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英国5400多万人的全国队列研究的关联电子健康记录分析
作者:小柯机器人 发布时间:2021/4/11 17:58:06

英国爱丁堡大学Cathie Sudlow团队研究了英国5400多万人的全国队列研究的关联电子健康记录。2021年4月7日,该研究发表在《英国医学杂志》上。

为了描述一种新的英格兰范围的电子健康记录(EHR)资源,从而在确保数据安全和隐私以及维护公众信任的同时,使全人群能够研究covid-19和心血管疾病,研究组使用英国国家医疗服务体系(NHS)关联人员记录的可访问数据资源,从初级保健、医院事件、死亡登记、covid-19实验室检测结果和社区配药数据中设置EHR,并计划进一步充实专科重症监护、心血管和covid-19疫苗接种数据。

2020年1月1日,共有5440万人在英国NHS全科医生处注册。2020年1月1日至10月31日,研究组对确诊和疑似covid-19、典型心血管疾病(突发中风或短暂性缺血发作和突发心肌梗死)和全因死亡进行统计分析。关联队列包括96%以上的英国人。通过综合全国医疗机构的个人数据,大约95%人口的年龄、性别和种族数据是完整的。

在5330万既往无中风或短暂性脑缺血发作诊断的人群中,2020年1月1日至10月31日,共有98721人首次发生中风或短暂性脑缺血发作,其中30%仅记录在初级保健中,4%仅记录在死亡登记记录中。在5320万既往无心肌梗死诊断的人群中,有62966人在随访期间发生心肌梗死,其中8%仅记录在初级保健中,12%仅记录在死亡登记记录中。

共有959470人确诊或疑似covid-19,其中714162例记录在初级保健数据中,126349例记录在住院记录中,776503例记录在covid-19实验室检测数据中,50504记录在死亡登记记录中。虽然有58%均在初级保健数据和covid-19实验室检测数据中记录,但仅有15%和18%分别只在一项数据中记录。

该研究结果表明了将健康环境中的个人水平数据联系起来,以最大限度地提高关键特征的完整性,并确定心血管事件和covid-19诊断的重要性。

附:英文原文

Title: Linked electronic health records for research on a nationwide cohort of more than 54 million people in England: data resource

Author: Angela Wood, Rachel Denholm, Sam Hollings, Jennifer Cooper, Samantha Ip, Venexia Walker, Spiros Denaxas, Ashley Akbari, Amitava Banerjee, William Whiteley, Alvina Lai, Jonathan Sterne, Cathie Sudlow

Issue&Volume: 2021/04/07

Abstract:

Objective To describe a novel England-wide electronic health record (EHR) resource enabling whole population research on covid-19 and cardiovascular disease while ensuring data security and privacy and maintaining public trust.

Design Data resource comprising linked person level records from national healthcare settings for the English population, accessible within NHS Digital’s new trusted research environment.

Setting EHRs from primary care, hospital episodes, death registry, covid-19 laboratory test results, and community dispensing data, with further enrichment planned from specialist intensive care, cardiovascular, and covid-19 vaccination data.

Participants 54.4 million people alive on 1 January 2020 and registered with an NHS general practitioner in England.

Main measures of interest Confirmed and suspected covid-19 diagnoses, exemplar cardiovascular conditions (incident stroke or transient ischaemic attack and incident myocardial infarction) and all cause mortality between 1 January and 31 October 2020.

Results The linked cohort includes more than 96% of the English population. By combining person level data across national healthcare settings, data on age, sex, and ethnicity are complete for around 95% of the population. Among 53.3 million people with no previous diagnosis of stroke or transient ischaemic attack, 98721 had a first ever incident stroke or transient ischaemic attack between 1 January and 31 October 2020, of which 30% were recorded only in primary care and 4% only in death registry records. Among 53.2 million people with no previous diagnosis of myocardial infarction, 62966 had an incident myocardial infarction during follow-up, of which 8% were recorded only in primary care and 12% only in death registry records. A total of 959470 people had a confirmed or suspected covid-19 diagnosis (714162 in primary care data, 126349 in hospital admission records, 776503 in covid-19 laboratory test data, and 50504 in death registry records). Although 58% of these were recorded in both primary care and covid-19 laboratory test data, 15% and 18%, respectively, were recorded in only one.

Conclusions This population-wide resource shows the importance of linking person level data across health settings to maximise completeness of key characteristics and to ascertain cardiovascular events and covid-19 diagnoses. Although this resource was initially established to support research on covid-19 and cardiovascular disease to benefit clinical care and public health and to inform healthcare policy, it can broaden further to enable a wide range of research.

DOI: 10.1136/bmj.n826

Source: https://www.bmj.com/content/373/bmj.n826

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj