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Open Access 16-01-2024 | Dementia | DATA RESOURCE

Assessing the importance of primary care diagnoses in the UK Biobank

Authors: Lei Clifton, Xiaonan Liu, Jennifer A Collister, Thomas J Littlejohns, Naomi Allen, David J Hunter

Published in: European Journal of Epidemiology | Issue 2/2024

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Abstract

The UK Biobank has made general practitioner (GP) data (censoring date 2016–2017) available for approximately 45% of the cohort, whilst hospital inpatient and death registry (referred to as “HES/Death”) data are available cohort-wide through 2018–2022 depending on whether the data comes from England, Wales or Scotland. We assessed the importance of case ascertainment via different data sources in UKB for three diseases that are usually first diagnosed in primary care: Parkinson’s disease (PD), type 2 diabetes (T2D), and all-cause dementia. Including GP data at least doubled the number of incident cases in the subset of the cohort with primary care data (e.g. from 619 to 1390 for dementia). Among the 786 dementia cases that were only captured in the GP data before the GP censoring date, only 421 (54%) were subsequently recorded in HES. Therefore, estimates of the absolute incidence or risk-stratified incidence are misleadingly low when based only on the HES/Death data. For incident cases present in both HES/Death and GP data during the full follow-up period (i.e. until the HES censoring date), the median time difference between an incident diagnosis of dementia being recorded in GP and HES/Death was 2.25 years (i.e. recorded 2.25 years earlier in the GP records). Similar lag periods were also observed for PD (median 2.31 years earlier) and T2D (median 2.82 years earlier). For participants with an incident GP diagnosis, only 65.6% of dementia cases, 69.0% of PD cases, and 58.5% of T2D cases had their diagnosis recorded in HES/Death within 7 years since GP diagnosis. The effect estimates (hazard ratios, HR) of established risk factors for the three health outcomes mostly remain in the same direction and with a similar strength of association when cases are ascertained either using HES only or further adding GP data. The confidence intervals of the HR became narrower when adding GP data, due to the increased statistical power from the additional cases. In conclusion, it is desirable to extend both the coverage and follow-up period of GP data to allow researchers to maximise case ascertainment of chronic health conditions in the UK.
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Literature
1.
go back to reference Sudlow C et al. Mar., UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age, PLoS Med, 2015;12(3). Sudlow C et al. Mar., UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age, PLoS Med, 2015;12(3).
2.
go back to reference Livingston G. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission, Lancet, 2020;396(10248):413–446. Livingston G. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission, Lancet, 2020;396(10248):413–446.
3.
go back to reference Bloem BR, Okun MS, Klein C. Parkinson’s Disease. The Lancet. 2021;397(10291):2284–303.CrossRef Bloem BR, Okun MS, Klein C. Parkinson’s Disease. The Lancet. 2021;397(10291):2284–303.CrossRef
4.
go back to reference Jacobs BM et al. Oct., Parkinson’s disease determinants, prediction and gene–environment interactions in the UK Biobank, J. Neurol. Neurosurg. Psychiatry, 2020;91(10):1046–1054. Jacobs BM et al. Oct., Parkinson’s disease determinants, prediction and gene–environment interactions in the UK Biobank, J. Neurol. Neurosurg. Psychiatry, 2020;91(10):1046–1054.
5.
go back to reference Xu C, Hou Y, Fang X, Yang H, Cao Z. The role of type 2 diabetes in the association between habitual glucosamine use and dementia: a prospective cohort study, Alzheimer’s Res. Ther, 2022;14(1):1–10. Xu C, Hou Y, Fang X, Yang H, Cao Z. The role of type 2 diabetes in the association between habitual glucosamine use and dementia: a prospective cohort study, Alzheimer’s Res. Ther, 2022;14(1):1–10.
7.
go back to reference Bragg F, Trichia E, Aguilar-Ramirez D, Bešević J, Lewington S, Emberson J. Predictive value of circulating NMR metabolic biomarkers for type 2 Diabetes risk in the UK Biobank study. BMC Med. 2022;20(1):1–12.CrossRef Bragg F, Trichia E, Aguilar-Ramirez D, Bešević J, Lewington S, Emberson J. Predictive value of circulating NMR metabolic biomarkers for type 2 Diabetes risk in the UK Biobank study. BMC Med. 2022;20(1):1–12.CrossRef
8.
go back to reference Liu X, Collister JA, Clifton L, Hunter DJ, Littlejohns TJ. Polygenic risk of Prediabetes, undiagnosed Diabetes, and Incident Type 2 Diabetes stratified by Diabetes risk factors. J Endocr Soc. Feb. 2023;7(4):1–7. Liu X, Collister JA, Clifton L, Hunter DJ, Littlejohns TJ. Polygenic risk of Prediabetes, undiagnosed Diabetes, and Incident Type 2 Diabetes stratified by Diabetes risk factors. J Endocr Soc. Feb. 2023;7(4):1–7.
9.
go back to reference Eastwood SV et al. Sep., Algorithms for the Capture and Adjudication of Prevalent and Incident Diabetes in UK Biobank, PLoS One, 2016;11(9). Eastwood SV et al. Sep., Algorithms for the Capture and Adjudication of Prevalent and Incident Diabetes in UK Biobank, PLoS One, 2016;11(9).
12.
go back to reference Stamatakis E, Owen KB, Shepherd L, Drayton B, Hamer M, Bauman AE. Is Cohort Representativeness Passé ? Poststratified Associations of Lifestyle Risk Factors with Mortality in the UK Biobank, Epidemiology, 2021;32(2):179–188. Stamatakis E, Owen KB, Shepherd L, Drayton B, Hamer M, Bauman AE. Is Cohort Representativeness Passé ? Poststratified Associations of Lifestyle Risk Factors with Mortality in the UK Biobank, Epidemiology, 2021;32(2):179–188.
13.
go back to reference Clifton L, Collister JA, Liu X, Littlejohns TJ, Hunter DJ. Assessing agreement between different polygenic risk scores in the UK Biobank. Sci Rep 2022. Jul. 2022;121(1):1–8. Clifton L, Collister JA, Liu X, Littlejohns TJ, Hunter DJ. Assessing agreement between different polygenic risk scores in the UK Biobank. Sci Rep 2022. Jul. 2022;121(1):1–8.
14.
go back to reference Stewart R et al. Jan., A 32-Year Prospective Study of Change in Body Weight and Incident Dementia: The Honolulu-Asia Aging Study, Arch. Neurol, 2005;62(1):55–60. Stewart R et al. Jan., A 32-Year Prospective Study of Change in Body Weight and Incident Dementia: The Honolulu-Asia Aging Study, Arch. Neurol, 2005;62(1):55–60.
15.
go back to reference Sperling RA, et al. Toward defining the preclinical stages of Alzheimer’s Disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s Disease. Alzheimer’s Dement. May 2011;7(3):280–92. Sperling RA, et al. Toward defining the preclinical stages of Alzheimer’s Disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s Disease. Alzheimer’s Dement. May 2011;7(3):280–92.
16.
go back to reference Floud S, et al. Body mass index, diet, Physical Inactivity, and the incidence of Dementia in 1 million UK women. Neurology. Jan. 2020;94(2):e123–32. Floud S, et al. Body mass index, diet, Physical Inactivity, and the incidence of Dementia in 1 million UK women. Neurology. Jan. 2020;94(2):e123–32.
Metadata
Title
Assessing the importance of primary care diagnoses in the UK Biobank
Authors
Lei Clifton
Xiaonan Liu
Jennifer A Collister
Thomas J Littlejohns
Naomi Allen
David J Hunter
Publication date
16-01-2024
Publisher
Springer Netherlands
Published in
European Journal of Epidemiology / Issue 2/2024
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI
https://doi.org/10.1007/s10654-023-01095-0

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