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Identifying risk of future asthma attacks using UK medical record data: a Respiratory Effectiveness Group initiative

Identifying risk of future asthma attacks using UK medical record data: a Respiratory Effectiveness Group initiative
Identifying risk of future asthma attacks using UK medical record data: a Respiratory Effectiveness Group initiative
Background: Asthma attacks are common, serious, and costly. Individual factors associated with attacks, such as poor symptom control, are not robust predictors.

Objective: We investigated whether the rich data available in UK electronic medical records could identify patients at risk of recurrent attacks.

Methods: We analyzed anonymized, longitudinal medical records of 118,981 patients with actively treated asthma (ages 12-80 years) and ?3 years of data. Potential risk factors during 1 baseline year were evaluated using univariable (simple) logistic regression for outcomes of ?2 and ?4 attacks during the following 2-year period. Predictors with significant univariable association (P<.05) were entered into multiple logistic regression analysis with backwards stepwise selection of the model including all significant independent predictors. The predictive accuracy
of the multivariable models was assessed.

Results: Independent predictors associated with future attacks included baseline-year markers of attacks (acute oral corticosteroid [OCS] courses, emergency visits), more frequent reliever use and healthcare utilization, worse lung function, current smoking, blood eosinophilia, rhinitis, nasal polyps, eczema, gastroesophageal reflux disease, obesity, older age, and being female. The number of OCS courses had the strongest association. The final cross-validated models incorporated 19 and 16 risk factors for ?2 and ?4 attacks over 2 years, respectively, with areas under the curve of 0.785 (95% CI 0.780-0.789) and 0.867 (0.860-0.873), respectively.

Conclusions: Routinely collected data could be used proactively via automated searches to identify individuals at risk of recurrent asthma attacks. Further research is needed to assess the impact of such knowledge on clinical prognosis.

Study Registration: ENCePP 4869
2213-2198
1-18
Blakey, John D.
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Price, David B.
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Pizzichini, Emilio
f209bca9-4130-4eec-bc7d-4be01383d531
Popov, Todor A.
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Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Postma, Dirkje S.
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Josephs, Lynn K.
39b4fd8d-cf15-480b-ade3-9c22e08af1d5
Kaplan, Alan
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Papi, Alberto
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Kerkhof, Marjan
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Hillyer, Elizabeth V.
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Chisholm, Alison
b9c6e5d9-a4f3-4d05-aaa4-a1435fdc7771
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Blakey, John D.
40ef8163-32fd-448e-8704-b02a9a83296c
Price, David B.
3b39783f-ac9e-4cab-85d3-25d4c5cbbd23
Pizzichini, Emilio
f209bca9-4130-4eec-bc7d-4be01383d531
Popov, Todor A.
5a003e62-e355-4cea-9e37-43225ec5a340
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Postma, Dirkje S.
23c1567d-a264-48a1-9ab4-01beda374e42
Josephs, Lynn K.
39b4fd8d-cf15-480b-ade3-9c22e08af1d5
Kaplan, Alan
5a6fefa8-f438-4519-8605-6ddb7c28647c
Papi, Alberto
8447eef8-34fd-482e-8e91-f8231acd05f7
Kerkhof, Marjan
9cac1b00-4b26-46d6-a3b2-0e7ea25836ad
Hillyer, Elizabeth V.
750e7064-b386-46c7-8248-87405d1ed0bf
Chisholm, Alison
b9c6e5d9-a4f3-4d05-aaa4-a1435fdc7771
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953

Blakey, John D., Price, David B., Pizzichini, Emilio, Popov, Todor A., Dimitrov, Borislav D., Postma, Dirkje S., Josephs, Lynn K., Kaplan, Alan, Papi, Alberto, Kerkhof, Marjan, Hillyer, Elizabeth V., Chisholm, Alison and Thomas, Mike (2016) Identifying risk of future asthma attacks using UK medical record data: a Respiratory Effectiveness Group initiative. The Journal of Allergy and Clinical Immunology: In Practice, 1-18. (doi:10.1016/j.jaip.2016.11.007).

Record type: Article

Abstract

Background: Asthma attacks are common, serious, and costly. Individual factors associated with attacks, such as poor symptom control, are not robust predictors.

Objective: We investigated whether the rich data available in UK electronic medical records could identify patients at risk of recurrent attacks.

Methods: We analyzed anonymized, longitudinal medical records of 118,981 patients with actively treated asthma (ages 12-80 years) and ?3 years of data. Potential risk factors during 1 baseline year were evaluated using univariable (simple) logistic regression for outcomes of ?2 and ?4 attacks during the following 2-year period. Predictors with significant univariable association (P<.05) were entered into multiple logistic regression analysis with backwards stepwise selection of the model including all significant independent predictors. The predictive accuracy
of the multivariable models was assessed.

Results: Independent predictors associated with future attacks included baseline-year markers of attacks (acute oral corticosteroid [OCS] courses, emergency visits), more frequent reliever use and healthcare utilization, worse lung function, current smoking, blood eosinophilia, rhinitis, nasal polyps, eczema, gastroesophageal reflux disease, obesity, older age, and being female. The number of OCS courses had the strongest association. The final cross-validated models incorporated 19 and 16 risk factors for ?2 and ?4 attacks over 2 years, respectively, with areas under the curve of 0.785 (95% CI 0.780-0.789) and 0.867 (0.860-0.873), respectively.

Conclusions: Routinely collected data could be used proactively via automated searches to identify individuals at risk of recurrent asthma attacks. Further research is needed to assess the impact of such knowledge on clinical prognosis.

Study Registration: ENCePP 4869

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INPRACTICE-D-16-00283R2.pdf - Accepted Manuscript
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Accepted/In Press date: 4 November 2016
e-pub ahead of print date: 22 December 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 403145
URI: https://eprints.soton.ac.uk/id/eprint/403145
ISSN: 2213-2198
PURE UUID: 0537ca64-6461-49d5-bf40-01fc2724459d

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Date deposited: 28 Nov 2016 09:39
Last modified: 15 Oct 2019 05:19

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Contributors

Author: John D. Blakey
Author: David B. Price
Author: Emilio Pizzichini
Author: Todor A. Popov
Author: Borislav D. Dimitrov
Author: Dirkje S. Postma
Author: Lynn K. Josephs
Author: Alan Kaplan
Author: Alberto Papi
Author: Marjan Kerkhof
Author: Elizabeth V. Hillyer
Author: Alison Chisholm
Author: Mike Thomas

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