Introduction to UK GO data

GPRD: General Practice Research Database

THIN: Health Improvement Network

Some new data too

Data sources

• Records from GP routine records • GPRD=THIN (almost)• >6% of the UK population• >350 GP practices• >6½ million individual people

UK NHS―National Health Service

• Largest UK employer―4th largest employer in world• 1.7 million employees• 40,000 GPs• 10,000 GP practices• GPs see 140 patients per week

Data content

• Diagnoses: GP and some hospital• Biochemistry: HbA1c etc• Risk factors: weight, smoking etc• Family history (some)• Drugs (all prescribed drugs)• Outpatient contacts • Free text• GPRD only….linked data:

• Cancer registry data• Hospital inpatient data

Quality: representativeness

The Population of the United Kingdom (2001) Compared to the Population of THIN

0

2

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6

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16

18

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age Groups Years

Po

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Population of UK Population of THIN

Quality: completeness

THIN Data - Recording Over Time in adults

0

10

20

30

40

50

60

70

80

90

100

Year

Pati

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ts (

%)

Smoking

Height

Weight

BP

Quality: completeness

0.000%

0.200%

0.400%

0.600%

0.800%

1.000%

1.200%

Geographical region

% d

eath

*

% death in THIN

% death in UK

Strengths

• Size―over 5% UK population• Nationally representative• Fast―information already collected • Frequent collections• All prescribable drugs• Population based• Study design flexibility • ‘Real Life’ data―collected during normal GP visit• Link to GP and patient for additional information

Weaknesses

• £cost! • No direct link to secondary care data (THIN)• No direct link of prescriptions to diagnoses -

temporal implied link• Limited information on OTC medications• Limited data on lifestyles, diet etc• Not dispensed prescriptions• Limited information on hospital prescribing• Some medications only administered by specialists

Weaknesses re Ca.

• Details of the cancer diagnosis variable • No systematic cancer staging data• Metastatic cancer: have to infer• Hospital cancer treatments not known

New data!

Survival after incident cancer: diabetes vs. non-diabetes

Incident cancers by cancer site

All cancers Breast Prostate Colorectal Lung Bladder Ovary and

Endometrium Pancreas Liver Parameter NDM DM NDM DM NDM DM NDM DM NDM DM NDM DM NDM DM NDM DM NDM DM Patients – n; % 140,141 9,890

30,901 1,286

16,872 1,475

15,617 1,363

12,666 891

7,076 716

5,625 424

2,125 375

1,334 252

Age – years (mean) 65.7 71.4

58.8 70.0

72.1 73.6

69.6 72.1

70.1 72.1

70.7 72.4

63.6 67.5

70.8 71.2

68.8 69.8 Sex – % women 53.3 41.0

99.0 97.7

n/a n/a

46.9 39.0

38.6 36.1

27.7 18.8

100.0 100.0

53.8 44.5

47.9 29.8

Smoking – % ever smoked 42.4 52.1

33.1 35.8

44.3 52.1

39.2 49.1

68.5 78.0

52.2 62.7

27.6 31.0

41.4 56.0

43.6 60.7 Diabetes duration – years (mean) n/a 10.4

n/a 11.3

n/a 11.0

n/a 11.2

n/a 8.6

n/a 11.4

n/a 10.4

n/a 5.6

n/a 9.0

BMI males – kg/m2 (mean) 26.0 28.6

25.7 27.8

26.1 28.3

26.3 29.0

25.1 28.4

26.1 28.7

n/a n/a

25.8 28.2

26.5 29.4 BMI females – kg/m2 (mean) 25.8 30.4

25.7 30.7

n/a n/a

25.8 29.5

24.9 29.2

25.8 28.7

27.3 32.7

25.5 28.3

26.2 31.0

SBP – mmHg (mean) 139.5 139.0

138.3 141.8

141.4 140.0

139.3 137.4

138.3 135.3

142.3 140.9

140.6 141.1

140.1 135.3

137.9 136.2 Total cholesterol – mmol/l (mean) 5.0 4.4

5.5 4.8

4.9 4.3

4.9 4.3

4.8 4.2

4.9 4.5

5.5 4.7

5.1 4.4

5.0 4.3

HbA1c in year prior – % 5.8 7.4

5.9 7.5

5.8 7.3

5.8 7.3

6.2 7.5

6.1 7.5

5.8 7.4

6.2 8.5

5.7 7.3 Prior vascular disease – %

Large vessel disease 13.9 30.7

6.1 23.3

19.9 34.3

15.4 30.4

21.5 40.3

19.9 34.6

8.2 20.0

16.2 25.9

17.6 32.9 Eye problems (some) 1.3 14.4

0.9 13.8

1.5 14.5

1.6 16.3

1.5 14.0

1.7 12.4

1.0 12.0

1.8 11.2

1.7 20.2

Eye problems (severe visual loss/blindness) 1.8 3.3

1.1 3.1

1.9 3.0

2.2 3.4

2.4 4.0

2.2 2.1

1.4 3.3

2.6 2.4

2.6 3.2

No renal disease 99.1 92.9

99.7 95.6

98.6 91.1

99.2 93.1

99.1 91.0

98.4 92.2

99.4 94.8

99.1 95.2

99.1 94.8 Mild renal disease 0.0 4.6

0.0 2.8

0.0 5.7

0.0 4.2

0.0 7.0

0.0 5.3

0.0 3.5

0.0 3.0

0.1 2.8

Moderate/severe renal disease 0.9 2.5

0.3 1.5

1.4 3.2

0.7 2.7

0.9 2.0

1.6 2.5

0.6 1.6

0.9 1.8

0.8 2.4 General morbidity:

Charlson index, adjusted – mean 4.7 6.9

3.8 6.5

5.3 7.0

5.0 6.9

5.3 7.2

5.2 6.8

4.3 6.2

5.2 6.6

5.1 7.3 Charlson index, unadjusted – mean 2.5 4.2

2.2 3.9

2.5 4.1

2.4 4.2

2.8 4.5

2.5 4.0

2.3 3.9

2.5 3.9

2.7 4.7

GP contacts in previous year – mean 6.5 10.9

4.9 9.2

6.9 10.3

6.6 10.6

8.7 12.4

7.0 10.2

7.0 9.9

9.0 13.7

8.8 14.0 Total observation time – years 610,856 28,722 198,581 5,211 65,183 4,972 61,308 4,178 13,171 940 32,675 2,685 25,343 1,451 1,484 255 1,502 272

Incident cancers by DM treatment

Diabetes by treatment in the first three months following cancer diagnosis

All non-diabetes

All type 2 diabetes Met mono Sulf mono Insulin mono Met + Sulf Met + Insulin

Patients – n; % 140,141

9,890

1,635 16.5

1,844 18.6

753 7.6

1,295 13.1

320 3.2

Age – years (mean; sd) 65.7 15.0

71.4 9.7

70.2 9.8

73.6 9.3

70.2 9.3

71.7 9.0

67.4 9.0

Sex – % women 53.3

41.0

44.1

40.3

41.3

39.1

43.7 Smoking – % ever smoked 42.4

52.1

53.8

47.8

54.2

51.5

58.1

Diabetes duration – years (mean; median) n/a n/a

10.4 8.9

8.1 6.8

9.9 8.7

15.3 14.3

12.2 10.8

15.5 14.4

BMI males – kg/m2 (mean; sd) 26.0 3.7

28.6 4.3

29.8 4.3

27.3 3.9

28.2 4.4

28.7 4.3

30.2 4.2

BMI females – kg/m2 (mean; sd) 25.8 4.8

30.4 5.9

32.1 5.6

28.3 5.3

29.9 5.9

30.6 5.6

33.6 5.9

Systolic blood pressure – mmHg (mean; sd) 139.5 20.2

139.0 19.5

137.7 18.2

141.4 21.4

139.6 19.9

139.5 18.2

138 17.9

Total cholesterol – mmol/l (mean; sd) 5.0 1.2

4.4 1.1

4.3 1.1

4.5 1.2

4.3 1.1

4.3 1.1

4.1 1.0

HbA1c in year prior – % (mean; sd) 5.8 0.9

7.4 1.5

7.1 1.3

7.4 1.6

8.3 1.6

7.7 1.5

8.3 1.5

Prior vascular disease – % Large vessel disease 13.9

30.7

27.4

32.7

39.6

31.0

35.9

Eye problems (some) 1.3

14.4

10.9

11.0

30.5

16.7

25.6 Eye problems (severe visual loss/blindness) 1.8

3.3

2.0

4.2

4.9

3.0

5.6

No renal disease 99.1

92.9

94.4

92.6

88.4

93.9

91.6 Mild renal disease 0.0

4.6

4.8

4.0

6.2

4.9

7.5

Moderate/severe renal disease 0.9

2.5

0.8

3.4

5.3

1.2

0.9 General morbidity:

Charlson index,adjusted (mean; sd) 4.7 1.8

6.9 1.8

6.5 1.7

7.1 1.9

7.4 2.0

6.9 1.7

6.8 1.8

Charlson index, unadjusted (mean; sd) 2.5 0.9

4.2 1.4

3.9 1.2

4.2 1.5

4.9 1.7

4.2 1.3

4.5 1.5

GP contacts in previous year (mean; median) 6.5 5

10.9 9

10.6 9

10.2 8

13.4 10

10.7 9

13.4 11

Total observation time – years 610,856

28,722

4,564

5,754

2,054

3,950

690

Cancers – n; %

Breast 30,901 22.0

1,286 13.0

276 16.9

233 12.6

87 11.6

184 14.2

51 15.9

Prostate 16,872 12.0

1,475 14.9

274 16.7

259 14.0

89 11.8

234 18.1

48 15.0

Colorectal 15,617 11.1 1,363 13.8 213 13.0 249 13.5 97 12.9 181 14.0 43 13.4

Mean survival by Ca. site (years)

17.4

7.5

26.9

11.0

18.2

8.8

14.2

7.7

13.6

7.9

10.5

8.4

3.3 3.2 2.6 2.61.7 1.4

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All cancers Breast Ovarian & Endometrium

Colorectal Bladder Prostate Liver Lung Pancreas

Δ mean survival by Ca. site (years)

9.9

15.9

9.4

6.45.7

2.1

0.1 0.1 0.30

2

4

6

8

10

12

14

16

18

All cancers Breast Ovarian & Endometrium

Colorectal Bladder Prostate Liver Lung Pancreas

Cumulative mortality (crude)

DM

Non-DM

Cumulative mortality (adjusted)

DM

Non-DM

Adjusted: age, sex, smoking, morbidity

HR DM vs-N-DM (Cox)

Model # Model specification HR 95% CI p-value

Model 1 Age at Ca. diagnosis 1.067 1.024 1.113 0.00229

Model 2 Model 1, plus sex 1.040 0.997 1.084 0.06579

Model 3 Model 2, plus smoking status 1.129 1.082 1.176 0.00000

Model 4 Model 3, plus baseline morbidity* 0.969 0.928 1.011 0.14448

Model 5 Model 4, plus cancer site 0.904 0.860 0.951 0.00009

Model 6 Model 5, plus year of Ca. Diagnosis** 0.890 0.843 0.939 0.00002

Model 7 Model 6, plus no post-Ca. exposure to metformin 1.167 1.076 1.266 0.00018

Key: *, number of GP contacts in the year prior; **, after 1994 only

adjHR: DM vs N-DM (=1) by treatment

1.121.10

0.94

0.87

0.79

0.75

0.80

0.85

0.90

0.95

1.00

1.05

1.10

1.15

Sulfonylurea monotherapy

Insulin monotherpy

Met+Insulin combination

Met+Sulf combination

Metfromin monotherapy

Cum-mortality: ± metformin (adjusted)

Met-

Met+

Met-

Met+

Exposed in first 3 monthsExposed anytime aft Ca. diagHR=0.83; 0.78-0.89; p<0.00001HR=0.72; 0.68-0.76; p<0.00001

Cancer site Cases Events HR p-value Cases Events HR p-value

All cancers 130,270 51,468 0.975 0.918 1.037 0.42163 127,869 50,328 0.835 0.784 0.888 0.00000

Breast 31,720 6,459 1.125 0.918 1.379 0.25766 31,365 6,378 0.997 0.809 1.229 0.97808

Prostate 17,762 5,943 1.147 0.978 1.345 0.09195 17,426 5,834 1.034 0.877 1.218 0.69206

Colorectal 16,368 6,905 0.900 0.761 1.065 0.22008 16,043 6,766 0.783 0.659 0.931 0.00564

Lung 13,083 9,798 0.695 0.597 0.808 0.00000 12,697 9,499 0.626 0.537 0.730 0.00000

Bladder 7,497 2,893 1.107 0.876 1.399 0.39296 7,356 2,823 0.958 0.756 1.216 0.72644

Ovarian and Endomeytrial 5,882 2,165 0.585 0.419 0.817 0.00168 5,747 2,103 0.550 0.390 0.777 0.00069

Pancreas 2,314 1,788 0.712 0.550 0.923 0.01022 2,250 1,737 0.655 0.503 0.853 0.00169

Liver 1,452 1,010 0.705 0.503 0.987 0.04184 1,411 978 0.673 0.475 0.955 0.02636

All cancers 130,270 51,468 0.834 0.787 0.885 0.00000 127,869 50,328 0.717 0.675 0.761 0.00000

Breast 31,720 6,459 1.063 0.891 1.268 0.49931 31,365 6,378 0.927 0.773 1.112 0.41267

Prostate 17,762 5,943 1.061 0.920 1.225 0.41555 17,426 5,834 0.960 0.829 1.112 0.58756

Colorectal 16,368 6,905 0.804 0.688 0.940 0.00611 16,043 6,766 0.709 0.604 0.831 0.00002

Lung 13,083 9,798 0.626 0.533 0.735 0.00000 12,697 9,499 0.562 0.477 0.663 0.00000

Bladder 7,497 2,893 0.929 0.748 1.153 0.50314 7,356 2,823 0.818 0.655 1.020 0.07486

Ovarian and Endomeytrial 5,882 2,165 0.607 0.453 0.813 0.00083 5,747 2,103 0.579 0.429 0.781 0.00035

Pancreas 2,314 1,788 0.626 0.466 0.840 0.00180 2,250 1,737 0.582 0.432 0.785 0.00038

Liver 1,452 1,010 0.569 0.398 0.813 0.00195 1,411 978 0.557 0.385 0.807 0.00198

Model A = age + sex + smoking + metformin parameter; Model B = age + sex + smoking + baseline morbidity + metformin parameter

Met+ vs Met- (<3 mths) Model A

Met+ vs Met- (>3 mths) Model A

95% CI

Met+ vs Met- (<3 mths) Model B

Met+ vs Met- (>3 mths) Model B

95% CI