Cardiovascular (CV), renal, and metabolic (CRM) diseases now constitute an increasing burden on healthcare resources and the treatment of these conditions. Globally, CRM conditions, including Type 2 Diabetes mellitus (T2DM), chronic kidney disease (CKD), heart failure (HF), and cardiovascular diseases (CVD), have been identified as a cause of death and form a considerable burden on health services. Recent evidence has shown that CRM diseases individually and collectively cause a substantial impact on healthcare resources. However, there is a lack of evidence on how these conditions are linked. Therefore, this study aims to describe and analyse the patterns of adult patients moving from one CRM disease state to another as recorded on the Clinical Practice Research Datalink (CPRD) GOLD database. CPRD GOLD database will be linked to digital databases such as Hospital Episode Statistics (HES) and Index of Multiple Deprivations (IMD) databases. Proportions and characteristics of the patients in each state will be presented in a coherent format for the last 15 years, providing an overview of the patients' movement across different diseased states and depicting their interconnectivity. The study's findings will help in future health services re-design, CRM burden quantifying, and serve as precursors for other similar studies. The study period would span from 1st January 2005 to 1st January 2020.
Cardiovascular (CV), renal, and metabolic (CRM) diseases now account for considerable clinical and economic burden and constitute significant risk factors. Globally, approximately 33% of global deaths were attributable to CRM diseases (17.6 million of 52.8 million) in 2010, while the clinical burden is increasing and associated with high costs and hospitalisations.
There is a substantial burden of CRM disease and a lack of evidence around overall interconnectivity between CRM diseases, particularly the renal component. Therefore, the study aims to characterise the prevalence and interconnectivity of CRM diseases within a UK population across different "states" of CRM disease (T2DM, CVD,CKD, and HF). Further, we will estimate the proportions of individuals in each health state, the clinical and demographic characteristics of individuals within each state, and the change in the overall prevalence of CRM and distribution of individuals between states over the study period (1st January 2005 – January 2020).
A non-interventional study will be undertaken via a repeated cross-sectional analysis of adult patients on the Clinical Practice Research Datalink (CPRD) GOLD database linked to the Hospital Episode Statistics (HES) and Index of Multiple Deprivations (IMD) databases . The study period would span from 1st January 2005 to 1st January 2020.
A descriptive analysis using appropriate summary statistics will be used depending on the type of variables. Prevalence will be estimated as a crude measure, and age and sex standardised-to account for any age or sex distribution changes across the study period. All estimates will be presented with 95% confidence intervals. At the same time, the overlap of the conditions will be expressed as the percentage (and 95% CI) of the prevalent CRM population that falls within each health state. Yearly estimates of prevalence and overlap will be plotted graphically to visually assess change and potential for non-linear effects.
The outcomes are the prevalent diagnoses of T2DM, CVD, HF, and CKD within the CPRD GOLD linked to HES and IMD databases. The Read codes will identify these within the record of patients that meet the inclusion and exclusion criteria on the 1st January each year. Please refer to appendix section for the Read codes for these conditions.
Within the cardiovascular condition, overlap of T2DM and CKD in the subgroup with a diagnosis of congestive heart failure will be evaluated.
Remi Popoola - Chief Investigator - Boehringer Ingelheim Limited
Remi Popoola - Corresponding Applicant - Boehringer Ingelheim Limited
Andrew Frankel - Collaborator - Imperial College Healthcare NHS Trust
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Samuel Seidu - Collaborator - University of Leicester
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation