Development of an identification tool for patients over 65 years at risk of death or emergency hospital admission during cold weather.

Date of Approval
Application Number
16_061
Technical Summary

Cold weather poses primary care challenges both for prevention and treatment of resulting morbidity. Approximately 24,000 extra deaths occur every winter in England & Wales, chiefly in older people: figures which will rise as the population ages. In March 2015, NICE recommended GPs should flag patients living in cold or hard to heat homes, but GPs currently have neither capacity to visit everyone nor tools to determine those at highest risk. This proposal will address this second issue, to help primary care teams focus resources towards those most likely to benefit. We will use CPRD, linked with Hospital Episode Statistics, to investigate predictors of emergency hospital admission and mortality following cold spells, and examine primary care contacts around such events. We will also link local weather data over the period of follow up to identify cold weather spells. This will allow precise estimation of risks associated with cold weather. We will investigate the degree and nature of contact with primary care during cold spells, both for patients who die or are admitted to hospital within 14 days, and other patients. Prediction equations will be built using a training set (randomly chosen half of the data) and tested in the remainder.

Health Outcomes to be Measured

1 - Death (with cause). Although all-cause mortality will be the primary focus, we will also assess death of cardiovascular disease (ICD10 codes I20-I25 and I60-I69) 2 - Emergency admission to hospital. Each emergency admission during the follow up period (ending at first emergency admission or 31st March 2014, whichever is earlier) to be ascertained for each patient.

Collaborators

Richard Morris - Chief Investigator - University of Bristol
Richard Morris - Corresponding Applicant - University of Bristol
Alastair Hay - Collaborator - University of Bristol
Claudio Sartini - Collaborator - University College London ( UCL )
Daniel Lasserson - Collaborator - University of Birmingham
Peter Tammes - Collaborator - University of Bristol

Linkages

HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;Other