Development and validation of an algorithm to accurately identify atopic eczema patients in primary care electronic health records from the UK

Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging due to its episodic and heterogeneous nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network (THIN). We found that at least one of 5 diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, the positive predictive value (PPV) for a physician-confirmed diagnosis of AE, was 86% (95%CI 80-91%). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% CI -0.3,1.9) and -1.3 years respectively (95%CI -2.5, -0.1). A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from the THIN primary care electronic health records in the UK

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes:a national observational study

Acknowledgements Some of the data were presented as an abstract at the Diabetes UK Professional Conference in 2017. Diabetes data for Scotland are available for analysis by members of the Scottish Diabetes Research Network (SDRN) thanks to the hard work and dedication of NHS staff across Scotland who enter the data and people and organisations (the Scottish Care Information –Diabetes Collaboration (SCI-DC) Steering Group, the Scottish Diabetes Group, the Scottish Diabetes Survey Group, the managed clinical network managers and staff in each Health Board) involved in setting up, maintaining and overseeing SCI-DC. The SDRN receives core support from the Chief Scientist’s Office at the Scottish Government Health Department. Members of the Scottish Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data collection include R. Lindsay (Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK); J. McKnight (Western General Hospital, Edinburgh, UK); S. Philip (Institute of Applied Health Sciences, University of Aberdeen, UK); Members of the Scottish Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data management include L. Blackbourn (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); B. Farran (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); D. McAllister (Institute of Health and Wellbeing, University of Glasgow, UK); P. McKeigue (Usher Institute of Population Health Sciences, University of Edinburgh, UK); S. Read (Usher Institute of Population Health Sciences, University of Edinburgh, UK).Peer reviewedPublisher PD

Infections in children with eczema in UK general practice- a cohort study.

BackgroundCase reports and cross-sectional studies suggest increased risks of cutaneous and non-cutaneous infections in eczema; this relationship needs to be assessed in large population-based studies with diagnostic confirmation. The objective was to examine associations between eczema and common childhood infections.MethodsIndividuals registered prior to age 18 in the Health Improvement Network, a UK general practice database, from 2003 to 2013 were included in this cohort study. We determined the association between eczema and selected infectious outcomes, including cutaneous (dermatophyte, herpes simplex virus, impetigo, molluscum contagiosum and warts), and non-cutaneous infections (otitis media, streptococcal throat infections, and pneumonia).ResultsEczema was diagnosed in 14.4% (95% confidence interval 14.4, 14.4), and the average age of eczema diagnosis was 7.94 years (7.91, 7.98). All of the infectious illnesses were more prevalent in those with eczema compared to those without, with adjusted odds ratios (95% confidence intervals) as follows: dermatophyte 2.54 (2.47-2.61), herpes simplex virus, 2.08 (2.04-2.12), impetigo 2.61 (2.53-2.68), molluscum contagiosum 3.11 (3.07-3.14) and warts 1.98 (1.96-2.00). For non-cutaneous outcomes, the odds of otitis media, streptococcal throat infections and pneumonia were 2.24 (2.22-2.25), 1.75 (1.69-1.82) and 1.27 (1.23,1.31). Associations were attenuated in sensitivity analyses.ConclusionSelected infectious illnesses were more prevalent in those with eczema versus those without, with the strength of association varying from 75% increase in streptococcal throat infections to a three-fold increased prevalence for molluscum contagiosum. Findings suggest there may be generalized immune dysfunction in eczema predisposing to increased risk of various infections, which is important for clinical management

Human leukocyte antigen class-I variation is associated with atopic dermatitis: A case-control study.

Atopic dermatitis (AD) is a common immune-medicated skin disease. Previous studies have explored the relationship between Human Leukocyte Antigen (HLA) allelic variation and AD with conflicting results. The aim was to examine HLA Class I genetic variation, specifically peptide binding groove variation, and associations with AD. A case-control study was designed to evaluate HLA class I allelic variation and binding pocket polymorphisms, using next generation sequencing on 464 subjects with AD and 388 without AD. Logistic regression was used to evaluate associations with AD by estimating odds ratios (95% confidence intervals). Significant associations were noted with susceptibility to AD (B*53:01) and protection from AD (A*01:01, A*02:01, B*07:02 and C*07:02). Evaluation of polymorphic residues in Class I binding pockets revealed six amino acid residues conferring protection against AD: A9F (HLA-A, position 9, phenylalanine) [pocket B/C], A97I [pocket C/E], A152V [pocket E], A156R [pocket D/E], B163E [pocket A] and C116S [pocket F]. These findings demonstrate that specific HLA class I components are associated with susceptibility or protection from AD. Individual amino acid residues are relevant to protection from AD and set the foundation for evaluating potential HLA Class I molecules in complex with peptides/antigens that may initiate or interfere with T-cell responses