Showing papers by "Colin J Crooks published in 2012"
TL;DR: The existence of such a steep gradient suggests that there are opportunities to reduce hospitalizations down to the low rates seen in the most affluent areas, and thus, there is the potential to prevent almost 10 000 admissions and over 1000 deaths a year.
Abstract: Objective Inequalities in health are well recognized in cardiovascular disease and cancer, but in comparison, we have minimal understanding for upper gastrointestinal bleeding. Since furthering our understanding of such inequality signposts preventable disease, we investigated in detail the association between upper gastrointestinal bleeding and socioeconomic status. Design Population-based cohort study. Setting All English National Health Service hospitals. Population English adult population, 1 January 2001 to 31 December 2007. Exposure measures Deprivation scores defined according to quintiles of neighbourhood areas ranked by the Indices of Multiple Deprivation for England 2007. Outcome measures Rates of all adult admissions coded with a primary diagnosis of upper gastrointestinal bleed were analysed by deprivation quintile and adjusted for age, sex, region and year using Poisson regression. Results The annual hospitalization rate for non-variceal haemorrhage was 84.6 per 100 000 population (95% CI 83.5 to 84.1; n=237 145), and for variceal haemorrhage, it was 2.83 per 100 000 population (95% CI 2.87 to 2.99; n=8291). There was a twofold increase in the hospitalization rate ratio for non-variceal haemorrhage from the most deprived areas compared to the least deprived (2.00, 95% CI 1.98 to 2.03). The ratio for variceal haemorrhage was even more pronounced (2.49, 95% CI 2.32 to 2.67). Inequality increased over the study period (non-variceal p Conclusion Both variceal and non-variceal haemorrhage hospitalization rates increased with deprivation, and there was a similar gradient in all areas of the country and in all age bands. The existence of such a steep gradient suggests that there are opportunities to reduce hospitalizations down to the low rates seen in the most affluent, and thus, there is the potential to prevent almost 10 000 admissions and over 1000 deaths a year.
47 citations
TL;DR: Restrictive definitions of gastrointestinal bleeding in linked datasets fail to capture the full heterogeneity in coding possible following complex clinical events, and too broad a definition in primary care introduces events not severe enough to warrant hospital admission.
Abstract: Primary care records from the UK have frequently been used to identify episodes of upper gastrointestinal bleeding in studies of drug toxicity because of their comprehensive population coverage and longitudinal recording of prescriptions and diagnoses. Recent linkage within England of primary and secondary care data has augmented this data but the timing and coding of concurrent events, and how the definition of events in linked data effects occurrence and 28 day mortality is not known. We used the recently linked English Hospital Episodes Statistics and General Practice Research Database, 1997–2010, to define events by; a specific upper gastrointestinal bleed code in either dataset, a specific bleed code in both datasets, or a less specific but plausible code from the linked dataset. This approach resulted in 81% of secondary care defined bleeds having a corresponding plausible code within 2 months in primary care. However only 62% of primary care defined bleeds had a corresponding plausible HES admission within 2 months. The more restrictive and specific case definitions excluded severe events and almost halved the 28 day case fatality when compared to broader and more sensitive definitions. Restrictive definitions of gastrointestinal bleeding in linked datasets fail to capture the full heterogeneity in coding possible following complex clinical events. Conversely too broad a definition in primary care introduces events not severe enough to warrant hospital admission. Ignoring these issues may unwittingly introduce selection bias into a study’s results.
35 citations
TL;DR: A sequence of methods for routinely analysing spontaneous report databases that was easily understandable and reproducible is demonstrated, to focus the limited resources for hypothesis testing studies towards adverse events with the strongest support from the data.
Abstract: Background: The detection of adverse events following immunization (AEFI) fundamentally depends on how these events are classified. Standard methods impose a choice between either grouping similar events together to gain power or splitting them into more specific definitions. We demonstrate a method of medically guided Bayesian information sharing that avoids grouping or splitting the data, and we further combine this with the standard epidemiological tools of stratification and multivariate regression.
10 citations
6 citations
TL;DR: This study aimed to develop a scoring system containing both tumour and cirrhosis factors to accurately predict the outcome in patients with small hepatocellular carcinoma (HCC).
Abstract: We thank Drs Wong and Wong for their comments about our study. We fully agree that the model for endstage liver disease (MELD) scoring system plays an important role in determining the degree of liver dysfunction in chronic liver disease patients, in terms of outcome prediction. However, the MELD is a composite prognostic model composed of three variables. Our study aimed to develop a scoring system containing both tumour and cirrhosis factors to accurately predict the outcome in patients with small hepatocellular carcinoma (HCC). Ascites is a wellknown factor to impact the survival of cirrhotic patients with or without HCC. To avoid inter-observer bias, the imaging studies were evaluated by two experienced medical experts to assess the severity of ascites and ensure a consistent result. The effect of antiviral treatment for preventing postoperative tumour recurrence in HCC patients has been a controversial issue. A recent multicentre randomised controlled trial from Taiwan showed that adjuvant interferon a-2b did not reduce the incidence of post-operative recurrence of viral hepatitis-related HCC. The factor of antiviral treatment was not included in the analysis because the aetiology of chronic liver injury in our study population was quite heterogeneous, including single and dual viral infection, alcohol, metabolic and cryptogenic liver disease. Moreover, different anti-cancer treatment modalities were given to our patients. In fact, only a small proportion of patients received different forms of antiviral treatment for a variable duration sometime before or after anti-cancer treatment, making the statistical analysis of using antivirals less robust. The methods of diagnosis and surveillance programme of HCC are mostly according to current guidelines. Some of our patients may not have followed medical advice exactly, or did not receive surveillance for HCC on a regular basis, and it can be argued that these patients could be diagnosed at a late stage, thus with a relatively poor prognosis. However, we believe that the presentation of HCC at diagnosis is a more objective, crucial and reproducible factor to affect the long-term outcome.
1 citations
TL;DR: Adult CD and UC incidence is higher than previously reported in the UK, but has been stable over the past decade, and corresponds to previously reported age and sex distribution.
1 citations