Health inequalities are preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness, or opportunities to take action and access treatment when ill health occurs. Unfortunately, the Covid-19 has widened some health inequalities across the UK by disproportionately affecting those already experiencing health inequalities, such as those in the most deprived areas and people from ethnic minority backgrounds. There is a need and understanding, that addressing inequalities where they exist can improve the health of the population as a whole.
However, to date there have been few studies which comprehensively outline the incidence (rate of new cases) and prevalence (proportion of existing cases) over time of common health conditions broken down by demographic, geographical and socio-economic factors. Undertaking such an activity would be beneficial to patients (and the wider NHS) as it will provide needed intelligence to 1) uncover currently unknown inequalities in presentation and access to healthcare resources, 2) improve our understanding of the trends of pre-existing inequalities and 3) support commissioners with service planning in areas of greatest need. Therefore, we are proposing to undertake an epidemiological analysis of over 300 clinical conditions, previously noted as requiring intensive use of healthcare resources. We will undertake annual estimates of the incidence and prevalence of these identified conditions, and provide the estimates broken down by demographic, geographical and socio-economic factors.
The NHS describe health inequalities as preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness, or opportunities to take action and access treatment when ill health occurs. However, to date there have been few studies which comprehensively outline the incidence and prevalence (over time of common health conditions presenting to the NHS.
Therefore, we are proposing to undertake an epidemiological analysis of over 300 clinical conditions, previously identified as requiring intensive use of health-care resources. We intend to describe the annual incidence rates and annual point prevalence of these health conditions between 1st January 1995 and 1st January 2022 using the CPRD GOLD and AURUM dataset. For each condition, we will present the crude incidence rates for each condition from 1995 to 2022 will be calculated by dividing the number of patients aged ≥18, who for the first time meet the diagnostic criteria (numerator) by the total number of person-years at risk (denominator) for the given year.
In addition to the overall crude rates, where suitable we will also present the data broken down by age group, sex, ethnicity and index for multiple deprivation (at both practice and patient level). However, where data frequency is low, numbers will be suppressed to maintain anonymity.
We aim to examine the following 308 conditions taken from the following study https://www.thelancet.com/journals/landig/article/PIIS2589-7500(19)3001… which outlines 308 conditions. The criteria for inclusion were conditions codes that had more than 10 000 finished consultant episodes. If a condition had fewer than 10 000 finished consultant episodes but the prevalence was greater than 0·01% then it was also considered to be clinically important by the authors clinical panel is also included. The following conditions are included:
Benign Neoplasm – Brain
Benign Neoplasm – Colon
Benign Neoplasm – Ovary
Benign Neoplasm – Stomach
Benign Neoplasm – Uterus
Cervical Intra-epithelial Neoplasia
Haemangioma
Leiomyoma
Hodgkins Lymphoma
Leukaemia
"Monoclonal Gammopathy of Undetermined
Significance"
Myelodysplastic Syndrome
Non Hodgkins Lymphoma
Plasma Cell Malignancy
Polycythaemia vera
Primary Malignancy – Biliary
Primary Malignancy – Bladder
Primary Malignancy – Bone
Primary Malignancy – Bowel
Primary Malignancy – Brain
Primary Malignancy – Breast
Primary Malignancy – Cervix
Primary Malignancy – Kidney
Primary Malignancy – Liver
Primary Malignancy – Lung
Primary Malignancy – Melanoma
Primary Malignancy – Mesothelioma
Primary Malignancy – Multiple Sites
Primary Malignancy – Oesophageal
Primary Malignancy – Oropharyngeal
Primary Malignancy – other
Primary Malignancy – Ovary
Primary Malignancy – Pancreas
Primary Malignancy – Prostate
Primary Malignancy – Skin
Primary Malignancy – Stomach
Primary Malignancy – Testis
Primary Malignancy – Thyroid
Primary Malignancy – Uterus
Secondary Malignancy – Adrenal
Secondary Malignancy – Bone
Secondary Malignancy – Bowel
Secondary Malignancy – Brain
Secondary Malignancy – Liver
Secondary Malignancy – Lung
Secondary Malignancy – Lymph Nodes
Secondary Malignancy – other
Secondary Malignancy – Peritoneum
Secondary Malignancy – Pleura
Abdominal Aortic Aneurysm
Atrial Fibrillation
Atrioventricular Block, first degree
Atrioventricular Block, second degree
Atrioventricular Block, third degree
Bifascicular Block
Cardiomyopathy – other
Coronary Heart Disease (not otherwise specified)
Dilated cardiomyopathy
Heart Failure
Hypertension
Hypertrophic cardiomyopathy
Intracerebral Haemorrhage
Ischaemic Stroke
Left Bundle Branch Block
Multiple valve disorder
Myocardial Infarction
Non-rheumatic Aortic valve disorder
Non-rheumatic Mitral valve disorder
Pericardial Effusion
Peripheral Arterial Disease
Primary Pulmonary Hypertension
Pulmonary Embolism
Raynauds Disease
Rheumatic Valve Disorder
Right Bundle Branch Block
Secondary Pulmonary Hypertension
Sick Sinus Syndrome
Stable Angina
Stroke – not otherwise specified
Subarachnoid Haemorrhage
Subdural haematoma
Supraventricular Tachycardia
Transient Ischaemic Attack
Trifascicular Block
Unstable Angina
Venous thrombolism (Excl PE)
Ventricular Tachycardia
Abdominal Hernia
Alcoholic Liver Disease
Anal Fissure
Angiodysplasia of colon
Anorectal Fistula
Anorectal Prolapse
Appendicitis
Autoimmune liver disease
Barrett's Oesophagus
Cholangitis
Cholecystitis
Cholelithiasis
Cirrhosis
Coeliac Disease
Crohns Disease
Diaphragmatic Hernia
Diverticular Disease
Fatty Liver
Gastritis
Gastro-oesophageal Reflux Disease
Irritable Bowel Syndrome
Liver Failure
Oesophageal Ulcer
Oesophageal Varices
Pancreatitis
Peptic Ulcer
Peritonitis
Portal Hypertension
Ulcerative Colitis
Volvulus
Deafness
Meniere's Disease
Tinnitus
Cystic Fibrosis
Diabetes Mellitus – other or not specified
Hyperparathyroidism
Low HDL-C
Obesity
Polycystic Ovarian Syndrome
Raised LDL-C
Raised Total Cholesterol
Raised Triglycerides
Syndrome of Inappropriate AntiDiuretic Hormone
Thyroid Disease
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Anterior Uveitis
Blindness
Cataract
Diabetic Eye Disease
Glaucoma
Keratitis
Macular Degeneration
Posterior Uveitis
Ptosis
Retinal Detachment
Retinal Vascular Occlusion
Scleritis
Acute Kidney Injury
Benign Prostatic Hyperplasia
Chronic Cystitis
Chronic Kidney Disease
Dysmenorrhoea
End Stage Renal Disease
Endometrial Hyperplasia
Endometriosis
Erectile Dysfunction
Female Infertility
Glomerulonephritis
Hydrocele
Male infertility
Menorrhagia
Neuropahtic Bladder
Obstructive and reflux uropathy
Postcoital Bleeding
Postmenopausal Bleeding
Tubulo-interstitial Nephropathy
Undescended Testis
Urinary Incontinence
Urolithiasis
Uterovaginal Prolapse
Allergic/chronic Rhinitis
Asbestosis
Aspiration Pneumonitis
Asthma
Bronchiectasis
Chronic Obstructive Pulmonary Disease
Chronic Sinusitis
Hypertrophic Nasal Turbinates
Nasal Polyps
Pleural Effusion
Pleural Plaque
Pneumothorax
Pulmonary Collapse
Pulmonary Fibrosis
Respiratory Failure
Sleep apnoea
Agranulocytosis
Anaemia – other
Aplastic Anaemia
Folate Deficiency Anaemia
Hypersplenism
Hyposplenism
Immunodeficiency
Iron Deficiency Anaemia
Other haemolytic anaemia
Primary thrombocytopaenia
Sarcoidosis
Secondary Polycythaemia
Secondary Thrombocytopaenia
Sickle Cell Disease
Sickle Cell Trait
Thalassaemia
Thalassaemia Trait
Thrombophilia
Vitamin B12 deficiency anaemia
Bacterial Infection
Chronic Viral Hepatitis
Encephalitis
Fungal Infection
HIV
Infection – Anorectal
Infection – Bone
Infection – Digestive System
Infection – Ear/Upper Respiratory Tract
Infection – Eye
Infection – Heart
Infection – Liver
Infection – Lower Respiratory Tract
Infection – Male Genitourinary
Infection – Other Genitourianry
Infection – Other nervous system
Infection – Other organisms
Infection – Other organs
Infection – Skin
Meningitis
Parasitic Infection
Pelvic Inflammatory Disease
Rheumatic Fever
Septicaemia
Tuberculosis
Urinary Tract Infection
Viral Infection
Alcohol Misuse
Anxiety
Autism
Bipolar Affective Disorder
Delirium
Dementia
Depression
Eating Disorders
Hyperkinetic Disorders
Intellectual Disability
Obsessive Compulsive Disorder
Personality Disorder
Schizophrenia
Substance Misuse
Ankylosing Spondylosis
Carpal Tunnel Syndrome
Collapsed Vertebra
Enteropathic Arthropathy
Enthesopathy and synovial disorder
Fibromatosis
Fracture – Hip
Fracture – Wrist
Giant Cell Arteritis
Gout
Intervertebral Disc Disorder
Juvenile Arthritis
Lupus Erythematosus
Osteoarthritis
Osteoporosis
Polymyalgia Rheumatica
Psoriatic Arthritis
Reactive Arthritis
Rheumatoid Arthritis
Scleroderma
Scoliosis
Sjogren Syndrome
Spinal Stenosis
Spondylolisthesis
Spondylosis
Autonomic Neuropathy
Bell's Palsy
Cerebral Palsy
Chronic Fatigue Syndrome
Diabetic Neuropathy
Epilepsy
Essential Tremor
Idiopathic Intracranial Hypertension
Migraine
Motor Neurone Disease
Multiple Sclerosis
Myasthenia Gravis
Parkinson's Disease
Peripheral Neuropathy
Trigeminal Neuralgia
Congenital Septal Defect
Down Syndrome
High Birth Weight
Intrauterine Hypoxia
Low Birth Weight
Neonatal Jaundice
Patent Ductus Arteriosus
Post-term Delivery
Premature Delivery
Respiratory Distress of the Newborn
Sepsis of the Newborn
Spina Bifida
Acne
Actinic keratosis
Alopecia Areata
Dermatitis
Hidradenitis suppurativa
Lichen Planus
Pilonidal cyst/sinus
Psoriasis
Rosacea
Seborrheic Dermatitis
Urticaria
Vitiligo
Specific sub-types of the conditions listed above:
Blood cancers commonly associated with donor transplant (included where indolent lymphomas have transformed to DLBCL). Additionally, other blood and marrow transplant indications, indications for haematopoietic stem cell transplant for severe autoimmune disease, and indications for haematopoietic stem cell transplant for solid tumours (as described by BSBMTCT):
Leukaemia, acute myeloid
Leukaemia, acute lymphoblastic
Leukaemia, chronic myeloid
Leukaemia, acute lymphocytic
Leukaemia, chronic lymphocytic
Non-Hodgkin's Lymphoma
Non-Hodgkin's Lymphoma, diffuse large B-cell
Non-Hodgkin's Lymphoma, follicular
Non-Hodgkin's Lymphoma, peripheral T-cell
Non-Hodgkin's Lymphoma, mantle cell
Non-Hodgkin's Lymphoma, primary mediastinal large B-cell
Non-Hodgkin's Lymphoma, transformed follicular
Non-Hodgkin's Lymphoma, transformed Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma (Richter's syndrome/transformation )
Non-Hodgkin's Lymphoma, transformed nodular lymphocyte predominant B-cell lymphoma (previously called Nodular Lymphocyte Predominant Hodgkin Lymphoma)
Non-Hodgkin's Lymphoma, transformed Waldenström macroglobulinemia
Non-Hodgkin's Lymphoma, transformed marginal zone lymphoma
Non-Hodgkin's lymphoma, transformed mucosa associated lymphoid tissue (MALT)
Non-Hodgkin's lymphoma, acute lymphoblastic
Non-Hodgkin's lymphoma, primary CNS
Waldenström macroglobulinemia (AKA Non-Hodgkin's lymphoma, lymphoplasmacytic)
Myeloma
Hodgkin's Lymphoma
Aplastic Anaemia
Myelodysplastic syndromes
Myelofibrosis
Edwing's sarcoma (AKA PNET)
Neuroblastoma
Germ cell
Soft tissue sarcoma
Breast cancer
Ovarian Cancer
Lung cancer
Renal Cancer
Multiple Sclerosis
Chronic inflammatory demyelinating polyneuropathy
Neuromyelitis optica
Systemic sclerosis
Systemic lupus erythematosus
Systemic Vasculitis (including Behcet’s disease, Wegener’s granulomatosis, cryoglobulinaemia, Churg-Strauss angiitis, polychondritis, Takayasu
arteritis, polyarteritis nodosa and undifferentiated vasculitis)
Inflammatory Arthritis (including rheumatoid arthritis and adult onset Still’s disease)
Dermatomyositis-polymyositis
Crohn’s disease
Refractory Coeliac disease type II
Immune cytopenias (ITP, AIHA, Evan’s syndrome)
Type I diabetes
Primary immunodefficiency (adult)
Maternal and neonatal outcomes:
Maternal physical health
Gestational hypertension
Pre-eclampsia
Gestational diabetes
Placenta Praevia
Length of stay in hospital
Placental Abruption
Placenta maladherence
Placental Insufficiency
Hyperemesis gravidarum
Placental Insufficiency
Hyperemesis gravidarum
Ectopic pregnancy
Molar pregnancy/ Choriocarcinoma
Obstetric haemorrhage ( postpartum)
Molar pregnancy/ Choriocarcinoma
Obstetric haemorrhage ( postpartum)
Obstetric cholestasis
Perineal trauma-3rd and 4th degree
Spontaneous vaginal
Induced vaginal
Instrumental delivery
Caesarean Section
Maternal mental health
Post-partum Depression
Puerperal Psychosis
Affective Psychosis
Non-affective Psychosis
Postnatal Anxiety
Self Harm or Suicide Attempt
Neonatal
Small for Gestational Age
Foetal Growth Restriction
Birth Weight
Low Birth Weight
Congenital Anomaly
Neurodevelopmental disorder
Hypoxic Ischaemic Encephalopathy
Neonatal Jaundice
Necrotising Enterocolitis
Cerebral Palsy
Joht Singh Chandan - Chief Investigator - University of Birmingham
Joht Singh Chandan - Corresponding Applicant - University of Birmingham
Aditya Acharya - Collaborator - University of Birmingham
Anuradhaa Subramanian - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Nicola Adderley - Collaborator - University of Birmingham
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation