[show abstract][hide abstract] ABSTRACT: Objectives To develop and validate algorithms to identify new users of long-acting reversible contraceptives (LARCs) in a primary care database, The Health Improvement Network (THIN). Methods Women in THIN aged 12 to 49 years in 2005 were studied. THIN was searched using Read and MULTILEX codes to identify new users of copper intrauterine devices (Cu-IUDs), the levonorgestrel-releasing intrauterine system (LNG-IUS) and progestogen-only implants. Validation was undertaken for a randomly selected sample of 398 LARC users, in which their primary care physicians were asked to complete a questionnaire detailing LARC use. Results Questionnaires were received for 379 patients (95%), confirming 316 (83%) as new LARC users. Confirmation rates for Cu-IUDs, the LNG-IUS and progestogen-only implants were 64%, 94% and 89%, respectively. The use of Read codes alone had the lowest confirmation rate, particularly for Cu-IUD users. Confirmation rates increased by using MULTILEX codes when available, or by examination of computerised medical records. Conclusions Computer algorithms were used to identify new LARC users. While THIN is a useful resource for studying LARC uptake, steps to gather additional information are necessary to ensure the validity of LARC classification.
The European Journal of Contraception and Reproductive Health Care 11/2013; · 1.81 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database.
Thirty-day case fatality was stratified by age, sex, and calendar year after ICH and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year.
Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20-49 years, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend < 0.001), and decreased over the period 2000-2001 to 2006-2008 (ICH: from 53.1% to 35.8%, p-trend < 0.001; SAH: from 33.3% to 24.7%, p-trend = 0.02). Risk of death was significantly higher among stroke patients during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09-3.24, p < 0.01; SAH: HR 2.87, 95% CI 2.07-3.97, p < 0.01) and remained elevated among survivors at 1 year (ICH: HR 2.02, 95% CI 1.75-2.32, p < 0.01; SAH: HR 1.32, 95% CI 1.02-1.69, p = 0.03).
More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated risk of death compared with matched individuals from the general population.
[show abstract][hide abstract] ABSTRACT: Data on the epidemiology and aetiology of meningioma are limited.
The Health Improvement Network UK primary care database was used to ascertain incident cases of meningioma between January 1996 and June 2008. Ten thousand controls analysis were frequency-matched by age, sex and year. A nested case control analysis was performed to determine risk factors for meningioma.
The incidence of meningioma was 5.30 per 100,000 person-years over the study period. The incidence was higher in women than in men (7.19 vs. 3.05 per 100,000 person-years). Cerebrovascular disease (OR 1.86; 95% CI 1.46-2.36) and a history of cancer, thyroid disease, epilepsy, migraine and headache and exposure to antiepileptics were significantly associated with an increased risk of meningioma. Ischemic heart disease and exposure to antiepileptics were associated with a decreased risk of meningioma.
The incidence of meningioma in the UK remained stable over the 12-year study period and was twofold higher in women than men. Although the prevalence and incidence of meningioma remained stable during the study, further research into risk factors and predisposing conditions for the onset of meningioma and early symptoms of tumor development is warranted to improve prevention and early diagnosis of this disease.
[show abstract][hide abstract] ABSTRACT: Population-based studies have shown that gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) coexist
more commonly than expected by chance. We aimed to investigate the relationship between GERD and IBS in primary care. The
General Practice Research Database was used to identify patients with a first diagnosis of GERD (n=6,421) or IBS (n=2,932). Patients were followed up for 12months after diagnosis to investigate the incidence of IBS among GERD patients
and GERD among IBS patients. The relative risk (RR) of developing IBS was 3.5 (95%CI: 2.3–5.4) in the GERD cohort compared
with the comparison cohort. The RR of developing GERD was 2.8 (95% CI: 1.7–4.9) in the IBS cohort compared with the comparison
cohort. A first diagnosis of either IBS or GERD significantly increases the risk of a subsequent diagnosis of the other condition.
Digestive Diseases and Sciences 04/2012; 54(5):1079-1086. · 2.26 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aetiology of meningiomas is largely unknown although hormones have been suggested to play a role.
A cohort study was performed to evaluate hormone-related factors associated with meningioma. Patients (12-89 years) with a first diagnosis of meningioma (January 1996-June 2008) were identified from The Health Improvement Network UK primary care database and age- and sex-matched to controls (n=10000) from the same cohort. Odds ratios (ORs) were calculated following a nested case control analysis using unconditional logistic regression.
In total, 745 patients with meningioma were identified from a study population of 2171287. No significantly increased risk of meningioma was found among female users of oral contraceptives (OR: 1.15; CI: 0.67-1.98), hormone replacement therapy (OR: 0.99; CI: 0.73-1.35) or low-dose cyproterone acetate (CPA; OR: 1.51; CI: 0.33-6.86) compared with non-users. There was a significantly increased risk of meningioma among male users of androgen analogues (OR: 19.09; CI: 2.81-129.74) and among users of high-dose CPA (OR: 6.30; CI: 1.37-28.94) compared with non-users, however there were only three cases currently using these drugs. No significant association was found between meningioma and prostate, breast, or genital cancers.
Our results do not support a role for exogenous hormone use by females in meningioma development. The risk in males was only observed with high-dose, short-term (<1 year) therapy.
While hormonal cancers and therapies are not associated with meningioma in females, the risk in males requires further investigation.
[show abstract][hide abstract] ABSTRACT: Few data exist on the treatment of gastroesophageal reflux disease (GERD) in paediatrics. The objective of this study was to examine treatment patterns of GERD in paediatrics in the primary care.
Incident GERD cases among paediatric patients were identified using The Health Improvement Network UK primary care database. We assessed prescription treatments in 30 days before and any time after the date of diagnosis. Initial treatment was defined as that received in 30 days either side of diagnosis. Odds ratios and 95% confidence intervals of receiving the treatment were calculated by multiple logistic regressions.
The incident GERD cohort comprised 1700 paediatric patients aged 1-17 years. Antacids were initially prescribed in 49.2% of patients. Similar proportions of patients (23.3 and 22.9%) received histamine-2 receptor antagonists (H(2)RAs) and proton pump inhibitors (PPIs); 7.5% were prescribed prokinetics and 19.3% received no prescribed treatment. Overall, 24.7% of initial H(2)RA users switched to PPIs, and 9.8% of those using PPIs switched to H(2)RAs. The likelihood of the use of PPI increased with age and was lower in girls than in boys (odds ratio: 0.7; 95% confidence interval: 0.5-0.9).
Antacids are the drugs most frequently prescribed by primary care physicians to paediatric patients with GERD, and approximately half receive an initial course of antisecretory treatment with H(2)RAs or PPIs. This study suggests that treatment patterns in paediatrics differ from those in adults.
European journal of gastroenterology & hepatology 03/2011; 23(3):232-7. · 1.66 Impact Factor
[show abstract][hide abstract] ABSTRACT: The leading comorbidities and causes of death in patients with chronic obstructive pulmonary disease (COPD) are lung cancer and cardiovascular disease. The aim of this study was to establish the incidence of lung cancer, myocardial infarction and heart failure in patients with COPD in UK primary care.
The General Practice Research Database (GPRD) was used to identify a cohort of 1927 patients with a first recorded diagnosis of COPD. This cohort was followed for up to 5 years to identify new diagnoses of lung cancer, myocardial infarction and heart failure. Mortality was also assessed. The relative risk (RR) of each outcome in the COPD cohort was compared with that in a control cohort with no diagnosis of COPD.
The risk of lung cancer was significantly increased in individuals with a diagnosis of COPD compared with those with no COPD diagnosis (RR: 3.33; 95% confidence interval [CI]: 2.33-4.75; adjusted for age, sex and smoking status). A diagnosis of COPD was also associated with a significant increase in the risk of heart failure (age- and sex-adjusted RR: 2.94; 95% CI: 2.46-3.51) and death (age- and sex-adjusted RR: 2.76; 95% CI: 2.45-3.12), but not myocardial infarction (age- and sex-adjusted RR: 1.18; 95% CI: 0.81-1.71).
Patients with a diagnosis of COPD are at significantly increased risk of lung cancer, heart failure and death compared with the general population. They do not appear to be at increased risk of myocardial infarction.
Respiratory medicine 11/2010; 104(11):1691-9. · 2.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Few studies have examined the incidence of complications from gastro-esophageal reflux disease (GERD) in children and adolescents in primary care. Here we aimed to describe the natural history of GERD in a pediatric population with no reflux esophagitis at initial diagnosis, assessing diagnoses of new esophageal complications and extra-esophageal conditions.
We used The Health Improvement Network UK primary care database (which includes data on more than 2 million patients) to identify individuals aged 1-17 years with a first diagnosis of gastro-esophageal reflux or heartburn in the period 2000-2005, via a computerized search followed by a manual review of the patient records. This search identified 1242 individuals with an incident diagnosis of GERD but no record of esophagitis. This cohort was followed-up to detect new diagnoses of esophageal complications and extra-esophageal conditions.
During a mean follow-up period of almost 4 years, 40 children and adolescents had a confirmed new diagnosis of reflux esophagitis (incidence: 10.9 per 1000 person-years). No cases of Barrett's esophagus, esophageal stricture or esophageal ulcer were reported. Individuals with GERD had double the risk of an extra-esophageal condition such as asthma, pneumonia, cough or chest pain compared with children and adolescents with no diagnosis of GERD.
Children and adolescents with GERD may be at risk of developing reflux esophagitis and a range of other extra-esophageal conditions, but more severe esophageal complications are rare.
Scandinavian journal of gastroenterology 04/2010; 45(7-8):814-21. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Post-launch drug safety monitoring is essential for the detection of adverse drug signals that may be missed during preclinical trials. Traditional methods of postmarketing surveillance such as spontaneous reporting have intrinsic limitations, many of which can be overcome by the additional application of structured pharmacoepidemiological approaches. However, further improvement in drug safety monitoring requires a shift towards more proactive pharmacoepidemiological methods that can detect adverse drug signals as they occur in the population.
To assess the feasibility of using proactive monitoring of an electronic medical record system, in combination with an independent endpoint adjudication committee, to detect adverse events among users of selected drugs.
UK General Practice Research Database (GPRD) information was used to detect acute liver disorder associated with the use of amoxicillin/clavulanic acid (hepatotoxic) or low-dose aspirin (acetylsalicylic acid [non-hepatotoxic]). Individuals newly prescribed these drugs between 1 October 2005 and 31 March 2006 were identified. Acute liver disorder cases were assessed using GPRD computer records in combination with case validation by an independent endpoint adjudication committee. Signal generation thresholds were based on the background rate of acute liver disorder in the general population.
Over a 6-month period, 8148 patients newly prescribed amoxicillin/clavulanic acid and 5577 patients newly prescribed low-dose aspirin were identified. Within this cohort, searches identified 11 potential liver disorder cases from computerized records: six for amoxicillin/clavulanic acid and five for low-dose aspirin. The independent endpoint adjudication committee refined this to four potential acute liver disorder cases for whom paper-based information was requested for final case assessment. Final case assessments confirmed no cases of acute liver disorder. The time taken for this study was 18 months (6 months for recruitment and 12 months for data management and case validation). To reach the estimated target exposure necessary to raise or rule out a signal of concern to public health, we determined that a recruitment period 2-3 times longer than that used in this study would be required. Based on the real market uptake of six commonly used medicinal products launched between 2001 and 2006 in the UK (budesonide/eformoterol [fixed-dose combination], duloxetine, ezetimibe, metformin/rosiglitazone [fixed-dose combination], tiotropium bromide and tadalafil) the target exposure would not have been reached until the fifth year of marketing using a single database.
It is feasible to set up a system that actively monitors drug safety using a healthcare database and an independent endpoint adjudication committee. However, future successful implementation will require multiple databases to be queried so that larger study populations are included. This requires further development and harmonization of international healthcare databases.
Drug Safety 03/2010; 33(3):223-32. · 3.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: To estimate the prevalence and incidence of depression; investigate its association with risk factors including comorbidities and drug and health care use; and describe treatment patterns of depression in primary care using The Health Improvement Network database.
In this cohort study, subjects with a first recorded diagnosis of depression (Read code) between January 1, 2002, and December 31, 2004 (n=47,170) were identified from a source population of 1,287,829 subjects aged 10-79 years. A comparison group was sampled from the same population and frequency matched to the depression cohort by age, sex, and calendar year (n=50,000). Depression diagnoses were validated using physician-completed questionnaires. Odds ratios and 95% CIs for the relationship of depression with a range of factors were estimated using unconditional logistic regression in a nested case-control analysis.
The prevalence of depression was 11.23% (95% CI, 11.18-11.28). This prevalence decreased with increasing age and was higher in women than in men. The incidence was 13.89 per 1,000 person-years (95% CI, 13.82-14.08). Depression was associated with frequent use of health services, smoking, pregnancy in the previous year, anxiety, stress, sleep disorders, digestive and respiratory disorders, and pain. In the trimester following diagnosis, 82% of cases were treated-98% with antidepressants and 81.5% with selective serotonin reuptake inhibitors (SSRIs).
We found a high prevalence and incidence of depression diagnoses in primary care in the United Kingdom. Following diagnosis, the majority of individuals were prescribed SSRIs. A diagnosis of depression is associated with a number of prior comorbidities, which could mask the depression. This fact should be taken into account when screening individuals in primary care.
The Primary Care Companion to The Journal of Clinical Psychiatry 01/2010; 12(1):PCC.08m00764.
[show abstract][hide abstract] ABSTRACT: The epidemiology of gastroesophageal reflux disease (GERD) has yet to be investigated using the symptomatic threshold criteria recommended by the Montreal Definition. This study aimed to determine the prevalence of symptom-defined GERD across five regions of China, and to investigate variables associated with GERD.
A representative sample of 18 000 adults (aged 18-80 years) were selected equally from rural and urban areas in each region (n = 1800). According to the Montreal Definition, GERD is present when mild symptoms of heartburn and/or regurgitation occur on >or=2 days a week, or moderate-to-severe symptoms of heartburn and/or regurgitation occur on >or=1 day a week.
In total, 16 091 participants completed the survey (response rate: 89.4%) and 16 078 responses were suitable for analysis. Applying the Montreal criteria, the prevalence of symptom-defined GERD was 3.1% and varied significantly (p < 0.001) among the five regions (from 1.7% in Guangzhou to 5.1% in Wuhan) and between rural and urban populations (3.8% vs 2.4%). Factors significantly associated with GERD included living in a rural area and a family history of gastrointestinal diseases.
This population-based survey found that the prevalence of symptom-defined GERD in China was 3.1%, which is lower than that found in Western countries.
[show abstract][hide abstract] ABSTRACT: To determine the prevalence and incidence of a diagnosis of gastroesophageal reflux disease (GERD) in children and adolescents in UK primary care, and to assess comorbidities that are associated with a diagnosis of GERD.
Incident GERD cases during 2000-05 were identified from The Health Improvement Network (THIN) UK primary care database via a computer search for diagnostic codes for GERD, followed by manual review of the patient records.
We identified 1700 children with a first diagnosis of GERD during 2000-05. The incidence of GERD was 0.84 per 1000 person-years. The incidence decreased with age from 1.48 per 1000 person-years among 1-year-old children until the age of 12 years, whereupon it increased to a maximum at 16-17 years of 2.26 per 1000 person-years for girls and 1.75 per 1000 person-years for boys. Pregnant adolescents were not included in the study. In addition to typical GERD symptoms (epigastric pain, heartburn, reflux, regurgitation), 21.2% of children reported nausea or vomiting. Children with neurological disorders were at increased risk of a GERD diagnosis. Hiatus hernia and congenital esophageal disorders were also associated with a diagnosis of GERD. Children and adolescents using antiepileptics, oral/inhaled steroids, beta-agonists and paracetamol had an increased risk of a GERD diagnosis.
The incidence of a GERD diagnosis was age-dependent and was highest among very young children and older female adolescents. Children with neurological impairments and other comorbidities were at increased risk of a GERD diagnosis.
Scandinavian journal of gastroenterology 12/2009; 45(2):139-46. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Adverse psychosocial factors, including work-related stress, are, like gastroesophageal reflux disease (GERD), increasing health problems in industrialized countries. The importance of clarifying the relation between psychosocial factors and GERD has been stressed, but there are few population-based studies.
This was a population-based, cross-sectional, case-control study based on two health surveys conducted in the Norwegian county Nord-Trondelag in 1984-86 and 1995-97. GERD symptoms were assessed in the second survey, which included 65,333 participants, representing 70% of the county's adult population. The 3153 persons reporting severe GERD symptoms were defined as cases and the 40,210 persons without such symptoms were defined as controls. Data on psychosocial factors and potential confounders were collected using questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using unconditional logistic regression.
In models adjusted for age, sex, smoking, obesity and socioeconomic status, positive associations were observed between high job demands (OR 1.9, 95% CI 1.6-2.2), low job control (OR 1.1, 95% CI 1.0-1.2) and job strain (OR 1.9, 95% CI 1.6-2.4) and risk of GERD symptoms. Persons reporting low job satisfaction had a twofold (95% CI 1.6-2.5) increased risk of GERD compared to persons reporting high job satisfaction. Self pressure (OR 1.8, 95% CI 1.6-2.1) and time pressure (OR 2.0, 95% CI 1.7-2.4) were positively associated with GERD symptoms. These associations were attenuated after further adjustment for anxiety, depression, myocardial infarction, angina pectoris, stroke and insomnia, but remained statistically significant.
This population-based study reveals a link between stressful psychosocial factors, including job strain, and GERD symptoms.
Scandinavian journal of gastroenterology 12/2009; 45(1):21-9. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Anxiety disorders are common and can cause substantial quality of life impairment.
The aim of this study was to investigate the frequency of anxiety in UK primary care. Treatment patterns and factors associated with an anxiety diagnosis were also assessed.
The Health Improvement Network was used to identify all patients aged 10-79 years with a new diagnosis of anxiety in 2002-04 (n = 40 873) and age-, sex- and calendar-year-matched controls (n = 50 000). A nested case-control analysis was used to quantify potential risk factors for anxiety by multivariate logistic regression.
The prevalence of anxiety was 7.2% and the incidence was 9.7 per 1000 person-years. Incidence and prevalence were highest in women and young adults (20-29 years). Anxiety was associated with heavy alcohol use, smoking and addiction problems as well as stress, sleep and depression disorders. Anxiety patients used health care services more frequently than controls. Among patients diagnosed with anxiety, 63% were treated pharmacologically. Antidepressants accounted for almost 80% of prescriptions.
The prevalence and incidence of anxiety are high in UK primary care and are almost twice as high in women than in men. Anxiety is associated with other psychiatric morbidity as well as frequent health care use. Antidepressants are the most commonly used pharmacological treatment.
Family Practice 11/2009; 27(1):9-16. · 1.83 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: Acid suppression may increase the risk of community-acquired pneumonia. We investigated this association in the United Kingdom primary care system taking account of the potential for confounding by indication.
Methods: We identified patients aged 20–79 years in The Health Improvement Network database with a new diagnosis of pneumonia between 2000 and 2005 (n = 7297). Cases were validated by manual review and compared with age- and sex-matched controls (n = 9993). Using unconditional logistic regression, we estimated the relative risk (RR) of pneumonia associated with current use of acid-suppressive drugs compared to nonuse.
Results: Newly diagnosed community-acquired pneumonia was increased with current use of proton pump inhibitors (RR = 1.16 [95% confidence interval 1.03–1.31]) but not H2-receptor antagonists (0.98 [0.80–1.20]). An increased risk of pneumonia was evident only in the first 12 months of treatment with proton pump inhibitors. There was some evidence of a dose response. Among patients taking proton pump inhibitors for less than 1 year, the risk of community-acquired pneumonia was stronger when current use was for dyspepsia or peptic ulcer (1.73 [1.29–2.34]) than for gastroesophageal reflux disease or prevention of upper gastrointestinal injury associated with aspirin or nonsteroidal anti-inflammatory drugs (1.22 [0.97–1.52]).
Conclusions: We observed a small increase in the risk of community-acquired pneumonia associated with current proton pump inhibitor use, particularly during the first 12 months of treatment and at higher doses. This may be due in part to the underlying indication.
[show abstract][hide abstract] ABSTRACT: Fibromyalgia is characterized by widespread musculoskeletal pain and palpation tenderness. In addition to these classic symptoms, fibromyalgia patients tend to report a number of other complaints. What these other complaints are and how often they are reported as compared with related referents from the general population is not very well known. We therefore hypothesized that subjects with fibromyalgia report more of a wide range of symptoms as compared with referents of the same sex and age from the general population.
138 women with diagnosed fibromyalgia in primary health care and 401 referents from the general population matched to the cases by sex, age and residential area responded to a postal questionnaire where information on marital status, education, occupational status, income level, immigrant status, smoking habits physical activity, height and weight history and the prevalence of 42 defined symptoms was sought.
The cases had lower educational and income levels, were more often unemployed, on sick leave or on disability pension and were more often first generation immigrants than the referents. They were also heavier, shorter and more often had a history of excessive food intake and excessive weight loss. When these differences were taken into account, cases reported not only significantly more presumed fibromyalgia symptoms but also significantly more of general symptoms than the referents. The distribution of symptoms was similar in subjects with fibromyalgia and referents, indicating a generally higher symptom reporting level among the former.
Subjects with fibromyalgia had a high prevalence of reported general symptoms than referents. Some of these differences may be a consequence of the disorder while others may reflect etiological processes.
BMC Public Health 10/2009; 9:402. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated the association of chronic obstructive pulmonary disease (COPD) with modifiable risk factors such as smoking and prescription medications, and investigated possible risk factors unique to patients who had never smoked. The UK General Practice Research Database was used to identify a cohort of patients with a first diagnosis of COPD (n = 1927) along with age- and sex-matched controls without COPD (n = 16 546). The incidence of COPD diagnoses and the risks associated with medication use, co-morbidities, and demographic factors, were estimated. The incidence of COPD was 2.6 per 1000 person-years (95% confidence interval [CI]: 2.5-2.7) among 40-89 year-olds. The risk significantly increased in current and former smokers (OR: 6.15 [95% CI: 5.41-7.00] and 3.45 [95% CI: 2.96-4.02]), respectively. The risk was significantly lower in former smokers than current smokers (OR: 0.61; 95% CI: 0.52-0.71). Current statin use was significantly associated with a reduced risk (OR: 0.45; 95% CI: 0.25-0.80). In never smokers, risk factors included advanced age and obesity. The risk in never smokers was more strongly related to paracetamol use (OR: 1.82; 95% CI: 1.33-2.49) than in current and former smokers (OR: 1.48; 95% CI: 1.18-1.86). In summary, COPD is associated with a range of cardiovascular and respiratory conditions and the risk is influenced by current and past medications. While the risk factors are similar in smokers and never smokers, some were unique to never smokers. Moreover, subjects who stopped smoking had a substantially lower COPD risk than those who continued smoking.
[show abstract][hide abstract] ABSTRACT: Gastroesophageal reflux disease and sleep problems are common health problems in Western nations. It is important to clarify the association between sleep and gastroesophageal reflux disease, but only a few population-based studies have been conducted.
A population-based, cross-sectional, case-control study was based on 2 large health surveys performed in the Norwegian county Nord-Trondelag in 1984-1986 and 1995-1997. Gastroesophageal reflux disease was assessed in the second survey, which included 65,333 participants (70% of the county's adult population). The 3153 persons who reported severe reflux symptoms constituted the cases, and the 40,210 persons without reflux symptoms constituted the controls. Data on insomnia, sleep problems, and several potential confounders were collected in questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using unconditional logistic regression in crude and multivariable models.
In models adjusted for age, sex, tobacco smoking, obesity, and socioeconomic status, positive associations were observed between presence of insomnia (OR, 3.2; 95% CI, 2.7-3.7), sleeplessness (OR, 3.3; 95% CI, 2.9-3.8), problems falling asleep (OR, 3.1; 95% CI, 2.5-3.8), and risk of gastroesophageal reflux disease. These associations were attenuated after further adjustments for anxiety, depression, myocardial infarction, angina pectoris, stroke, and gastrointestinal symptoms, but they remained statistically significant.
A large population-based study indicated a link between sleep problems and gastroesophageal reflux disease that might be bidirectional.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2009; 7(9):960-5. · 5.64 Impact Factor
[show abstract][hide abstract] ABSTRACT: Ischaemic heart disease (IHD) can be excluded in the majority of patients with unspecific chest pain. The remainder have what is generally referred to as non-cardiac chest pain, which has been associated with gastrointestinal, neuromusculoskeletal, pulmonary, and psychiatric causes.
To assess morbidity and mortality following a new diagnosis of non-specific chest pain in patients without established IHD.
Population-based cohort study with nested case-control analysis.
UK primary care practices contributing to the General Practice Research Database.
Patients aged 20-79 years with chest pain who had had no chest pain consultation before 2000 and no IHD diagnosis before 2000 or within 2 weeks after the index date were selected from the General Practice Research Database. The selected 3028 patients and matched controls were followed-up for 1 year.
The incidence of chest pain in patients without established IHD was 12.7 per 1000 person-years. In the year following the index date, patients who had chest pain but did not have established IHD were more likely than controls to receive a first IHD diagnosis (hazard ratio [HR] = 18.2, 95% confidence interval [CI] = 11.6 to 28.6) or to die (HR = 2.3, 95% CI = 1.3 to 4.1). Patients with chest pain commonly had a history of gastro-oesophageal reflux disease (GORD; odds ratio [OR] = 2.0, 95% CI = 1.5 to 2.7) or went on to be diagnosed with GORD (risk ratio 4.5, 95% CI = 3.1 to 6.4).
Patients with chest pain but without established IHD were found to have an increased risk of being diagnosed with IHD. Chest pain in patients without established IHD was also commonly associated with GORD.
British Journal of General Practice 04/2009; 59(560):e78-86. · 1.83 Impact Factor