The health of animals and people are interconnected and interdependent, a fact increasingly recognised by global organisations concerned with human health and animal health alike. Sixty percent of infectious diseases that can affect people are zoonotic (transmissible between animals and humans). In the UK, Public Health England (PHE) have a statutory duty to report quarterly on common animal-associated infections in England and Wales. Applying PHEs current list of zoonotic diseases to CPRD datasets it is estimated that more than one million distinct patients had a diagnosis of zoonotic disease entered into their primary care medical record. Despite their combined prevalence, these selected zoonoses are poorly studied, having featured in none of the human research studies approved by CPRD since September 2015. Zoonotic diseases are their consequences are poorly characterised in the research literature. The proposed study will address urgent gaps in understanding both the near- and longer term impacts that zoonotic disease has on human health and health systems.
The health of animals and people are interconnected and interdependent, a fact increasingly recognised by global organisations concerned with human health and animal health alike and one that has been brought into sharp relief in recent months with the emergence of the COVID-19 pandemic. Sixty percent of infectious diseases in humans are zoonotic, but despite their combined prevalence and statutory reporting in the UK, most zoonoses are poorly studied, having featured in none of the human research studies approved by CPRD since September 2015.
Therefore, the overarching aim of this study is to characterise the burden of human illness associated with a wide range of zoonotic diseases.
The proposed study has the following objectives: 1) chart secular trends in the epidemiology of individual zoonotic diseases (primary); 2) describe phenotypic characteristics for susceptibility to individual zoonotic diseases; 3) characterise acute and chronic co-morbidities following manifestation and diagnosis of zoonotic diseases; 4) enumerate not only excess mortality associated with the natural history of zoonotic diseases; but also 5) excess health resource use associated with the natural history of zoonotic diseases.
This matched cohort study will utilise both the CPRD GOLD & Aurum datasets as well as linked HES, ONS Mortality, and Deprivation data. The primary exposures are a diagnosis of the notifiable zoonotic diseases recorded in either primary or secondary care; of which at least a million cases are estimated. The principal outcomes are age-sex adjusted co-morbidity, adjusted all-cause mortality, and adjusted health resource use (rates & cost) consisting of GP consultation, other primary care consultation, all-cause hospital admission, A&E attendance, and outpatient referral. Differences in event rates for the outcomes of interest between cases and matched controls will be assessed by multivariate Poisson regression, while healthcare cost differences will be tested with generalised linear modelling with appropriate distribution and link functions.
Zoonoses incidence (disaggregated) | Charlson Co-morbidity Index | all-cause mortality | healthcare resource use expressed as nor only rate but also cost for each of: GP consultation | other primary care consultations | hospital admissions | A&E attendance | outpatient referral
Alex Cook - Chief Investigator - University of Surrey
Georgina Cherry - Corresponding Applicant - University of Surrey
Andrew Hancock - Collaborator - Zoetis Inc.
Chris D Poole - Collaborator - Digital Health Labs Limited
Isaac Odeyemi - Collaborator - Zoetis Inc.
James Frost - Collaborator - Digital Health Labs Limited
2011 Rural-Urban Classification at LSOA level;HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Practice Level Index of Multiple Deprivation