Background
We know veterans (those who served in the Armed Forces and have now left) are more likely to face complex co-occurring physical and mental health problems, yet little is known about veterans' health outcomes and their use of health services. This is important because there are numerous services for veterans' mental health needs, but very few services tailored to address veterans’ physical health needs, or those with more complex health problems. A cost and time-effective way to increase our understanding about veterans accessing primary care is to examine primary care (General Practice) records. To address these challenges, we propose to explore the utility and feasibility of the Clinical Practice Research Datalink (CPRD) for veterans’ health research, and specifically, to determine and characterise the physical and mental health outcomes of veterans.
Methods
CPRD provides anonymised data from 60 million patients who have accessed primary care services across the UK. Initial investigations by our team, suggest that we will have access to data from approximately 70,000 veterans. We will also determine a group of non-veterans within the CPRD data to make comparisons.
Anticipated impact
This project will aid our understanding about the value of using CPRD as an additional data source for veterans’ health research, particularly exploring the profile and long-term health outcomes of veterans within the UK healthcare system. Currently, we have limited knowledge about the health needs of veterans accessing primary care and the proposed study has the potential to play a key role in addressing this.
Aims: 1) To examine the feasibility and utility of using the Clinical Research Practice Datalink (CPRD) for veterans’ health research, and 2) To determine and characterise the physical and mental health outcomes of veterans and explore whether they are different to a non-veteran comparison group.
Primary exposures: Veteran status, GP veteran accreditation status
Covariates: Socio-demographic characteristics (age, sex, ethnicity, Index of Multiple Deprivation*, area of residence), lifestyle behaviours (smoking, physical activity, obesity), co-prescribing
Outcomes: Common physical and mental disorders: depression, anxiety, psychosis, schizophrenia, suicidal ideation, post-traumatic stress disorder, TBI, addictions (including alcohol), cardiovascular conditions, musculoskeletal conditions, hearing loss, cancer, diabetes, dementia, Parkinson disease are the primary outcomes of interest (classified using medical codes, SNOMED, Read). Medication prescriptions (e.g., antihypertensives, psychotropics, opiates), and healthcare utilisation (e.g., inpatient admissions, specialist referrals, primary care consultations) are secondary outcomes. For a subsample of patients, cancer and common physical and mental disorder data will be complemented with information from the HES Admitted Patient Care (HES APC) dataset.
Study design: Prospective matched cohort study.
Methods: Descriptive statistics to explore differences in primary exposures and outcomes of interest. Subsequently, time to event analyses will be conducted (e.g. Cox regression, Poisson) to compare differences in the incidence in the outcomes of interest, among veteran patients compared to a non-veteran comparison group.
Linked datasets: Index of Multiple Deprivation (patient level)*, HES Admitted Patient Care (HES APC).
Findings: This study will help us to understand whether CPRD is a useful data source for veterans’ health research. In addition, the results will help us to understand the incidence and prevalence of health disorders among veterans, how this compares to non-veterans and their healthcare utilisation.
*Index of Multiple deprivation will be used in analyses as a potential confounder and effect modifier in associations between veteran status and health.
Primary outcomes: depression; anxiety; psychosis; schizophrenia; suicidal ideation; post-traumatic stress disorder; TBI; addictions (including alcohol); cardiovascular conditio ns, musculoskeletal conditions; hearing loss; cancer; diabetes; dementia; and Parkinson disease.
Secondary outcomes: main medication prescriptions (e.g., antihypertensives; psychotropics; opiates) ; and healthcare utilisation (e.g., inpatient admissions; specialist referrals; primary care consultations).
PROVE validation study outcomes: Veteran status validation with GP practice records in sub-sample of 100 patients (n=10 GP practices x 10 patients). The validation outcome will be concordance between CPRD data and GP records on: number of veterans registered at GP practice, veterans status, date veteran status recorded, and recorded Service branch information (appendix 3).
Sharon Stevelink - Chief Investigator - King's College London (KCL)
Gemma Archer - Corresponding Applicant - King's College London (KCL)
Alex Dregan - Collaborator - King's College London (KCL)
Natalia Kika - Collaborator - King's College London (KCL)
Nicola Fear - Collaborator - King's College London (KCL)
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation