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Health informatics
Research
Optimising case detection within UK electronic health records: use of multiple linked databases for detecting liver injury
  1. Kevin Wing1,
  2. Krishnan Bhaskaran1,
  3. Liam Smeeth1,
  4. Tjeerd P van Staa2,3,
  5. Olaf H Klungel2,
  6. Robert F Reynolds4,
  7. Ian Douglas1
  1. 1Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Pharmacoepidemiology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
  3. 3Health eResearch Centre, University of Manchester, Manchester, UK
  4. 4Department of Epidemiology, Pfizer, New York, New York, USA
  1. Correspondence to Kevin Wing; kevin.wing{at}lshtm.ac.uk

Abstract

Objectives We aimed to create a ‘multidatabase’ algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm.

Design Method development for case ascertainment.

Setting Three UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database.

Participants 16 040 people over the age of 18 years with linked CPRD–HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013.

Primary outcome measures (1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status.

Results Within the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95).

Conclusions CPRD–HES–ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD–HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.

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This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-012102

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