Background of need
Coeliac disease is common, affecting 1 in every 100 people in the UK, but fewer than a third of these are diagnosed. Early diagnosis allows dietary change to be recommended that avoids complications of growth and development in children and other detrimental health effects in adulthood, and reduces health care costs incurred by the NHS. Currently there is evidence of delay between people’s first presentation with symptoms and when they receive a diagnosis, with inequality in testing by socioeconomic deprivation.
To improve earlier diagnosis of coeliac disease in children and in adults of those at higher risk of the disease using all their routine medical records, thus enabling targeted testing.
1. Identifying risk factor patterns for coeliac disease: Using the information available for patients prior to Coeliac disease diagnosis or a pseudo index date in controls, we will use Bayesian supervised Latent Dirichlet Allocation topic modelling to learn predictive patterns of; symptoms, signs, consultation behaviour, diagnoses, tests and prescriptions; for both children and adults who are at risk of having coeliac disease, and compare these to their matched population controls.
2. Risk tool development: We will optimise an algorithm based on these risk factor patterns within the testing cohort to create a tool that flags people at risk of coeliac disease before their diagnosis whilst minimising false positives and false negatives. We will then perform internal validation and calibration on the final algorithm within a held-out validation cohort.
3. Comparison with traditional predictive model: We will compare the risk tool from 2. with more traditional predictive model methodology using logistic regression and selected candidate signs and symptoms based on current diagnostic guidelines, and assess the calibration and discrimination of this traditional predictive model compared to tool from 2. for identifying Coeliac disease early.
Colin Crooks - Chief Investigator - University of Nottingham
Laila Tata - Corresponding Applicant - University of Nottingham
Joe West - Collaborator - University of Nottingham
Timothy Card - Collaborator - University of Nottingham