Suchergebnisse

ABSTRACTObjectivesA substantial level of excess alcohol consumption results in a wide range of harm and the potential impact on health at the population level of a reduction in consumption is considerable. A proposed policy for reducing alcohol consumption is restricting the availability of alcohol through reducing the density of alcohol outlets. We set out to create a high spatial resolution alcohol outlet dataset suitable for evaluating longitudinal changes in chronic alcohol related conditions.
ApproachRequests were made for the names and location of all licensed alcohol outlets within each of the 22 Unitary Authorities in Wales, between Nov 2005 and Dec 2011. Data requested for each outlet consisted of: the date permission was granted or the licence became active, the licence expiry date or an indicated date of outlet closure, whether this premise is licensed for ON and/or OFF premise sales, the hours permissible to sell alcohol or general opening hours of the outlet and the type of premise as assigned by the LA if available. Our approach included collating, geocoding and manually matching alcohol outlet data received from each unitary authority for use in a longitudinal analysis of outlet density.
ResultsAll authorities were able to provide an actual or approximate license issue date, allowing us to summarise the number of outlets annually. Several authorities were unable to provide precise outlet closure dates, so the date of the last interaction with the outlet was used to generate an approximate end date. One-half of the unitary authorities were able to provide the On/Off sales status of outlets, and 9 were able to provide opening hours. From these data we were able to geocode 53% (range 28% to 72% by local authority) using GIS, the remaining 47% were matched using Google products to verify and extract a precise geographic location.
Conclusions The collation and processing of retrospective alcohol outlet data was successfully completed to enable the building of a longitudinal exposure dataset. There was considerable variation between the unitary authorities in the quality of address data, and data related to the availability of alcohol, for example opening hours. The lack of address structure required us to devise a manual address matching process to capture the addresses that could not be geocoded. To aid future data linkage based evaluations to provide policy evidence in a timely manner, local government datasets should use standardised data fields, including addresses and Point-of-Capture address verification.

ABSTRACTObjectiveTo explore whether children with pelvicalyceal dilatation (PCD, a marker detected during the 18-20 week gestation ultrasound scan in which there is enlargement of tubes that collect urine in the kidney) have more hospital admissions for kidney problems in childhood compared to children without the marker.
Approach We were funded by NISCHR to study outcomes associated with markers of uncertain significance at the second trimester anomaly scan (Welsh Study of Mothers and Babies). Data collected in the WSMB was uploaded to the Secure Anonymised Information Linkage (SAIL) databank and record linked to hospital activity data. Patterns of hospital admissions for renal causes were described and compared between those with no markers and those with PCD. Children were followed up from birth until 31st December 2014 or until the age of 5. A Cox Proportional Hazard Model was used to investigate the impact of PCD on time to first presentation.
Results (Preliminary)Of the WSMB cohort, 20,834 children were eligible for inclusion in analyses. Those with PCD had 6.29 times the hazard of a renal admission compared to those without the marker (95% CI: 3.69 to 10.72). Children with PCD were more likely to have multiple renal admissions to hospital - median (interquartile range) number of renal admissions, 2.5 (1 to 5) compared to 1 (1 , 1) in children without markers.
ConclusionPreliminary analysis suggests there is increased childhood renal morbidity associated with the presence of a PCD marker detected on the 18-20 week gestation ultrasound scan. These findings will inform the discussions clinicians have with parents when discussing the implications of this marker for the health of the chid.

IntroductionSelf reported data on health is often burdensome and expensive. Administrative data provides inexpensive global coverage of health and is less prone to social desirability for behaviors such as alcohol consumption. Recent studies have found varying correspondence between self-reported and administrative data for a number of chronic and acute conditions.
Objectives and ApproachWe sought to test the agreement between self-rated heavy drinking (35+ units for women, 50+ for men) and primary care physician (GP) coded (Read mapped ICD-10 codes) heavy drinking, and their association with alcohol related hospital admissions.
We assessed agreement between self-reported and GP coded heavy drinking data, from a prospective UK cohort and linked GP and hospital data using Cohen's kappa (95% CI). Then using Cox regression we the compared the time to alcohol related admission for both. Goodness-of-fit was assessed using AIC.
ResultsOf the 10,892 participants a total of 6,609 were linkable to both the Hospital Admissions database (PEDW) and the GP practice data, with no systematic differences between those linked and not. The sample were mostly female (57%) with a mean age of 48.2 years (SD = 15.5). In total there were 81 alcohol related admissions, with 2.7% classified as heavy drinkers by GPs and 31.7% self-rated. There was poor agreement between raters (K=0.044; 95% CI = 0.037, 0.050). GP coded heavy drinking was strongly associated with admission (β = 1.90 95% CI 1.34, 2.58, AIC = 1350.71), as was self-rating (β = 1.14 (5% CI 0.67, 1.62, AIC = 1358.19).
Conclusion/ImplicationsThe low levels of agreement but similar AICs suggest that self-rated and GP classification are measuring a similar construct but at different levels. This analysis suggest that routinely collected GP ratings of heavy drinking may be a cheaper and more efficient method of assessing heavy drinking at a population level.

Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.

IntroductionThe excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization.
ObjectivesTo compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission.
MethodsRoutine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established.
ResultsThere was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%.
ConclusionWith the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.

Funding Economic and Social Research Council, Medical Research Council, Alcohol Research UK, Public Health Wales. Acknowledgments This work was supported by funds from the Economic and Social Research Council, the Medical Research Council, and Alcohol Research UK to the ELAStiC Project (ES/L015471/1) and Public Health Wales. The views expressed are entirely those of the authors and should not be assumed to be the same as those of the funding body. The research was also supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, a UK Clinical Research Collaboration Public Health Research Centre of Excellence, and The Centre for the Improvement of Population Health through E-records Research (CIPHER). CIPHER is funded by: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government), and the Wellcome Trust (Grant reference: MR/K006525/1). Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (grant RES-590-28-0005), Medical Research Council, the Welsh Government, and the Wellcome Trust (grant WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. ; Peer reviewed ; Publisher PDF

The Brecon Group Register was established through pump-priming financial support provided by Novo Nordisk and subsequent funding from the Welsh Government. This study was funded by the Diabetes Research and Wellness Foundation (reference PP2017). The funders were not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication. ; Peer reviewed ; Publisher PDF

IntroductionExcessive alcohol consumption has adverse effects on health and there is a recognised need for thelongitudinal analysis of population data to improve our understanding of the patterns of alcohol use,harms to consumers and those in their immediate environment. The UK has a number of linkable,longitudinal databases that if assembled properly could support valuable research on this topic.
Aims and objectivesThis paper describes the development of a broad set of cross-linked cohorts, e-cohorts, surveys andlinked electronic healthcare records (EHRs) to construct an alcohol-specific analytical platform inthe United Kingdom using datasets on the population of Wales.
The objective of this paper is to provide a description of existing key datasets integrated withexisting, routinely collected electronic health data on a secure platform, and relevant derived variablesto enable population-based research on alcohol-related harm in Wales. We illustrate our use of thesedata with some exemplar research questions that are currently under investigation.
MethodsRecord-linkage of routine and observational datasets. Routine data includes hospital admissions,general practice, and cohorts specific to children. Two observational studies were included. Routinesocioeconomic descriptors and mortality data were also linked.
ConclusionWe described a record-linked, population-based research protocol for alcohol related harm on a secureplatform. As the datasets used here are available in many countries, ELAStiC provides a templatefor setting up similar initiatives in other countries. We have also defined a number of alcohol specificvariables using routinely-collected available data that can be used in other epidemiological studiesinto alcohol related outcomes. With over 10 years of longitudinal data, it will help to understandalcohol-related disease and health trajectories across the lifespan.

Background: Excess alcohol consumption has serious adverse effects on health and violence-related harm. In the UK around 37% of men and 29% of women drink to excess and 20% and 13% report binge drinking. The potential impact on population health from a reduction in consumption is considerable. One proposed method to reduce consumption is to reduce availability through controls on alcohol outlet density. In this study we investigate the impact of a change in the density of alcohol outlets on alcohol consumption and alcohol-related harms to health in the community. Methods/Design: A natural experiment of the effect of change in outlet density between 2005-09, in Wales, UK; population 2.4 million aged 16 years and over. Data on outlets are held by the 22 local authorities in Wales under The Licensing Act 2003. The study outcomes are change in (1) alcohol consumption using data from annual Welsh Health Surveys, (2) alcohol-related hospital admissions using the Patient Episode Database for Wales, (3) Accident & Emergency department attendances between midnight-6am, and (4) alcohol-related violent crime against the person, using Police data. The data will be anonymously record-linked within the Secure Anonymised Information Linkage Databank at individual and 2001 Census Lower Super Output Area levels. New methods of network analysis will be used to estimate outlet density. Longitudinal statistical analysis will use (1) multilevel ordinal models of consumption and logistic models of admissions and Accident & Emergency attendance as a function of change in individual outlet exposure, adjusting for confounding variables, and (2) spatial models of the change in counts/rates of each outcome measure and outlet density. We will assess the impact on health inequalities and will correct for population migration. Discussion: This inter-disciplinary study requires expertise in epidemiology and public health, health informatics, medical statistics, geographical information science, and research into alcohol-related violence. Information governance requirements for the use of record-linked data have been approved together with formal data access agreements for the use of the Welsh Health Survey and Police data. The dissemination strategy will include policy makers in national and local government. Public engagement will be through the Clinical Research Collaboration-Cymru "Involving People" network, which will provide input into the implementation of the research.

Background Excess alcohol consumption has serious adverse effects on health and results in violence-related harm. Objective This study investigated the impact of change in community alcohol availability on alcohol consumption and alcohol-related harms to health, assessing the effect of population migration and small-area deprivation. Design A natural experiment of change in alcohol outlet density between 2006 and 2011 measured at census Lower Layer Super Output Area level using observational record-linked data. Setting Wales, UK; population of 2.5 million aged ≥ 16 years. Outcome measures Alcohol consumption, alcohol-related hospital admissions, accident and emergency (A&E) department attendances from midnight to 06.00 and violent crime against the person. Data sources Licensing Act 2003 [Great Britain. Licensing Act 2003. London: The Stationery Office; 2003. URL: www.legislation.gov.uk/ukpga/2003/17/contents (accessed 8 June 2015)] data on alcohol outlets held by the 22 local authorities in Wales, alcohol consumption data from annual Welsh Health Surveys 2008–12, hospital admission data 2006–11 from the Patient Episode Database for Wales (PEDW) and A&E attendance data 2009–11 were anonymously record linked to the Welsh Demographic Service age–sex register within the Secure Anonymised Information Linkage Databank. A final data source was recorded crime 2008–11 from the four police forces in Wales. Methods Outlet density was estimated (1) as the number of outlets per capita for the 2006 static population and the per quarterly updated population to assess the impact of population migration and (2) using new methods of network analysis of distances between each household and alcohol outlets within 10 minutes of walking and driving. Alcohol availability was measured by three variables: (1) the previous quarterly value; (2) positive and negative change over the preceding five quarters; and (3) volatility, a measure of absolute quarterly changes during the preceding five quarters. Longitudinal statistical analysis used multilevel Poisson models of consumption and Geographically Weighted Regression (GWR) spatial models of binge drinking, Cox regression models of hospital admissions and A&E attendance and GWR models of violent crime against the person, each as a function of alcohol availability adjusting for confounding variables. The impact on health inequalities was investigated by stratifying models within quintiles of the Welsh Index of Multiple Deprivation. Results The main finding was that change in walking outlet density was associated with alcohol-related harms: consumption, hospital admissions and violent crime against the person each tracked the quarterly changes in outlet density. Alcohol-related A&E attendances were not clinically coded and the association was less conclusive. In general, social deprivation was strongly associated with the outcome measures but did not substantially modify the associations between the outcomes and alcohol availability. We found no evidence for an important effect of population migration. Limitations Limitations included the absence of any standardised methods of alcohol outlet data collation, processing and validation, and incomplete data on on-sales and off-sales. We were dependent on the quality of clinical coding and administrative records and could not identify alcohol-related attendances in the A&E data set. Conclusion This complex interdisciplinary study found that important alcohol-related harms were associated with change in alcohol outlet density. Future work recommendations include defining a research standard for recording outlet data and classification of outlet type, the methodological development of residence-based density measures and a health economic analysis of model-predicted harms.

ABSTRACT
ObjectivesThe ELAStiC (Electronic Longitudinal Alcohol Study in Communities) project was established to determine factors that predict pathways into alcohol misuse and the life-course effects of alcohol use and misuse on health and well-being. This is achieved through accessing existing longitudinal data that are key sources of evidence for social and health policy, developing statistical methods and modelling techniques from a diverse range of disciplines, working with stakeholders in both policy, practice and the third sector to bring relevance to the work, and to bring together a diverse team of experts to collaborate and facilitate learning across diverse fields.
ApproachThe project will link data that include cohort studies such as; UK Biobank, ALSPAC (Avon Longitudinal Study of Parents and Children), Millennium Cohort Study, British Household Panel Survey, Understanding Society, E_CATALyST (Caerphilly Health and Social Needs Electronic Cohort Study) and WECC (Wales Electronic Cohort for Children). These data will be linked with routine data from primary and secondary healthcare in England, Scotland and Wales. Additional data from education and police data source will also be linked as part of the project.
The main work packages for the project are:
Methodological InnovationsMethodological developments in mechanisms for correcting bias in reporting alcohol consumption and for combining routine data with cohort data; the application of Markov models for examining the extent to which past behaviour influences future behaviour, and econometric hedonic pricing methods for providing insights into the costs of alcohol-related harm.
Pathways into HarmDo family structure, household composition, youngsters' previous ill-health and educational attainment predict their use of alcohol and what socio-economic factors and household transitions contribute to hazardous alcohol consumption in adults?
Secondary HarmsWhat is the effect on children's health and educational achievement of living in households in which one or more adults has experienced alcohol-related harm?
Mental Health & Well-BeingWhat is the relationship between alcohol consumption, hospital admission and mental health in adults and children?
ResultsThe results of the data linkage between the multiple cohorts and health, education and police data will be reported. The challenges of linking cohort and other data types from different nations will be discussed.
ConclusionsOur project will aim to provide evidence that informs the UK Government's commitment to "radically reshape the approach to alcohol and reduce the number of people drinking to excess", by working with existing longitudinal data collected in the UK to inform policy and practice.