Outline of presentation (workshop!)

Prevalence in Perspective

PRIMIS

Fifth Annual Conference 11 – 12 May 2005

Piecing Together the Future

Dr Pete HorsfieldPRIMIS Clinical Director

Dr Dai EvansPRIMIS Clinical Adviser

PRIMIS

Outline of presentation (workshop!)

• Data sources

• Exploration and comparison of prevalence data from different sources

• Discussion

PRIMIS

Data sources• PRIMIS data extractions

– Cumulative 01.01.2003 – 31.01.2005– 0.5 million patients (Epilepsy); 16 million (DM, BP)

• Key Health Statistics 1998– Office for National Statistics– General Practice Research Database– 1.2 million patients

• QMAS– National prevalence day– Entire population (almost)– www.qualitymedicalsolutions.co.uk

• QResearch (2003)– University of Nottingham research database– 426 practices– 2.9 million patients

PRIMIS

• Medical Statistics are like a bikini

• What they reveal is interesting, but what they conceal is vital

Hypertension Prevalence: Age/Sex Breakdown rate per thousand

0

50

100

150

200

250

300

350

400

450

500

Age bands

Rat

e Pe

r Tho

usan

d

Female 0.10 0.22 0.38 1.29 3.76 7.55 14.26 24.30 41.59 73.69 126.40 188.54 257.36 331.31 396.08 443.26 453.88 415.10 343.66 242.93 134.89 50.00

Male 0.16 0.28 0.46 0.87 2.33 5.46 12.19 22.84 42.16 76.67 124.33 178.02 237.04 303.79 357.07 384.70 378.86 324.34 253.44 161.87 72.70 16.67

All 0.13 0.25 0.42 1.07 3.04 6.50 13.20 23.55 41.88 75.22 125.35 183.21 247.14 317.84 377.81 417.88 425.48 386.37 320.42 226.45 121.64 42.31

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of treated hypertension, KHS, 1998

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

0 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rat

e pe

r th

ousa

nd

FemalesMales All

Hypertension Prevalence: Age/Sex Breakdown rate per thousand

0

50

100

150

200

250

300

350

400

450

500

Age bands

Ra

te P

er T

ho

us

an

d

Female 0.10 0.22 0.38 1.29 3.76 7.55 14.26 24.30 41.59 73.69 126.40 188.54 257.36 331.31 396.08 443.26 453.88 415.10 343.66 242.93 134.89 50.00

Male 0.16 0.28 0.46 0.87 2.33 5.46 12.19 22.84 42.16 76.67 124.33 178.02 237.04 303.79 357.07 384.70 378.86 324.34 253.44 161.87 72.70 16.67

All 0.13 0.25 0.42 1.07 3.04 6.50 13.20 23.55 41.88 75.22 125.35 183.21 247.14 317.84 377.81 417.88 425.48 386.37 320.42 226.45 121.64 42.31

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of treated hypertension, KHS, 1998

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

0 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rate p

er t

housand

FemalesMales All

PRIMIS

Prevalence of Hypertension

95% CI

PRIMIS (n=16 million) 103.6 103.5 – 103.8

Key Statistics 79.5 79.0 – 80.0

QMAS 108.9

QResearch 117.8 117.4 – 118.2

PRIMIS

Hypertension

1198

1073

1360

1081

530

933

1100

859

499 500579

506

1511

1222

627

1108

2055

0

500

1000

1500

2000

2500

B C D E H L M Q R S T U V X Z AA Network 7

Research Practices

Pat

ien

ts c

on

sult

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per

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000

2nd audit cycle 3rd audit cycle 4th audit cycle 5th audit cycle 6th audit cycle 7th audit cycle

Ischaemic Heart Disease Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

160

180

200

220

240

260

Age bands

Rat

e Pe

r Tho

usan

d

Female 0.02 0.05 0.08 0.11 0.18 0.28 0.49 0.94 2.61 6.84 15.08 27.43 52.47 82.12 118.65 151.58 169.19 176.57 172.61 146.75 121.95 128.57

Male 0.06 0.03 0.08 0.11 0.20 0.32 0.89 2.26 7.13 18.12 37.04 64.79 112.01 162.08 208.82 240.45 248.26 239.93 215.35 160.94 84.75 41.67

All 0.04 0.04 0.08 0.11 0.19 0.30 0.70 1.62 4.93 12.59 26.18 46.30 82.29 121.26 160.63 189.83 199.11 196.49 183.40 149.53 114.56 106.38

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of treated ischaemic heart disease, KHS, 1998

0.0

50.0

100.0

150.0

200.0

250.0

0 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rat

e pe

r th

ousa

nd

FemalesMales All

Prevalence of treated ischaemic heart disease, KHS, 1998

0.0

50.0

100.0

150.0

200.0

250.0

0 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rat

e pe

r th

ousa

nd

FemalesMales All

Ischaemic Heart Disease Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

160

180

200

220

240

260

Age bands

Ra

te P

er T

ho

us

an

d

Female 0.02 0.05 0.08 0.11 0.18 0.28 0.49 0.94 2.61 6.84 15.08 27.43 52.47 82.12 118.65 151.58 169.19 176.57 172.61 146.75 121.95 128.57

Male 0.06 0.03 0.08 0.11 0.20 0.32 0.89 2.26 7.13 18.12 37.04 64.79 112.01 162.08 208.82 240.45 248.26 239.93 215.35 160.94 84.75 41.67

All 0.04 0.04 0.08 0.11 0.19 0.30 0.70 1.62 4.93 12.59 26.18 46.30 82.29 121.26 160.63 189.83 199.11 196.49 183.40 149.53 114.56 106.38

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of treated ischaemic heart disease, KHS, 1998

0.0

50.0

100.0

150.0

200.0

250.0

0 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rate p

er t

housand

FemalesMales All

PRIMIS

Prevalence of Ischaemic heart disease

95% CI

PRIMIS (n=7.6 million) 37.9 37.7 – 38.0

Key Statistics 37.2 36.8 – 37.5

QMAS 34.6

QResearch 40.6 40.3 – 40.8

PRIMIS

MIs over last 6yrs in JKP (7400pts)

0

2

4

6

8

10

12

14

16

18

20

1 2 3 4 5 6

Year

MI

1999 2000 2001 2002 2003 2004

Transient Ischaemic Attack or Cerebrovascular Accident Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

160

Age bands

Rat

e Pe

r Tho

usan

d

Female 0.21 0.25 0.24 0.27 0.54 0.62 1.05 1.42 2.12 3.70 5.92 10.10 18.21 30.09 47.44 70.48 98.85 122.43 134.09 136.76 133.65 73.17

Male 0.19 0.25 0.24 0.37 0.34 0.44 0.67 0.94 1.91 3.81 7.64 14.73 27.08 45.82 67.79 97.37 124.95 141.70 143.61 120.26 85.31 0.00

All 0.20 0.25 0.24 0.32 0.44 0.53 0.86 1.17 2.01 3.75 6.79 12.43 22.65 37.79 56.97 82.08 108.74 128.55 136.55 133.55 123.93 56.60

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Transient Ischaemic Attack or Cerebrovascular Accident Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

160

Age bands

Rat

e Pe

r Tho

usan

d

Female 0.21 0.25 0.24 0.27 0.54 0.62 1.05 1.42 2.12 3.70 5.92 10.10 18.21 30.09 47.44 70.48 98.85 122.43 134.09 136.76 133.65 73.17

Male 0.19 0.25 0.24 0.37 0.34 0.44 0.67 0.94 1.91 3.81 7.64 14.73 27.08 45.82 67.79 97.37 124.95 141.70 143.61 120.26 85.31 0.00

All 0.20 0.25 0.24 0.32 0.44 0.53 0.86 1.17 2.01 3.75 6.79 12.43 22.65 37.79 56.97 82.08 108.74 128.55 136.55 133.55 123.93 56.60

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of stroke disease, KHS, 1998

0.0

5.0

10.0

15.0

20.0

25.0

0 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rat

e pe

r th

ousa

nd

FemalesMales All

Prevalence of stroke disease, KHS, 1998

0.0

5.0

10.0

15.0

20.0

25.0

0 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rate p

er t

housand

FemalesMales All

Transient Ischaemic Attack or Cerebrovascular Accident Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

160

Age bands

Ra

te P

er T

ho

us

an

d

Female 0.21 0.25 0.24 0.27 0.54 0.62 1.05 1.42 2.12 3.70 5.92 10.10 18.21 30.09 47.44 70.48 98.85 122.43 134.09 136.76 133.65 73.17

Male 0.19 0.25 0.24 0.37 0.34 0.44 0.67 0.94 1.91 3.81 7.64 14.73 27.08 45.82 67.79 97.37 124.95 141.70 143.61 120.26 85.31 0.00

All 0.20 0.25 0.24 0.32 0.44 0.53 0.86 1.17 2.01 3.75 6.79 12.43 22.65 37.79 56.97 82.08 108.74 128.55 136.55 133.55 123.93 56.60

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

PRIMIS

Prevalence of Stroke disease

95% CI

PRIMIS (n=5.3 million) 15.3 15.2 – 15.4

Key Statistics 2.3 2.2 – 2.3

QMAS 16.5

QResearch 17.9 17.8 – 18.1

Heart Failure Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

160

Age bands

Rat

e Pe

r Tho

usan

d

Female 0.16 0.18 0.19 0.15 0.13 0.11 0.17 0.18 0.40 0.61 1.23 2.63 6.07 12.74 24.22 45.41 71.26 104.38 131.85 147.35 138.42 121.95

Male 0.17 0.22 0.15 0.15 0.16 0.11 0.22 0.31 0.66 1.27 2.69 5.77 11.97 22.28 37.69 60.37 86.75 124.45 141.78 110.46 99.53 0.00

All 0.17 0.20 0.17 0.15 0.14 0.11 0.19 0.25 0.53 0.95 1.97 4.21 9.03 17.41 30.53 51.86 77.13 110.76 134.41 140.17 130.60 94.34

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

PRIMIS

Prevalence of Heart failure

95% CI

PRIMIS (n=5.3 million) 9.2 9.1 – 9.3

QMAS 4.2

Diabetes Mellitus Prevalence: Age/Sex Breakdown rate per thousand

0

10

20

30

40

50

60

70

80

90

100

110

120

130

Age bands

Rat

e Pe

r Tho

usan

d

Female 0.28 1.18 2.42 3.01 3.46 4.61 6.37 9.18 13.73 20.28 27.26 36.81 54.88 76.26 88.93 88.26 80.47 70.12 57.55 41.31 27.13 10.00

Male 0.30 1.21 2.36 3.29 3.70 5.07 7.48 11.11 17.78 28.70 40.99 55.16 77.63 104.26 118.22 117.23 103.99 93.11 74.02 48.09 24.69 16.67

All 0.29 1.19 2.38 3.15 3.58 4.84 6.94 10.18 15.82 24.61 34.25 46.11 66.32 89.97 102.64 100.81 89.37 77.40 61.80 42.69 26.61 11.54

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of treated diabetes mellitus, KHS, 1998

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

0 - 4 5 - 15 16 - 24 25 -34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rat

e pe

r th

ousa

nd

FemalesMales All

Diabetes Mellitus Prevalence: Age/Sex Breakdown rate per thousand

0

10

20

30

40

50

60

70

80

90

100

110

120

130

Age bands

Ra

te P

er T

ho

us

an

d

Female 0.28 1.18 2.42 3.01 3.46 4.61 6.37 9.18 13.73 20.28 27.26 36.81 54.88 76.26 88.93 88.26 80.47 70.12 57.55 41.31 27.13 10.00

Male 0.30 1.21 2.36 3.29 3.70 5.07 7.48 11.11 17.78 28.70 40.99 55.16 77.63 104.26 118.22 117.23 103.99 93.11 74.02 48.09 24.69 16.67

All 0.29 1.19 2.38 3.15 3.58 4.84 6.94 10.18 15.82 24.61 34.25 46.11 66.32 89.97 102.64 100.81 89.37 77.40 61.80 42.69 26.61 11.54

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of treated diabetes mellitus, KHS, 1998

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

0 - 4 5 - 15 16 - 24 25 -34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rate p

er t

housand

FemalesMales All

PRIMIS

Prevalence of Diabetes mellitus

95% CI

PRIMIS (n=8 million) 30.0 29.9 – 30.2

Key Statistics 16.7 16.5 – 17.0

QMAS 33.5

QResearch 32.0 31.8 – 32.2

Keele GPRN Core 36.4

PRIMIS

Diabetes

328 332

435

342331 338

362

210

270

351

276 279

322

345 340355

388

0

50

100

150

200

250

300

350

400

450

500

B C D E H L M Q R S T U V X Z AA Network7Research Practices

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ient

s co

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2nd audit cycle 3rd audit cycle 4th audit cycle 5th audit cycle 6th audit cycle 7th Audit cycle

Asthma (diagnosis ever) Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

160

180

200

220

Age bands

Rat

e Pe

r Tho

usan

d

Female 34.13 118.99 162.02 171.27 156.31 132.93 114.68 111.76 103.24 100.38 98.16 98.50 105.44 106.31 106.48 101.70 89.15 76.15 61.95 40.93 21.98 0.00

Male 57.10 156.98 202.25 187.71 147.92 118.09 100.05 88.48 86.24 74.56 71.50 65.86 76.14 85.36 90.13 94.66 88.12 72.70 55.98 19.90 0.00 0.00

All 45.92 138.49 182.65 179.71 152.06 125.41 107.31 99.96 94.62 87.26 84.74 82.05 90.85 96.09 98.93 98.67 88.77 75.05 60.47 37.10 18.18 0.00

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Active Asthma* Prevalence: Age/Sex Breakdown rate per thousand

0

10

20

30

40

50

60

70

80

90

100

110

Age bands

Rat

e P

er T

ho

usan

d

Female 23.65 65.40 77.87 77.14 64.15 67.32 65.05 67.70 64.04 65.36 65.28 70.02 80.46 85.04 85.25 83.26 69.67 59.02 45.62 27.65 10.99 0.00

Male 41.23 90.62 100.14 66.71 49.04 52.60 54.33 49.67 49.67 45.56 44.42 44.43 57.02 67.37 70.71 77.83 72.54 56.99 40.71 14.93 0.00 0.00

All 32.68 78.35 89.29 71.79 56.49 59.86 59.65 58.56 56.76 55.30 54.79 57.13 68.79 76.42 78.53 80.92 70.75 58.37 44.40 25.34 9.09 0.00

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

*Active asthma = asthma requiring medication in the last year

Prevalence of treated asthma, KHS, 1998

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

0 - 4 5 - 15 16 - 24 25 -34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rat

e pe

r th

ousa

nd

FemalesMales All

Prevalence of treated asthma, KHS, 1998

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

0 - 4 5 - 15 16 - 24 25 -34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rate p

er t

housand Females

Males All

Active Asthma* Prevalence: Age/Sex Breakdown rate per thousand

0

10

20

30

40

50

60

70

80

90

100

110

Age bands

Rate P

er T

ho

usan

d

Female 23.65 65.40 77.87 77.14 64.15 67.32 65.05 67.70 64.04 65.36 65.28 70.02 80.46 85.04 85.25 83.26 69.67 59.02 45.62 27.65 10.99 0.00

Male 41.23 90.62 100.14 66.71 49.04 52.60 54.33 49.67 49.67 45.56 44.42 44.43 57.02 67.37 70.71 77.83 72.54 56.99 40.71 14.93 0.00 0.00

All 32.68 78.35 89.29 71.79 56.49 59.86 59.65 58.56 56.76 55.30 54.79 57.13 68.79 76.42 78.53 80.92 70.75 58.37 44.40 25.34 9.09 0.00

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

*Active asthma = asthma requiring medication in the last year

PRIMIS

Prevalence of Asthma (treated)

95% CI

PRIMIS (n=0.9 million) 63.5 62.9 – 64.0

Key Statistics 74.3 73.8 – 74.8

QMAS 55.5

QResearch (all asthma) 72.3 71.6 – 72.9

Severe Mental Illness Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

Age bands

Rat

e P

er T

ho

usan

d

Female 1.38 1.74 6.50 32.76 67.52 70.84 75.54 77.18 74.98 70.91 66.66 62.09 58.04 51.37 55.80 67.54 81.26 103.70 106.13 116.51 82.35 0.00

Male 1.60 2.53 4.41 13.45 36.87 41.93 41.63 42.13 41.11 39.78 37.59 34.09 32.34 28.24 30.94 45.56 50.83 65.23 56.54 69.44 0.00 0.00

All 1.49 2.14 5.43 22.85 52.04 56.45 58.62 59.50 57.88 55.07 51.97 48.02 45.24 40.06 44.31 58.17 69.91 91.81 93.81 107.36 69.65 0.00

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

Prevalence of schizophrenia, KHS, 1998

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

0 - 4 5 - 15 16 - 24 25 -34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rat

e pe

r th

ousa

nd

FemalesMales All

Prevalence of schizophrenia, KHS, 1998

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

0 - 4 5 - 15 16 - 24 25 -34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+

Age group

Rate p

er t

housand

FemalesMales All

Severe Mental Illness Prevalence: Age/Sex Breakdown rate per thousand

0

20

40

60

80

100

120

140

Age bands

Rate P

er T

ho

usan

d

Female 1.38 1.74 6.50 32.76 67.52 70.84 75.54 77.18 74.98 70.91 66.66 62.09 58.04 51.37 55.80 67.54 81.26 103.70 106.13 116.51 82.35 0.00

Male 1.60 2.53 4.41 13.45 36.87 41.93 41.63 42.13 41.11 39.78 37.59 34.09 32.34 28.24 30.94 45.56 50.83 65.23 56.54 69.44 0.00 0.00

All 1.49 2.14 5.43 22.85 52.04 56.45 58.62 59.50 57.88 55.07 51.97 48.02 45.24 40.06 44.31 58.17 69.91 91.81 93.81 107.36 69.65 0.00

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99100-104

105-109

PRIMIS

Prevalence of Epilepsy

95% CI

PRIMIS (n=0.5 million) 10.7 10.4 – 11.0

QMAS 5.7

QResearch 10.2 10.1 – 10.4

PRIMIS

Issues

• Data quality• Definitions and standards• Selection bias• ‘Creative accounting’• Data extraction / interrogation routines