Azeem Majeed

Imperial College London, Londinium, England, United Kingdom

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Publications (336)1973.39 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine coverage of NHS Health Check, a national cardiovascular risk assessment programme in England, in the first four years after implementation, and to examine prevalence of high cardiovascular disease (CVD) risk and uptake of statins in high risk patients. Study sample was 95,571 patients in England aged 40-74 years continuously registered with 509 practices in the Clinical Practice Research Datalink between April 2009 and March 2013. Multilevel logistic regression models were used to assess predictors of Health Check attendance; elevated CVD risk factors and statin prescribing among attendees. Programme coverage was 21.4% over four years, with large variations between practices (0%-72.7%) and regions (9.4%-30.7%). Coverage was higher in older patients (adjusted odds ratio 2.88, 95% confidence interval 2.49-3.31 for patients 70-74 years) and in patients with a family history of premature coronary heart disease (2.37, 2.22-2.53), but lower in Black Africans (0.75, 0.61-0.92) and Chinese (0.68, 0.47-0.96) compared with White British. Coverage was similar in patients living in deprived and affluent areas. Prevalence of high CVD risk (QRISK2≥20%) among attendees was 4.6% One third (33.6%) of attendees at high risk were prescribed a statin after Health Checks. Coverage of the programme and statin prescribing in high risk individuals was low. Coverage was similar in deprived and affluent groups but lower in some ethnic minority groups, possibly widening inequalities. These findings raise a question about whether recommendations by WHO to develop CVD risk assessment programmes internationally will deliver anticipated health benefits. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 06/2015; 78. DOI:10.1016/j.ypmed.2015.05.022 · 2.93 Impact Factor
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    ABSTRACT: Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC). The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010. Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health-care providers need to plan to address a significant disease burden both socially and economically.
    Global journal of health science 06/2015; 5(1). DOI:10.7189/jogh.05.010409
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    British Journal of General Practice 06/2015; 65(635):314-6. DOI:10.3399/bjgp15X685441 · 2.36 Impact Factor
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    ABSTRACT: Introduction The Quality and Outcomes Framework (QOF) is a financial incentive scheme that rewards UK general practices for providing evidence-based care, including smoking cessation advice mainly as a secondary prevention intervention. We examined the effects on smoking outcomes and inequalities of a local version of QOF (QOF+), which ran from 2008 to 2011 and extended financial incentives to the provision of cessation advice as a primary prevention intervention. Methods Before-and-after study using data from 28 general practices in Hammersmith & Fulham, London, UK. We used logistic regression to examine changes in smoking outcomes associated with QOF+ within and between socio-demographic groups. Results Recording smoking status increased from 55.5% to 64.2% for men (p<0.001) and from 67.9% to 75.8% for women (p<0.001). All groups benefitted from the increase, but younger patients remained less likely to be asked about smoking than older patients. White patients were less likely to be asked than those from other ethnic groups. Smoking cessation advice increased from 32.7% to 54.0% for men (p<0.001) and from 35.4% to 54.1% for women (p<0.01) and there was little variation between groups for this outcome. Recorded smoking prevalence reduced from 25.0% to 20.8% for men (p<0.001) and from 16.1% to 12.5% for women (p<0.001). White patients and those from more deprived areas remained more likely to be smokers than other groups. Conclusion The introduction of QOF+ was associated with general improvements in recording of smoking outcomes, but inequalities in ascertainment and smoking prevalence with respect to age, ethnicity and deprivation persisted. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail:
    Nicotine & Tobacco Research 05/2015; DOI:10.1093/ntr/ntv107 · 2.81 Impact Factor
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    Michael Soljak, Azeem Majeed
    JAMA Internal Medicine 05/2015; 175(5):862. DOI:10.1001/jamainternmed.2015.69 · 13.25 Impact Factor
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    ABSTRACT: The cardiovascular and mortality risk in patients with incident type 2 diabetes in relation to smoking status and concurrent use of metformin is not well known. The risks of myocardial infarction (MI), stroke and mortality in incident type 2 diabetes patients were evaluated in relation to their smoking status with and without concurrent use of metformin. Cohort study in 82205 incident type 2 diabetes patients from the United Kingdom Clinical Practice Research Datalink. During 5.4 years of median follow-up, among patients without cardiovascular disease (CVD) history before diagnosis of diabetes (n=63166), compared to non-smokers without metformin treatment, current smokers with and without metformin had 8% (HR: 1.08; 95% CI: 0.81, 1.45) and 32% (HR: 1.32; 95% CI: 1.07, 1.65) increased risk of MI or stroke respectively. The respective HR (95% CI) for mortality in these patients were 0.96 (0.83, 1.11) and 1.86 (1.68, 2.07). The HR for mortality among ex-smokers with and without concurrent metformin treatment were 0.92 (0.83, 1.11) and 1.19 (1.10, 1.30) respectively. Ex-smokers did not have elevated risk of MI or stroke, irrespective of metformin treatment. Similar beneficial modifiable effects of metformin among ex- and current smokers were observed in patients with cardiovascular disease before diagnosis of diabetes (n=19039). In type 2 diabetes patients, concurrent treatment with metformin attenuates the observed higher cardiovascular and mortality risk in ex- and current smokers. In addition to smoking cessation support, treatment with metformin, particularly in ex- and current smokers, should be encouraged. This article is protected by copyright. All rights reserved.
    Journal of Diabetes 04/2015; DOI:10.1111/1753-0407.12302 · 2.35 Impact Factor
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    ABSTRACT: Objectives Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants - including private companies - have been allowed into the primary care market under ‘alternative provider of medical services’ contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice.
    Journal of the Royal Society of Medicine 04/2015; 108(5). DOI:10.1177/0141076815583303 · 2.02 Impact Factor
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    Ailsa J McKay, Raju K K Patel, Azeem Majeed
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    ABSTRACT: Tobacco control needs in India are large and complex. Evaluation of outcomes to date has been limited. To review the extent of tobacco control measures, and the outcomes of associated trialled interventions, in India. Information was identified via database searches, journal hand-searches, reference and citation searching, and contact with experts. Studies of any population resident in India were included. Studies where outcomes were not yet available, not directly related to tobacco use, or not specific to India, were excluded. Pre-tested proformas were used for data extraction and quality assessment. Studies with reliability concerns were excluded from some aspects of analysis. The Framework Convention on Tobacco Control (FCTC) was use as a framework for synthesis. Heterogeneity limited meta-analysis options. Synthesis was therefore predominantly narrative. Additional to the Global Tobacco Surveillance System data, 80 studies were identified, 45 without reliability concerns. Most related to education (FCTC Article 12) and tobacco-use cessation (Article 14). They indicated widespread understanding of tobacco-related harm, but less knowledge about specific consequences of use. Healthcare professionals reported low confidence in cessation assistance, in keeping with low levels of training. Training for schoolteachers also appeared suboptimal. Educational and cessation assistance interventions demonstrated positive impact on tobacco use. Studies relating to smoke-free policies (Article 8), tobacco advertisements and availability (Articles 13 and 16) indicated increasingly widespread smoke-free policies, but persistence of high levels of SHS exposure, tobacco promotions and availability-including to minors. Data relating to taxation/pricing and packaging (Articles 6 and 11) were limited. We did not identify any studies of product regulation, alternative employment strategies, or illicit trade (Articles 9, 10, 15 and 17). Tobacco-use outcomes could be improved by school/community-based and adult education interventions, and cessation assistance, facilitated by training for health professionals and schoolteachers. Additional tobacco control measures should be assessed.
    PLoS ONE 04/2015; 10(4):e0122610. DOI:10.1371/journal.pone.0122610 · 3.53 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-830. DOI:10.1016/S0016-5085(15)32822-5 · 13.93 Impact Factor
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    ABSTRACT: As the general election in the UK approaches and NHS policies are set to take centre stage, Thomas E Cowling, Matthew J Harris, and Azeem Majeed discuss the evidence, uncertainty, and debate behind access to primary care
    BMJ (online) 03/2015; 350(mar31 2):h1513. DOI:10.1136/bmj.h1513 · 16.38 Impact Factor
  • PLoS ONE 03/2015; 10(3):e0119185. DOI:10.1371/journal.pone.0119185 · 3.53 Impact Factor
  • Azeem Majeed
    BMJ Clinical Research 03/2015; 350(mar04 18):h1124. DOI:10.1136/bmj.h1124 · 14.09 Impact Factor
  • JAMA Internal Medicine 03/2015; 175(3):467. DOI:10.1001/jamainternmed.2014.7853 · 13.25 Impact Factor
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    ABSTRACT: Varicella and Herpes Zoster are common infectious diseases. Various studies have estimated rates of infection for both manifestations of these infections; however rates of hospital admissions across the country have not previously been described. This paper presents data on hospital admissions in England for Varicella and Herpes Zoster from 2001/2002 to 2010/2011. Time trends study of all hospital admissions for Varicella and Herpes Zoster from 2001/2002 to 2010/2011 in England. Hospital admissions across England from 2001/2002 to 2010/2011. We included all patients admitted to hospital from 2001/2002 to 2010/2011 diagnosed with Varicella and Zoster according to the International Classification of Diseases version 10 (ICD-10). The main outcome measures were admission rates by year and diagnosis and age-specific admission rates for Varicella and Zoster from 2001/2002 to 2010/2011. We analysed data from Hospital Episode Statistics which include patient characteristics such as age which was used here in order to standardise rates to the relevant population. We also used mid-year population estimates from the Office for National Statistics for standardisation purposes. All analyses were conducted using Stata v12.0. The hospital admission rate for Varicella cases has risen by 1.8% over the 10-year study period. While the overall admission rates for Herpes Zoster have decreased by 4% from 2001/2002 levels. The vast majority of Varicella and Zoster admissions were not associated with any complications. The introduction of Herpes Zoster vaccine is anticipated to decrease hospital admissions in older age groups further. A repeat of this study after a further period of time would help to evaluate the impact of the introduction of Herpes Zoster vaccine in England on hospital admissions.
    01/2015; 6(1):2054270414562984. DOI:10.1177/2054270414562984
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    ABSTRACT: The development of Electronic Health Records (EHRs) forms an integral part of the information strategy for the National Health Service (NHS) in the UK, with the aim of facilitating health information exchange for patient care and secondary use, including research and healthcare planning. Implementing EHR systems requires an understanding of patient expectations for consent mechanisms and consideration of public awareness towards information sharing as might be made possible through integrated EHRs across primary and secondary health providers.
    International Journal of Medical Informatics 01/2015; 6(4). DOI:10.1016/j.ijmedinf.2015.01.008 · 2.72 Impact Factor
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    ABSTRACT: Source: This publication on ‘eLearning for Undergraduate Health Professional Education’ responds to a need at the country level for evidence to inform and guide health professional education as an important vehicle in preparing health professionals to be ‘fit-for-purpose’. The World Health Organization (WHO) Department of Health Workforce in collaboration with the Department of Knowledge, Ethics and Research commissioned the Global eHealth Unit (GeHU) at Imperial College London to conduct a systematic review of the scientific literature to evaluate the effectiveness of eLearning for undergraduate health professional education. At a global level, it will assist in the implementation of the WHO’s global human resources for health strategy by providing the best evidence of how and where eLearning can best be used in country settings. The report also provides a foundation for the development of future WHO guidelines for pre-service training and the direction for future research.
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    ABSTRACT: The impact of thiopurine (TP) use on perianal surgery is uncertain. Our aim was to determine trends in perianal surgery and the impact of timing and duration of TPs on the risk of first perianal surgery. We identified a population-based cohort of incident cases of Crohn's disease between 1995 and 2009. We used Kaplan-Meier analysis to determine trends in TP usage and first perianal surgery by era of diagnosis: era 1 (1995-2002) and era 2 (2003-2009). We quantified the impact of duration and timing of TPs on the risk of perianal surgery using a Cox regression model. We identified a cohort of 5235 incident cases of Crohn's disease. The 5-year cumulative probability of first perianal surgery decreased from 2.7% to 1.7% between era 1 and era 2, respectively (P = 0.03). TP use for greater than 18 months was associated with a 40% risk reduction for first perianal surgery (hazard ratio: 0.60, 95% confidence interval: 0.39-0.95) and 49% if TPs were used for 2 years or more (hazard ratio: 0.51, 95% confidence interval: 0.32-0.99). There was no demonstrable additional benefit from early TP use within the first year after diagnosis (hazard ratio: 0.85, 95% confidence interval: 0.52-1.40, P = 0.53). Over the past 15 years, TP use has increased by 50%, whereas perianal surgery rates have decreased by 37% among UK population with Crohn's disease. Sustained use for 18 months was associated with a reduced risk of perianal surgery by almost a half in the first 5 years after diagnosis.
    Inflammatory Bowel Diseases 01/2015; DOI:10.1097/MIB.0000000000000290 · 5.48 Impact Factor
  • Azeem Majeed
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    ABSTRACT: The last few years have been a time of considerable change for general practitioners in England. In 2004, general practitioners negotiated a new contract with the United Kingdom's National Health Service. In came a new pay for performance scheme, along with the option of opting out of after-hours primary care. General practitioners' pay increased and job satisfaction improved. However, rather than then entering a period of stability, general practitioners subsequently found themselves facing even more changes in their working practices. Workload has increased, new responsibilities for commissioning health services have been given to general practitioners, and their income has fallen.
    The Journal of ambulatory care management 01/2015; 38(1):2-4. DOI:10.1097/JAC.0000000000000071
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    ABSTRACT: Data mining of electronic health records (eHRs) allows us to identify patterns of patient data that characterize diseases and their progress and learn best practices for treatment and diagnosis. Clinical Prediction Rules (CPRs) are a form of clinical evidence that quantifies the contribution of different clinical data to a particular clinical outcome and help clinicians to decide the diagnosis, prognosis or therapeutic conduct for any given patient. The TRANSFoRm diagnostic support system (DSS) is based on the construction of an ontological repository of CPRs for diagnosis prediction in which clinical evidence is expressed using a unified vocabulary. This paper explains the proposed methodology for constructing this CPR repository, addressing algorithms and quality measures for filtering relevant rules. Some preliminary application results are also presented.
    Studies in health technology and informatics 01/2015; 210:85-9.
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    ABSTRACT: Hypoglycemia has been associated with an increased risk of cardiovascular (CV) events and all-cause mortality. This study assessed whether, in a nationally representative population, there is an association between hypoglycemia, the risk of CV events, and all-cause mortality among insulin-treated people with type 1 diabetes (T1D) or type 2 diabetes (T2D). This retrospective cohort study used data from the Clinical Practice Research Datalink database, and included all insulin-treated patients (≥30 years of age) with a diagnosis of diabetes. In patients who experienced hypoglycemia, hazard ratios (HRs) for CV events in people with T1D were 1.51 (95% CI 0.83, 2.75; P = ns) and 1.61 (1.17, 2.22), respectively, for those with and without a history of CV disease (CVD) before the index date. In people with T2D, the HRs for patients with and without a history of CVD were 1.60 (1.21, 2.12) and 1.49 (1.23, 1.82), respectively. For all-cause mortality, HRs in people with T1D were 1.98 (1.25, 3.17), and 2.03 (1.66, 2.47), respectively, for those with and without a history of CVD. Among people with T2D, HRs were 1.74 (1.39, 2.18) and 2.48 (2.21, 2.79), respectively, for those with and without a history of CVD. The median time (interquartile range) from first hypoglycemia event to first CV event was 1.5 years (0.5, 3.5 years) and 1.5 years (0.5, 3.0 years), respectively, for people with T1D and T2D. Hypoglycemia is associated with an increased risk of CV events and all-cause mortality in insulin-treated patients with diabetes. The relationship between hypoglycemia and CV outcomes and mortality exists over a long period. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes Care 12/2014; 38(2). DOI:10.2337/dc14-0920 · 8.57 Impact Factor

Publication Stats

5k Citations
1,973.39 Total Impact Points


  • 2004–2015
    • Imperial College London
      • • School of Public Health
      • • Department of Primary Care and Public Health
      • • Imperial College Clinical Imaging Facility
      • • Faculty of Medicine
      Londinium, England, United Kingdom
  • 2009–2014
    • Imperial Valley College
      IPL, California, United States
    • The University of Edinburgh
      • Centre for Population Health Sciences
      Edinburgh, Scotland, United Kingdom
  • 2012
    • Taipei City Hospital
      • Department of Family Medicine
      T’ai-pei, Taipei, Taiwan
    • University of Oxford
      • Department of Primary Care Health Sciences
      Oxford, ENG, United Kingdom
  • 2011
    • University of Surrey
      • Department of Health Care Management and Policy
      Guildford, ENG, United Kingdom
  • 2002–2008
    • University of California, San Francisco
      • • Division of Hospital Medicine
      • • Department of Medicine
      San Francisco, CA, United States
    • University College London Hospitals NHS Foundation Trust
      Londinium, England, United Kingdom
    • St George's, University of London
      Londinium, England, United Kingdom
  • 2006
    • Medical University of South Carolina
      • Department of Family Medicine
      Charleston, SC, United States
  • 2002–2006
    • University of Leicester
      • Department of Health Sciences
      Leiscester, England, United Kingdom
  • 1998–2005
    • Office for National Statistics
      Londinium, England, United Kingdom
  • 2002–2004
    • King's College London
      Londinium, England, United Kingdom
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2003
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2000–2003
    • University College London
      • School of Public Policy
      London, ENG, United Kingdom
  • 1999
    • Kingston University
      Kingston, England, United Kingdom