Article Text


A retrospective cohort study assessing patient characteristics and the incidence of cardiovascular disease using linked routine primary and secondary care data
  1. Rupert A Payne1,
  2. Gary A Abel1,
  3. Colin R Simpson2
  1. 1General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK
  2. 2eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Rupert A Payne; rap55{at}


Objectives Data linkage combines information from several clinical data sets. The authors examined whether coding inconsistencies for cardiovascular disease between components of linked data sets result in differences in apparent population characteristics.

Design Retrospective cohort study.

Setting Routine primary care data from 40 Scottish general practitioner (GP) surgeries linked to national hospital records.

Participants 240 846 patients, aged 20 years or older, registered at a GP surgery.

Outcomes Cases of myocardial infarction, ischaemic heart disease and stroke (cerebrovascular disease) were identified from GP and hospital records. Patient characteristics and incidence rates were assessed for all three clinical outcomes, based on GP, hospital, paired GP/hospital (similar diagnoses recorded simultaneously in both data sets) or pooled GP/hospital records (diagnosis recorded in either or both data sets).

Results For all three outcomes, the authors found evidence (p<0.05) of different characteristics when using different methods of case identification. Prescribing of cardiovascular medicines for ischaemic heart disease was greatest for cases identified using paired records (p≤0.013). For all conditions, 30-day case fatality rates were higher for cases identified using hospital compared with GP or paired data, most noticeably for myocardial infarction (hospital 20%, GP 4%, p=0.001). Incidence rates were highest using pooled GP/hospital data and lowest using paired data.

Conclusions Differences exist in patient characteristics and disease incidence for cardiovascular conditions, depending on the data source. This has implications for studies using routine clinical data.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Payne RA, Abel GA, Simpson CR. A retrospective cohort study assessing patient characteristics and the incidence of cardiovascular disease using linked routine primary and secondary care data. BMJ Open 2012;2:e000723. doi:10.1136/bmjopen-2011-000723

  • Contributors RAP conceived the study. RAP and GAA contributed to the study design, analysis and interpretation and to the drafting of the article. CRS acquired the data and set up the linked database. All authors contributed to the critical revision of the paper and approval of the final version.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

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