A Majeed

Publications (56)275.97 Total impact

• Article: Effect of financial incentives on ethnic disparities in smoking cessation interventions in primary care: cross-sectional study.

  F L Hamilton, A A Laverty, E P Vamos, A Majeed, C Millett
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  ABSTRACT: BACKGROUND: Smoking cessation interventions are underprovided in primary care. Financial incentives may help address this. However, few studies in the UK have examined their impact on disparities in the delivery of smoking cessation interventions. METHODS: Cross-sectional study using 2007 data from 29 general practices in Wandsworth, London, UK. We used logistic regression to examine associations between disease group [cardiovascular disease (CVD), respiratory disease, depression or none of these diseases], ethnicity and smoking outcomes following the introduction of the Quality and Outcomes Framework in 2004. RESULTS: Significantly, more CVD patients had smoking status ascertained compared with those with respiratory disease (89 versus 72%), but both groups received similar levels of cessation advice (93 and 89%). Patients with depression or none of the diseases were less likely to have smoking status ascertained (60% for both groups) or to receive advice (80 and 75%). Smoking prevalence was high, especially for patients with depression (44%). White British patients had higher rates of smoking than most ethnic groups, but black Caribbean men with depression had the highest smoking prevalence (62%). CONCLUSIONS: Smoking rates remain high, particularly for white British and black Caribbean patients. Extending financial incentives to include recording of ethnicity and rewarding quit rates may further improve smoking cessation outcomes in primary care.
  Journal of Public Health 07/2012; · 2.06 Impact Factor
• Article: Association between patient and general practice characteristics and unplanned first-time admissions for cancer: observational study.

  A Bottle, C Tsang, C Parsons, A Majeed, M Soljak, P Aylin
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  ABSTRACT: Background:To identify patient and general practice (GP) characteristics associated with emergency (unplanned) first admissions for cancer in secondary care.Methods:Patients who had a first-time admission with a primary diagnosis of cancer during 2007/08 to 2009/10 were identified from administrative hospital data. We modelled the associations between the odds of these admissions being unplanned and various patient and GP practice characteristics using national data sets, including the Quality and Outcomes Framework (QOF).Results:There were 639 064 patients with a first-time admission for cancer, with 139 351 unplanned, from 7957 GP practices. The unplanned proportion ranged from 13.9% (patients aged 15-44 years) to 44.9% (patients aged 85 years and older, P<0.0001), with large variation by ethnicity (highest in Asians), deprivation, rurality and cancer type. In unadjusted analyses, all included patient and practice-level variables were statistically significant predictors of the admissions being unplanned. After adjustment, patient area-level deprivation was a key factor (most deprived compared with least deprived quintile OR 1.36, 95% CI 1.32-1.40). Higher total QOF performance protected against unplanned admission (OR 0.94 per 100 points; 95% CI 0.91-0.97); having no GPs with a UK primary medical qualification (OR 1.08, 95% CI 1.04-1.11) and being less able to offer appointments within 48 h were associated with higher odds.Conclusion:We have identified some patient and practice characteristics associated with a first-time admission for cancer being unplanned. The former could be used to help identify patients at high risk, while the latter raise questions about the role of practice organisation and staff training.
  British Journal of Cancer 07/2012; 107(8):1213-9. · 5.04 Impact Factor
• Article: Scope and effectiveness of mobile phone messaging for HIV/AIDS care: A systematic review.

  M H M M T van Velthoven, S Brusamento, A Majeed, J Car
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  ABSTRACT: The objective of this mixed method systematic review was to assess the scope, effectiveness, acceptability and feasibility of the use of mobile phone messaging for HIV infection prevention, treatment and care. We comprehensively searched the peer-reviewed and grey literature. Two authors independently screened citations, extracted data and assessed study quality of included studies (any research design) focusing on mobile phone messaging interventions for HIV care. We present a narrative overview of the results. Twenty-one studies met the inclusion criteria: three randomized controlled trials, 11 interventional studies using other study designs and seven qualitative or cross-sectional studies. We also found six on-going trials and 21 projects. Five of the on-going trials and all the above mentioned projects took place in low or middle-income countries. Mobile phone messaging was researched for HIV prevention, appointment reminders, HIV testing reminders, medication adherence and for communication between health workers. Of the three randomized controlled trials assessing the use of short message service (SMS) to improve medication adherence, two showed positive results. Other interventional studies did not provide significant results. In conclusion, despite an extensive search we found limited evidence on the effectiveness of mobile phone messaging for HIV care. There is a need to adequately document outcomes and constraints of programs using mobile phone messaging to support HIV care to assess the impact and to focus on best practice.
  Psychology Health and Medicine 07/2012; · 1.18 Impact Factor
• Article: Women develop type 2 diabetes at a higher body mass index than men.

  S Paul, G Thomas, A Majeed, K Khunti, K Klein
  Diabetologia 02/2012; 55(5):1556-7. · 6.81 Impact Factor
• Article: Trends and transient change in end-digit preference in blood pressure recording: studies of sequential and longitudinal collected primary care data.

  O N Alsanjari, S de Lusignan, J van Vlymen, H Gallagher, C Millett, K Harris, A Majeed
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  ABSTRACT: End-digit preference (EDP) is a known cause of inaccurate BP recording. Distortion has been reported around pay-for-performance (P4P) indicators. We studied sequential datasets (n = 148,000 to n = 900,000) and performed a longitudinal analysis of CONDUIT data (n = 250,000) over a 10-year period. We examined general trends in EDP and investigated the impact of diabetes and chronic kidney disease (CKD) P4P targets. EDP reduces over time in both datasets; the percentage of patients with a zero EDP declined from 70% to 27% and 68% to 26% for SBP and DBP respectively. There is more zero EDP at the extremes of BP, but in people with chronic disease, the use of zero EDP was mainly seen at higher BP levels. P4P targets are associated with increased preference for the even end-digit just below target: in diabetes odds ratio (OR) is 1.47 (p = 0.003) for SBP, 1.19 (p = 0.09) for DBP and in CKD OR 1.65 (p < 0.001) for SBP and 1.48 (p = 0.0001) for DBP. Trends observed in pilot data were validated with a longitudinal set. The decline in EDP is levelling off and P4P targets are associated with sub-target-EDP. Primary care should automate BP measurement and recording.
  International Journal of Clinical Practice 01/2012; 66(1):37-43. · 2.41 Impact Factor
• Article: Effectiveness of providing financial incentives to healthcare professionals for smoking cessation activities: systematic review.

  F L Hamilton, F Greaves, A Majeed, C Millett
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  ABSTRACT: OBJECTIVE: Financial incentives are seen as one approach to encourage more systematic use of smoking cessation interventions by healthcare professionals. A systematic review was conducted to examine the evidence for this. METHODS: Medline, Embase, PsychINFO, Cochrane Library, ISI Web of Science and sources of grey literature were used as data sources. Studies were included if they reported the effects of any financial incentive provided to healthcare professionals to undertake smoking cessation-related activities. Data extraction and quality assessment for each study were conducted by one reviewer and checked by a second. A total of 18 studies were identified, consisting of 3 randomised controlled trials and 15 observational studies. All scored in the mid range for quality. In all, 8 studies examined smoking cessation activities alone and 10 studied the UK's Quality and Outcomes Framework targeting quality measures for chronic disease management including smoking recording or cessation activities. Five non-Quality and Outcomes Framework studies examined the effects of financial incentives on individual doctors and three examined effects on groups of healthcare professionals based in clinics and general practices. Most studies showed improvements in recording smoking status and smoking cessation advice. Five studies examined the impact of financial incentives on quit rates and longer-term abstinence and these showed mixed results. CONCLUSIONS: Financial incentives appear to improve recording of smoking status, and increase the provision of cessation advice and referrals to stop smoking services. Currently there is not sufficient evidence to show that financial incentives lead to reductions in smoking rates.
  Tobacco control 11/2011; · 3.85 Impact Factor
• Article: Exclusion of patients from quality measurement of diabetes care in the UK pay-for-performance programme.

  A R H Dalton, R Alshamsan, A Majeed, C Millett
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  ABSTRACT: We examined associations between patient and practice characteristics and exclusions from quality indicators for diabetes during the first 3 years of the Quality and Outcomes Framework, a major pay-for-performance scheme in the UK. Three cross-sectional analyses, conducted using data from the electronic medical records of all patients with diabetes registered in 23 general practices in Brent, North West London between 2004/2005 and 2006/2007. Patterns of exclusions were examined for three intermediate outcome indicators. Excluded patients were less likely to achieve treatment targets for HbA(1c) (2004/2005, 2006/2007), blood pressure (2005/2006, 2006/2007) and cholesterol (2005/2006). Black and South Asian patients were more likely to be excluded from the HbA(1c) indicator than White patients [adjusted odds ratio = 1.64 (1.17-2.29) in 2005/2006]. Patients diagnosed with diabetes duration of > 10 years [adjusted odds ratio = 2.01 (1.65-2.45) for HbA(1c) in 2006-2007] and those with co-morbidities (adjusted odds ratio, ≥ 3 co-morbidities compared with no co-morbidity for HbA(1c) adjusted odds ratio = 1.90 (1.24-2.90) in 2004/2005] were more likely to be excluded. Larger practices excluded more patients from the HbA(1c) indicator [adjusted odds ratio, practice ≥ 7000 compared with < 3000, 3.52 (2.35-5.27) in 2005-2006]. More deprived practices consistently excluded more patients from all indicators, whilst in 2007 older patients were excluded to a larger degree [adjusted odds ratio = 2.52 (1.21-5.28) ≥ 75 compared with 18-44 for blood pressure control]. Patients excluded from pay-for-performance programmes may be less likely to achieve treatment goals and disproportionately come from disadvantaged groups. Permitting physicians to exclude patients from pay-for-performance programmes may worsen health disparities.
  Diabetic Medicine 02/2011; 28(5):525-31. · 2.90 Impact Factor
• Article: Weekend mortality for emergency admissions. A large, multicentre study.

  Paul Aylin, A Yunus, A Bottle, A Majeed, D Bell
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  ABSTRACT: Several studies have identified higher mortality for patients admitted as emergencies at the weekend compared with emergency admissions during the week, but most have focused on specific conditions or have had a limited sample size. Using routinely collected hospital administrative data, we examined in-hospital deaths for all emergency inpatient admissions to all public acute hospitals in England for 2005/2006. Odds of death were calculated for admissions at the weekend compared to admissions during the week, adjusted for age, sex, socioeconomic deprivation, comorbidity and diagnosis. Of a total of 4,317,866 emergency admissions, we found 215,054 in-hospital deaths with an overall crude mortality rate of 5.0% (5.2% for all weekend admissions and 4.9% for all weekday admissions). The overall adjusted odds of death for all emergency admissions was 10% higher (OR 1.10, 95% CI 1.08 to 1.11) in those patients admitted at the weekend compared with patients admitted during a weekday (p<0.001). This is the largest study published on weekend mortality and highlights an area of concern in relation to the delivery of acute services.
  Quality and Safety in Health Care 06/2010; 19(3):213-7. · 1.68 Impact Factor
• Article: A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected data.

  S de Lusignan, K Khunti, J Belsey, A Hattersley, J van Vlymen, H Gallagher, C Millett, N J Hague, C Tomson, K Harris, A Majeed
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  ABSTRACT: Incorrect classification, diagnosis and coding of the type of diabetes may have implications for patient management and limit our ability to measure quality. The aim of the study was to measure the accuracy of diabetes diagnostic data and explore the scope for identifying errors. We used two sets of anonymized routinely collected computer data: the pilot used Cutting out Needless Deaths Using Information Technology (CONDUIT) study data (n = 221 958), which we then validated using 100 practices from the Quality Improvement in Chronic Kidney Disease (QICKD) study (n = 760,588). We searched for contradictory diagnostic codes and also compatibility with prescription, demographic and laboratory test data. We classified errors as: misclassified-incorrect type of diabetes; misdiagnosed-where there was no evidence of diabetes; or miscoded-cases where it was difficult to infer the type of diabetes. The standardized prevalence of diabetes was 5.0 and 4.0% in the CONDUIT and the QICKD data, respectively: 13.1% (n = 930) of CONDUIT and 14.8% (n = 4363) QICKD are incorrectly coded; 10.3% (n = 96) in CONDUIT and 26.2% (n = 1143) in QICKD are misclassified; nearly all of these cases are people classified with Type 1 diabetes who should be classified as Type 2. Approximately 5% of T2DM in both samples have no objective evidence to support a diagnosis of diabetes. Miscoding was present in approximately 7.8% of the CONDUIT and 6.1% of QICKD diabetes records. The prevalence of miscoding, misclassification and misdiagnosis of diabetes is high and there is substantial scope for further improvement in diagnosis and data quality. Algorithms which identify likely misdiagnosis, misclassification and miscoding could be used to flag cases for review.
  Diabetic Medicine 02/2010; 27(2):203-9. · 2.90 Impact Factor
• Article: The increasing hospital disease burden of haemochromatosis in England.

  M L Cowan, S Westlake, S J Thomson, T M Rahman, A Majeed, J D Maxwell, J-Y Kang
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  ABSTRACT: Hereditary haemochromatosis is a preventable cause of liver disease with an increasing disease burden. To investigate time trends for hospital admission ascribed to haemochromatosis in England during the period from 1989/1990 to 2002/2003 and mortality from 1979 to 2005. Hospital admission data, relating to both in-patients and day-cases, were obtained from the Hospital Episodes Statistics service. Mortality rates for England and Wales were provided by the Office for National Statistics. Haemochromatosis is an uncommon cause for hospital admission. Age-standardized in-patient admission rates increased over the study period by 269% in men and by 290% in women: (from 0.64 to 2.36 and from 0.21 to 0.81 per year per 100 000). The increase in age-standardized day-case admission rates was even higher (men: from 2.78 to 34.9 per year per 100 000, 1155%; women: from 0.58 to 11.67 per year per 100 000, 1924%). Haemochromatosis was recorded as an uncommon cause of death. Hospital in-patient and day case admissions for haemochromatosis increased markedly over the study period while mortality remained low. Both admission rates and mortality were higher in men than in women. The increase in admission rate may reflect improved recognition and diagnosis of iron overload disorders following identification of the HFE gene.
  Alimentary Pharmacology & Therapeutics 10/2009; 31(2):247-52. · 3.77 Impact Factor
• Article: Laser and other light therapies for the treatment of acne vulgaris: systematic review.

  F L Hamilton, J Car, C Lyons, M Car, A Layton, A Majeed
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  ABSTRACT: Acne is common and can lead to scarring of the skin, as well as to psychological distress and reduced self-esteem. Most topical or oral treatments for acne are inconvenient and have side-effects. Laser and other light therapies have been reported to be convenient, safe and effective in treating acne. To carry out a systematic review of randomized controlled trials of light and laser therapies for acne vulgaris. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycInfo, LILACS, ISI Science Citation Index and Dissertation Abstracts International for relevant published trials. We identified 25 trials (694 patients), 13 of light therapy and 12 of light therapy plus light-activated topical cream (photodynamic therapy, PDT). Overall, the results from trials of light alone were disappointing, but the trials of blue light, blue-red light and infrared radiation were more successful, particularly those using multiple treatments. Red-blue light was more effective than topical 5% benzoyl peroxide cream in the short term. Most trials of PDT showed some benefit, which was greater with multiple treatments, and better for noninflammatory acne lesions. However, the improvements in inflammatory acne lesions were not better than with topical 1% adapalene gel, and the side-effects of therapy were unacceptable to many participants. Some forms of light therapy were of short-term benefit. Patients may find it easier to comply with these treatments, despite the initial discomfort, because of their short duration. However, very few trials compared light therapy with conventional acne treatments, were conducted in patients with severe acne or examined long-term benefits of treatment.
  British Journal of Dermatology 03/2009; 160(6):1273-85. · 3.67 Impact Factor
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  Article: Outcome measures in acne vulgaris: systematic review.

  H Barratt, F Hamilton, J Car, C Lyons, A Layton, A Majeed
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  ABSTRACT: Clinical trials require valid and reliable outcome measures to facilitate the interpretation and communication of results, and the secondary use of data for systematic reviews. There are numerous tools available to assess the severity of acne vulgaris in clinical trials, and extensive debate about the merits of these. To review the literature about investigator-assessed outcome measures used in clinical trials for acne vulgaris; and to evaluate the measurement properties of these tools. A systematic literature review was conducted of articles outlining and evaluating investigator-assessed outcome measures for acne. Thirty-one papers met the criteria for inclusion in the literature review, including nine papers proposing a novel means of assessing acne, and five evaluating existing outcome measures. Variable attempts had been made to evaluate these tools. The array of evaluation tools used in acne trials prohibits good secondary analysis of trial data, and complicates the interpretation of study results, potentially compromising clinical care. Existing outcome measures need to be assessed further and agreement reached about which should be used more widely. Other innovative methods of assessing acne should also be explored.
  British Journal of Dermatology 01/2009; 160(1):132-6. · 3.67 Impact Factor
• Article: Trends in cardiovascular admissions and procedures for people with and without diabetes in England, 1996-2005.

  A Bottle, C Millett, K Khunti, A Majeed
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  ABSTRACT: The aim of this study was to compare 10-year trends in admissions, with and without diabetes recorded, for myocardial infarction, angina, stroke, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG). We used national hospital-activity data in England collected between 1996 and 2005 and compared trends in admissions, after adjusting for age, sex and area-level deprivation. Overall, there was a modest fall in the number of admissions for angina and little change in the numbers of admissions for myocardial infarction (MI) and stroke. From 1996/1997 to 2005/2006, the numbers of admissions with diabetes recorded rose for each of MI, angina and stroke; the proportion of admissions with type 2 diabetes recorded rose from 7.2% to 13.9% for MI, from 6.7% to 15.3% for angina and from 6.2% to 11.3% for stroke. Over the 10-year period, after adjusting for age, sex and deprivation, the number of admissions for CABG rose about threefold; for PCI, the number of admissions with diabetes recorded rose 15-fold, compared with a fourfold increase in the number of admissions with diabetes not recorded. We found significant increases in the numbers of admissions with type 2 diabetes recorded for major cardiovascular events and procedures, which has important financial and public-health implications. Better prevention of type 2 diabetes in at-risk patients and aggressive cardiovascular risk-factor management in current patients with diabetes is needed.
  Diabetologia 11/2008; 52(1):74-80. · 6.81 Impact Factor
• Article: Obesity and intermediate clinical outcomes in diabetes: evidence of a differential relationship across ethnic groups.

  C Millett, K Khunti, J Gray, S Saxena, G Netuveli, A Majeed
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  ABSTRACT: To examine associations between obesity, ethnicity and intermediate clinical outcomes in diabetes. Population-based, cross-sectional study using electronic primary care medical records of 7300 people with diabetes from White, Black and south Asian ethnic groups. The pattern of obesity differed within ethnic groups, with rates significantly higher in younger when compared to older Black (women, 63% vs. 44%, P = 0.002; men, 37% vs. 20%, P = 0.005) and south Asian (women, 47% vs. 27%, P = 0.01; men, 21% vs. 13%, P = 0.05) people. Obese people with diabetes were significantly less likely to achieve an established target for blood pressure control (adjusted odds ratio 0.50, 95% confidence interval 0.42, 0.59). Differences in mean systolic blood pressure in obese and normal weight persons were significant in the White group but not in the Black groups or south Asian groups (6.9 mmHg, 1.9 mmHg and 2.7 mmHg, respectively). Differences in mean diastolic blood pressure between obese and normal weight persons were 4.8 mmHg, 3.6 mmHg and 3.4 mmHg in the White, Black and south Asian groups. Mean HbA(1c) and achievement of an established treatment target did not differ significantly with obesity in any ethnic group. Obesity is more prevalent amongst younger people than older people with diabetes in ethnic minority groups. The relationship between obesity and blood pressure control in diabetes differs markedly across ethnic groups. Major efforts must be implemented, especially in young people, to reduce levels of obesity in diabetes and improve long-term outcomes.
  Diabetic Medicine 07/2008; 25(6):685-91. · 2.90 Impact Factor
• Article: Trends in hospital admissions, in-hospital case fatality and population mortality from congenital heart disease in England, 1994 to 2004.

  J Billett, A Majeed, M Gatzoulis, M Cowie
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  ABSTRACT: To ascertain time trends in rates of hospital admission, operations, in-hospital case fatality and general mortality for congenital heart disease (CHD) in England and Wales. Retrospective analysis of Hospital Episodes Statistics for England (April 1995 to March 2004) and mortality statistics for England and Wales (1994-2003). All NHS patients admitted with a primary diagnosis of CHD to hospitals in England, and all deaths in England and Wales with an underlying cause of CHD. Age-standardised hospital admission rates, case fatality rates and death rates from congenital heart disease. Between 1995/1996 and 2003/2004 the age-standardised hospital admission rate for CHD increased from 30.7 per 100,000 (95% CI 29.9 to 31.4) to 35.5 per 100,000 (95% CI 34.7 to 36.4) in men and boys and from 28.2 per 100,000 (95% CI 27.4 to 28.9) to 32.8 per 100,000 (95% CI 32.0 to 33.6) in women and girls. Between 1997/1998 and 2003/2004 in-hospital case fatality rates fell from 2.10% (95% CI 1.97 to 2.22) to 0.83% (95% CI 0.74 to 0.92). Population mortality fell steadily over the decade from 1994 to 2003 in men and women, with the largest proportionate decrease in the 1-4-year age group. Admission rates for CHD have increased over the past decade, particularly amongst patients in older age groups. There has also been a significant decrease in both in-hospital case fatality rates and in general population mortality rates. These trends are consistent with improvements in the quality of care for these patients, improvements in survival and the predicted expansion in the number of adults living with CHD.
  Heart (British Cardiac Society) 04/2008; 94(3):342-8. · 4.22 Impact Factor
• Article: Quality of diabetes care in the UK: comparison of published quality-of-care reports with results of the Quality and Outcomes Framework for Diabetes.

  K Khunti, R Gadsby, C Millett, A Majeed, M Davies
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  ABSTRACT: To conduct a systematic review of published observational studies of quality of diabetes care in primary care in the UK and to compare the results with the quality of care data from the Quality and Outcomes Framework (QOF) of the new General Practice Contract in the UK. medline and embase were searched for articles published from 1999 to June 2006. We also searched for reference lists of studies that fitted our inclusion criteria. All members of the Primary Care Diabetes Europe were contacted and asked to send lists of any relevant published articles. Abstracts were reviewed and data were collected independently by two authors. Abstracts of 742 papers were identified, of which six papers fulfilled the final selection criteria. The total number of people included in the six published studies was 83 098 (a range of 504 to 54 180 people) compared with the UK QOF data of 1.8 million people with diabetes. The quality indicators for assessment of care varied between different published studies, making comparisons more difficult. Overall, there was a trend towards improvement in both process and outcome of care in the published studies. The quality of care achieved as a result of QOF was greater than that found in published studies. There have been improvements in both process and outcome measures recorded in publications of quality of diabetes care in the UK between 2000 and 2004. Modest financial incentives in primary care are a successful method of improving care for people with diabetes.
  Diabetic Medicine 01/2008; 24(12):1436-41. · 2.90 Impact Factor
• Article: Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982-2002.

  J Y Kang, A Elders, A Majeed, J D Maxwell, K D Bardhan
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  ABSTRACT: While overall hospital admission rates for peptic ulcer declined in England in the 1990 s, they increased among the elderly, especially for complicated ulcer. However, peptic ulcer admissions fell for all age groups in the United States. To examine time trends in the incidence of hospital admissions, mortality and operations because of peptic ulcer in Scotland from 1982 to 2002, and the use of various drugs relevant to the aetiology and treatment of peptic ulcer from 1992 to 2002. There was a general decrease in admission rates, especially for younger individuals. For individuals aged above 74 years, admission rates actually increased for gastric ulcer with haemorrhage among men, and for duodenal ulcer haemorrhage between both sexes. The number of operations fell dramatically, especially for younger patients. Mortality rates generally declined. Case fatality rates were greater for women than men, and declined over the study period for gastric ulcer, but increased for duodenal ulcer. The use of low-dose aspirin, oral anticoagulants, selective serotonin reuptake inhibitors and proton-pump inhibitors increased while those of non-steroidal anti-inflammatory drugs and histamine-2 antagonists declined. Admission rates for peptic ulcer generally fell for younger individuals, but increased for older people with haemorrhage.
  Alimentary Pharmacology & Therapeutics 08/2006; 24(1):65-79. · 3.77 Impact Factor
• Article: Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival.

  L G Shack, H E Wood, J Y Kang, D H Brewster, M J Quinn, J D Maxwell, A Majeed
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  ABSTRACT: Time trends in mortality from small intestinal cancer have not been studied for the 1990s. To examine secular trends in incidence of, mortality from, and survival from, small intestinal cancer in England & Wales and Scotland from 1975 to 2002, considering also histological type (incidence), subsite (incidence) and indices of social deprivation (incidence and survival). Data were extracted from the Scottish Cancer Registry database and the General Register Office for Scotland, and from the National Cancer Intelligence Centre at the Office for National Statistics for England & Wales. Incidence rates for small intestinal cancer increased for both England & Wales and Scotland over the study period. They were highest among older individuals and generally greater for males than for females. Despite the increase in incidence rates, mortality rates from small intestinal tumours tended to remain stable over the study period, and the general trend was towards increasing survival. Indices of social deprivation were not obviously related to the incidence of small intestinal cancer and did not influence survival. Incidence rates for small intestinal cancer for both England & Wales and Scotland increased in the last quarter of the 20th century, but survival rates improved and mortality rates declined.
  Alimentary Pharmacology & Therapeutics 05/2006; 23(9):1297-306. · 3.77 Impact Factor
• Article: Pancreatic cancer in England and Wales 1975-2000: patterns and trends in incidence, survival and mortality.

  H E Wood, S Gupta, J Y Kang, M J Quinn, J D Maxwell, S Mudan, A Majeed
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  ABSTRACT: Rates and time trends in mortality from pancreatic cancer vary considerably between countries. To examine trends and patterns in the incidence of, and the survival and mortality from, pancreatic cancer in England and Wales from 1975 to 2000; in particular, whether incidence and survival rates are related to socio-economic deprivation. We calculated annual age-specific and overall age-standardized incidence and mortality rates by sex for pancreatic cancer in total, and by subsite. We also estimated survival by sex and age group and by subsite. In males, the age-standardized rate fluctuated in the late 1970s, to peak at 13.0 per 100,000 in 1979, declined steadily by an average of 1.3% per year to around 10.3 per 100,000 in the mid-1990s and then levelled off. For females, the rate peaked at 8.4 per 100,000 in the late 1980s before declining and fluctuating around 7.7 per 100,000 in the late 1990s. Patterns and trends in mortality rates were closely similar to those in incidence, due to the very low survival rates: only 2-3% at 5 years from diagnosis. Survival rates improved only minimally over the period 1971-99. Incidence and mortality rates were slightly higher in both males and females living in the most deprived areas, but survival was not consistently related to socio-economic deprivation. The incidence of, and mortality from, pancreatic cancer in England and Wales have fallen from peak levels observed in the 1970s and 1980s, and levelled off in the 1990s for both sexes; survival rates remain very low.
  Alimentary Pharmacology & Therapeutics 05/2006; 23(8):1205-14. · 3.77 Impact Factor
• Article: Congenital anomaly surveillance in England and Wales.

  T Misra, N Dattani, A Majeed
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  ABSTRACT: The National Congenital Anomaly System (NCAS) was set up in 1964, following the thalidomide epidemic, as a monitoring system designed to detect changes in the frequency of reporting of malformations. Its original aim was to detect anomalies reported within 7 days of birth. The NCAS is voluntary at all stages and covers all live- and stillbirths. It has two tiers; a 'passive system' receiving congenital anomaly notifications through a standard paper notification form, known as the SD56, and the congenital anomaly registers that send notifications electronically. Congenital anomalies are classified using the International Classification of Diseases codes and 10 monitoring groups. The Office for National Statistics performs a statistical analysis on a monthly, quarterly and annual basis, using the cumulative sum technique, which is the basis upon which surveillance alerts are raised within the system. The NCAS is now an open database where congenital anomalies can be notified whenever they are detected. The aim of this paper is to describe the current operation and uses of the NCAS based on guidelines for the evaluation of public health surveillance systems published by the Centers for Disease Control and Prevention.
  Public Health 04/2006; 120(3):256-64. · 1.35 Impact Factor