Pell, Jill P., additional

Published
2020
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48. Corrigendum to “Vitamin D concentrations and COVID-19 infection in UK Biobank” [Diabetes Metabol Syndr: Clin Res Rev 2020 14 (4) 561–5]

Author

Hastie, Claire E., primary, Mackay, Daniel F., additional, Ho, Frederick, additional, Celis-Morales, Carlos A., additional, Katikireddi, Srinivasa Vittal, additional, Niedzwiedz, Claire L., additional, Jani, Bhautesh D., additional, Welsh, Paul, additional, Mair, Frances S., additional, Gray, Stuart R., additional, O’Donnell, Catherine A., additional, Gill, Jason MR., additional, Sattar, Naveed, additional, and Pell, Jill P., additional

Published
2020
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49. Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort

Author

McQueenie, Ross, primary, Foster, Hamish M. E., additional, Jani, Bhautesh D., additional, Katikireddi, Srinivasa Vittal, additional, Sattar, Naveed, additional, Pell, Jill P., additional, Ho, Frederick K., additional, Niedzwiedz, Claire L., additional, Hastie, Claire E., additional, Anderson, Jana, additional, Mark, Patrick B., additional, Sullivan, Michael, additional, O’Donnell, Catherine A., additional, Mair, Frances S., additional, and Nicholl, Barbara I., additional

Published
2020
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