NHS Digital Data Release Register - reformatted

University Of Surrey

Project 1 — DARS-NIC-203503-X7K8K

Opt outs honoured: N

Sensitive: Non Sensitive, and Sensitive

When: 2017/03 — 2017/05.

Repeats: One-Off

Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Outpatients
  • Office for National Statistics Mortality Data

Benefits:

The high CVD morbidity and mortality amongst the Asian population compared to Europeans represents a significant health inequality which needs to be explored, explained and addressed. Currently the precise risk is not known, so the costs effectiveness of a possible greater intensity of cholesterol, blood pressure and other interventions can’t be defined. Inclusion of enhanced treatment in national and international guidelines generally requires demonstration of cost effectiveness. By precisely calculating risk the University of Surrey will enable cost-effectiveness of any enhanced intervention to be determined. The current recommended method for risk prediction is NOT adequate for this group and uncertainty of risk leads generally to standard guidelines being applied and the consequent under-treatment widens the inequalities in CVD outcomes for this population. Some patients may also be inappropriately over treated where individual clinician approximate additional risk. This study has received a large investment from the NIHR, through a competitive, peer reviewed application process, to produce results of the highest standards to ensure this issue is addressed. The results will be used to derive a new model for CVD prediction for British Asians and this will be disseminated into routine clinical care. This research will result in clinicians being able to make informed decisions on how aggressively to treat this group as a whole, or specific subgroups (e.g. people with diabetes). Preventative treatment will benefit health care both in terms of improved health outcomes and associated reduced health care costs.

Outputs:

All outputs will be aggregate with small numbers suppressed in line with the HES Analysis guide. The outputs from this research will be published in major scientific journals. Target journals include the Lancet and New England Journal of Medicine. It is anticipated that the outputs will directly impact national guidelines in the preventative management regimes implemented for public health as well as in primary and secondary care. This is likely to be in place within two years of publication. Outputs will also directly impact the treatment of the study participants as well as the needs of the west London community for education and service development. There have already been many publications from the LOLIPOP study team including; 1. Coronary heart disease in Indian Asians. Tan ST, Scott W, Panoulas V, Sehmi J, Zhang W, Scott J, Elliott P, Chambers J, Kooner JS. Glob Cardiol Sci Pract. 2014 Jan 29;2014(1):13-23. doi: 10.5339/gcsp.2014.4. Collection 2014. PMID: 25054115 2. 6. Prevalence of coronary artery calcium scores and silent myocardial ischaemia was similar in Indian Asians and European whites in a cross-sectional study of asymptomatic subjects from a U.K. population (LOLIPOP-IPC). Jain P, Kooner JS, Raval U, Lahiri A. J Nucl Cardiol. 2011 May;18(3):435-42. doi: 10.1007/s12350-011-9371-2. Epub 2011 Apr 9. PMID: 21479755 3. 9. Ethnicity-related differences in left ventricular function, structure and geometry: a population study of UK Indian Asian and European white subjects. Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. 4. A replication study of GWAS-derived lipid genes in Asian Indians: the chromosomal region 11q23.3 harbors loci contributing to triglycerides. Braun TR, Been LF, Singhal A, Worsham J, Ralhan S, Wander GS, Chambers JC, Kooner JS, Aston CE, Sanghera DK. PLoS One. 2012;7(5):e37056. doi: 10.1371/journal.pone.0037056. Epub 2012 May 18. PMID: 22623978

Processing:

The University of Surrey are conducting a first full follow up of the participants in the LOLIPOP study and therefore need access to data from all the patients from the cohort that have been in the study for the past 10 years. Both HES and ONS data will be linked to cohort data to maximize the identification of their CVD outcomes (stroke, advanced coronary artery disease and myocardial infarction) to allow a more rigorous evaluation. Particularly as many people may have moved away from northwest London. NHS Digital will use the consented cohort already flagged under MR1143 to link to the requested data. The University of Surrey would receive a pseudonymised output from the HSCIC, which will be encrypted so re-identification cannot take place. No record level data will be provided to third parties and none of the data will be used within any commercial tool or product or for commercial gain. Only substantive employees of the University of Surrey will have access to the data and only for the purposes described in this document.

Objectives:

The Imperial College study team have recorded baseline characterisation of approximately 30,000 Indian Asian men and women aged 35-74 years and free from clinically manifest cardiovascular disease (CVD), in the London Life Sciences Prospective Population (LOLIPOP) study. LOLIPOP aims to precisely calculate the increased vascular risk for British Asians. Health economic analysis of the introduction of the CVD risk prediction calculator for use in Indian Asians will be performed as well as a qualitative study to evaluate the utility and acceptability to general practitioners and individuals of implementing the CVD risk prediction model in general practice. In parallel University of Surrey will develop models and conduct an economic evaluation to examine the cost-effectiveness of using the new risk estimator to detect the number of Asian men at risk. This includes the costs of identifying the cohort using the new risk estimator and putting them in a preventative scheme, and the benefit, both in terms of improved health outcomes and associated reduced health care costs