Burden of medically attended acute gastroenteritis and aetiology: a cohort study in CPRD in England.

Date of Approval
Application Number
Technical Summary

Infectious gastroenteritis is an important cause of morbidity and mortality with multiple aetiological causes including bacteria and virus. Often the causal agent is not known or recorded in routine medical practice hindering the estimation of cause-specific burden of disease from electronic medical records. No estimates are available for norovirus-associated hospitalizations in the paediatric population in the UK or for norovirus-associated deaths in children and adults aged under 65 years old. Moreover, the impact of gastroenteritis on chronic conditions, such as diabetes, is not well understood. This study aims to estimate the burden of medically attended gastroenteritis, in primary and secondary care settings, overall and in the diabetic population. To account for limited recording of infectious agent, a statistical model will be developed to estimate the frequency of gastroenteritis episodes attributable to norovirus, based on the temporal patterns of occurrence of gastroenteritis, overall and cause-specific, and accounting for population age groups. The project constitutes a case-study in developing methods to better estimate cause-specific burden of infectious diseases based on electronic medical records, with incomplete data. Evidence of cause-specific burden of disease can greatly improve the design of preventive measures, e.g. vaccination programs, as well as monitoring their public health impact.

Health Outcomes to be Measured

The outcome of interest is the occurrence of medically attended acute gastroenteritis (MAAGE) and medically attended norovirus gastroenteritis (MANGE) episodes with index date within the subject study follow-up (person-time at risk). MAAGE and MANGE episode A MAAGE episode is defined as a series of at least one MAAGE event with the lag time between successive events not exceeding 14 days. Hence, a recurrence with a lag time of more than 14 days will be considered as a new MAAGE episode. The episode index date is the date of the first MAAGE event of the MAAGE episode. MAAGE episodes will be classified as primary care-only or requiring hospitalization based on the level of care required over the course of the episode. Any episode containing at least one MAAGE event from HES Inpatient will be classified as requiring hospitalization. MAAGE episodes will be further classified according to aetiological cause, e.g. episodes related with Norovirus (MANGE), Rotavirus, Salmonella, Campylobacter, other Bacterial, Clostridium difficile, Parasitic. An algorithm will be developed with MAAGE experts to select a main cause for episodes with multiple cause-specific aetiologies recorded. MAAGE or MANGE associated death will be considered as deaths recorded in the ONS mortality linked data, for which MAAGE or MANGE were recorded as primary or contributory causes of death.


Germano Ferreira - Chief Investigator - Not from an Organisation
Germano Ferreira - Corresponding Applicant - Not from an Organisation
Benjamin Lopman - Collaborator - Centers for Disease Control - CDC
Clarence Tam - Collaborator - National University of Singapore
John Harris - Collaborator - University of Liverpool
Kaatje Bollaerts - Collaborator - P95
Margarita Riera-Montes - Collaborator - P95
Thomas Verstraeten - Collaborator - P95
Tom Cattaert - Collaborator - P95


HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data