Asthma, interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are chronic respiratory diseases that cause substantial disability and are associated with increased risk of death. Past studies have usually provided high-level snapshot pictures of their frequencies and associated impacts and costs. Now we need to understand how these are changing, both at national and local level, to inform public health policy and planning.
The aim of this study is to describe the number and population structure (e.g. age, sex, region, ethnicity and socioeconomic status) of people with asthma, ILD and COPD, both across England and by region, over a 15-year period. We will describe trends in important risk factors e.g. smoking; treatments; healthcare utilisation and disease outcomes such as deaths and hospital admissions over the same time period. To do this, we are developing an observatory, i.e. a large dataset of asthma, ILD and COPD patients which can potentially be maintained and regularly updated in the long term to answer further research questions about these diseases. This has already been developed for asthma in Wales and work is underway to replicate this for ILD and COPD.
Our results will provide insights into how common and severe these diseases are in different areas and populations. This knowledge will play a crucial role in public health planning and identifying areas for future research and development. Furthermore, understanding the impact of these diseases on individuals and associated costs is important in planning effective treatments and highlighting the resource needs of patients.
The study objective is to describe the changing epidemiology of asthma, ILD and COPD, both across England and regionally over the last 15 years. We will describe trends in key demographic characteristics, risk factors, treatments, healthcare utilisation and disease outcomes over the same time period.
We will include all individuals in CPRD Aurum with linkage available to HES and ONS and a diagnostic code ever for asthma, ILD and COPD to define our cohorts using validated codelists. We will use linked HES APC, HES A&E, HES OP, IMD and ONS data to determine disease outcomes, and define covariates and comorbidities. The methodology for curating these datasets will be harmonised with similar projects in Wales and Scotland to curate ILD and COPD datasets using SAIL/DataLoch (e.g. standardised case definitions).
Prevalence and incidence of asthma, ILD and COPD over a 15-year period will be calculated with stratification across key variables of interest (age, sex, socioeconomic status from IMD, region and ethnicity). We will describe the incident rate and proportion of use of treatments (relevant prescriptions, secondary care referrals and indicators of management within primary care e.g. self-management plans), healthcare utilisation (GP consultations, outpatient clinics, hospital admissions), disease-specific outcomes (asthma/COPD exacerbations) and mortality rates for the same time period.
This study will show the disease burden within England from asthma, ILD and COPD and characterise how well these diseases are currently managed within the health service. This is important for public health planning to adequately meet the resource needs of patients. Additionally, this project will generate a resource that can be re-used by collaborating respiratory researchers and methodological outputs including code and phenotypic understanding around respiratory conditions within English data. We will ensure that code and algorithms generated from the project are made available to collaborating research groups for future replication of study.
Prevalence and incidence of asthma, ILD and COPD captured using primary care records; treatments (e.g. prescriptions for relevant medications, pulmonary rehabilitation referral, self-management plans); healthcare utilisation; asthma, ILD and COPD outcomes (e.g. exacerbations, hospital admissions and deaths)
Jennifer Quint - Chief Investigator - Imperial College London
Sara Hatam - Corresponding Applicant - Imperial College London
Constantinos Kallis - Collaborator - Imperial College London
Sarah Cook - Collaborator - Imperial College London
Sarah Cook - Collaborator - Imperial College London
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation