Julia Hippisley-Cox

• MB ChB, MD, FRCP FPRCG
• Professor at University of Nottingham

Objectives: To estimate rates of discontinuation and restarting of statins, and to identify patient characteristics associated with either discontinuation or restarting. Design: Prospective open cohort study. Setting: 664 general practices contributing to the Clinical Practice Research Datalink in the United Kingdom. Data extracted in October 201...

Objectives To estimate rates of discontinuation and restarting of statins, and to identify patient characteristics associated with either discontinuation or restarting. Design Prospective open cohort study. Setting 664 general practices contributing to the Clinical Practice Research Datalink in the United Kingdom. Data extracted in October 2014. Pa...

This is a protocol to describe the development and validation of a set of prediction equations to quantify absolute survival for patients with different types of cancers taking account of other clinical factors available through routine linkage of cancer registry data to primary care electronic health records. We will also include estimates of cond...

Objective: To assess the risks of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia in patients with type 2 diabetes associated with prescribed diabetes drugs, particularly newer agents including gliptins or glitazones (thiazolidinediones). Design: Open cohort study in primary care. Setting: 1243 practices contributing...

Objective To assess associations between different antidepressant treatments and rates of three cardiovascular outcomes (myocardial infarction, stroke or transient ischaemic attack, and arrhythmia) in people with depression. Design Cohort study. Setting UK general practices contributing to the QResearch primary care database. Participants 238 963 p...

Objectives To describe implementation of a new national preventive programme to reduce cardiovascular morbidity. Design Observational study over 4 years (April 2009—March 2013). Setting 655 general practices across England from the QResearch database. Participants Eligible adults aged 40–74 years including attendees at a National Health Service...

Background Epilepsy is a serious condition which can profoundly affect an individual’s life. While there is some evidence to suggest an association between antidepressant use and epilepsy and seizures it is conflicting and not conclusive. Antidepressant prescribing is rising in the UK so it is important to quantify absolute risks with individual an...

Study question Is it possible to develop and externally validate risk prediction equations to estimate the 10 year risk of blindness and lower limb amputation in patients with diabetes aged 25-84 years? Methods This was a prospective cohort study using routinely collected data from general practices in England contributing to the QResearch and Clin...

Introduction Risk thresholds for using statins to prevent cardiovascular disease (CVD) have recently been lowered, so an increasing number of patients are now prescribed these drugs. Although the safety of long-term statin use has been generally established, concerns about the balance of risks and benefits of statins still exist for some medical pr...

Objective To develop and externally validate risk prediction equations to estimate the 10-year risk of heart failure in patients with diabetes, aged 25–84 years. Design Cohort study using routinely collected data from general practices in England between 1998 and 2014 contributing to the QResearch and Clinical Research Practice Datalink (CPRD) dat...

Zagarella asks whether risks of venous thromboembolism may be different in women with potential symptoms of polycystic ovarian syndrome (PCOS), such as acne and hirsutism, but without a formal diagnosis.1 2 Menstrual disorders and acne were recorded for a large proportion of cases and controls across the databases—23-36% for menstrual disorders and...

To derive and validate a set of clinical risk prediction algorithm to estimate the 10-year risk of 11 common cancers. Prospective open cohort study using routinely collected data from 753 QResearch general practices in England. We used 565 practices to develop the scores and 188 for validation. 4.96 million patients aged 25-84 years in the derivati...

To assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression. Cohort study. Patients registered with UK general practices contributing data to the QResearch database. 238 963 patients aged 20 to 64 years with a first diagnosis of depression between 1 Jan...

In May The BMJ corrected an error relating to adverse effects of statins in two articles but was asked to retract the articles. The editor referred the decision to an expert panel. Here, we publish its findings In October 2013 The BMJ published an Analysis article by Abramson et al1 arguing that cholesterol lowering guidelines should not be widene...

Objectives To validate the performance of a set of risk prediction algorithms developed using the QResearch database, in an independent sample from general practices contributing to the Clinical Research Data Link (CPRD). Setting Prospective open cohort study using practices contributing to the CPRD database and practices contributing to the QResea...

Objective To develop and validate risk algorithms (QBleed) for estimating the absolute risk of upper gastrointestinal and intracranial bleed for patients with and without anticoagulation aged 21-99 years in primary care. Design Open cohort study using routinely collected data from general practice linked to hospital episode statistics data and mort...

Many studies have found an increased risk of venous thromboembolism (VTE) associated with the use of combined hormonal contraceptives, but various methodologies have been used in the study design relating to definition of VTE event and the selection of appropriate cases for analysis. This study will focus on common oral hormonal contraceptives, inc...

To the Editor: Tillin et al recently reported a cohort study1 comparing the performance of QRISK2 and Framingham in the Southall and Brent cohort in London. We have a number of comments on the study and the interpretation of results. 1. Number of events . The main problem with the paper is that numbers are very small and given the resulting wide...

To develop and externally validate a risk algorithm (QAdmissions) to estimate the risk of emergency hospital admission for patients aged 18-100 years in primary care. Prospective open cohort study using routinely collected data from general practice linked to hospital episode data during the 2-year study period 1 January 2010 to 31 December 2011. 4...

Background: Bisphosphonates are the most commonly prescribed osteoporosis drugs but long-term effects are unclear, although antitumour properties are known from preclinical studies. Methods: Nested case–control studies were conducted to investigate bisphosphonate use and risks of common non-gastrointestinal cancers (breast, prostate, lung, bladder...

Background Antidepressants are among the most commonly prescribed drugs in primary care in England and their use is increasing. This is largely due to longer durations of treatment of depression. Observational studies have shown some differences in adverse outcomes associated with different antidepressant drugs but relatively little is known about...

To develop and validate a risk algorithm (QStroke) to estimate risk of stroke or transient ischaemic attack in patients without prior stroke or transient ischaemic attack at baseline; to compare (a) QStroke with CHADS2 and CHA2DS2VASc scores in patients with atrial fibrillation and (b) the performance of QStroke with the Framingham stroke score in...

Early diagnosis of cancer could improve survival so better tools are needed. To derive an algorithm to estimate absolute risks of different types of cancer in men incorporating multiple symptoms and risk factors. Cohort study using data from 452 UK QResearch® general practices for development and 224 for validation. Included patients were males age...

Early diagnosis of cancer could improve survival so better tools are needed. To derive an algorithm to estimate absolute risks of different types of cancer in women incorporating multiple symptoms and risk factors. Design and setting: Cohort study using data from 452 UK QResearch® general practices for development and 224 for validation. Included p...

To investigate the association between use of bisphosphonates estimated from prescription information and risk of gastrointestinal cancers. Series of nested case-control studies. General practices in the United Kingdom contributing to the QResearch primary care database (660) and the Clinical Practice Research Datalink (CPRD) (643). Patients aged ≥...

We were interested to read the paper by Shephard et al1 on the clinical features of bladder cancer in primary care, as we have previously published a paper2 in the BJGP where we reported on symptoms associated with renal tract cancer (of which around 80% were bladder cancers) in primary care. Both studies evaluated the risk or positive predictive v...

To provide estimates of the number and types of drugs that can be monitored for safety surveillance using electronic healthcare databases. Using data from eight European databases (administrative claims, medical records) and in the context of a cohort study, we determined the amount of drug exposure required for signal detection across varying magn...

To develop and validate an updated version of the QFracture algorithm for estimating the risk of a patient sustaining an osteoporotic fracture or hip fracture in a primary care population. Prospective open cohort study using routinely collected data from 420 general practices in the United Kingdom to develop updated QFracture scores and 207 practic...

Earlier diagnosis of renal tract cancer could help improve survival so better tools are needed to help this. To derive and validate an algorithm to estimate the absolute risk of renal tract cancer in patients with and without symptoms in primary care. Cohort study using data from 375 UK QResearch® general practices for development and 189 for valid...

Introduction Bisphosphonates are becoming a common treatment for osteoporosis particularly after discovery of the association between hormone replacement therapy and increased risk of breast cancer. As osteoporosis develops with age, treatment is a long-term intervention. Randomised control trials typically have limited follow-up times, which restr...

Earlier diagnosis of colorectal cancer could help improve survival so better tools are needed to help this. To derive and validate an algorithm to quantify the absolute risk of colorectal cancer in patients in primary care with and without symptoms. Cohort study using data from 375 UK QResearch® general practices for development and 189 for validat...

Pancreatic cancer has the worst survival for any cancer and is often diagnosed late when the cancer is advanced. Chances of survival are more likely if patients can be diagnosed earlier. To derive and validate an algorithm to estimate absolute risk of having pancreatic cancer in patients with and without symptoms in primary care. Cohort study using...

To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms. Cohort study with data from 375 UK QResearch general practices for development and 189 for validation. Women aged 30-84 without a diagnosis of ovarian cancer at baseline and without appetite loss, weight loss, abdominal pai...

Gastro-oesphageal is one of the most common cancers worldwide. Evidence suggested that increased awareness of symptoms and earlier diagnosis could help improve treatment options and improve survival. To derive and validate an algorithm to estimate the absolute risk of having gastro-oesophageal cancer in patients in primary care with and without sym...

Lung cancer has one of the lowest survival outcomes of any cancer because more then two-thirds of patients are diagnosed when curative treatment is not possible. The challenge is to help earlier diagnosis of lung cancer and hence improve prognosis. To derive and validate an algorithm incorporating information on symptoms, to estimate the absolute r...

Community-acquired pneumonia is one of the most common causes of hospitalisation and death in older people. Recent research suggests that statins might improve the outcome of infectious diseases because of their anti-oxidative and anti-inflammatory properties. To estimate the association between current statin use and the risk of community-acquired...

Many studies and meta-analyses have investigated the effects of statins on cancer incidence but without showing consistent effects. A series of nested case-control studies was conducted covering 574 UK general practices within the QResearch database. Cases were patients with primary cancers diagnosed between 1998 and 2008. The associations between...

To derive and validate a new clinical risk prediction algorithm (QThrombosis, www.qthrombosis.org) to estimate individual patients' risk of venous thromboembolism. Prospective open cohort study using routinely collected data from general practices. Cox proportional hazards models used in derivation cohort to derive risk equations evaluated at 1 and...

To investigate the association between antidepressant treatment and risk of several potential adverse outcomes in older people with depression and to examine risks by class of antidepressant, duration of use, and dose. Cohort study of people aged 65 and over diagnosed as having depression. 570 general practices in the United Kingdom supplying data...

Introduction Selective cyclo-oxygenase-2 (COX2) inhibitors are a widely used analgesic for patients with intolerance to traditional non-steroidal anti-inflammatory drugs and it is unclear how long-term use affects cancer risk. Methods A series of nested case-control studies were conducted using data from 574 UK general practices in the QResearch pr...

The aim of this study was to establish the relative safety and balance of risks for antidepressant treatment in older people. The study objectives were to (1) determine relative and absolute risks of predefined adverse events in older people with depression, comparing classes of antidepressant drugs [tricyclic and related antidepressants (TCAs), se...

Selective cyclooxygenase-2 (COX2) inhibitors are widely used as analgesics and it is unclear whether its long-term use affects cancer risk. A series of nested case-control studies using the QResearch primary care database. Associations of COX2 inhibitor use with risk of all cancers and 10 common site-specific cancers were estimated using conditiona...

The Health Protection Agency/QSurveillance national surveillance system utilizes QSurveillance®, a recently developed general practitioner database covering over 23 million people in the UK. We describe the spread of the first wave of the influenza A(H1N1) pandemic 2009 using data on consultations for influenza-like illness (ILI), respiratory illne...

Introduction The chemopreventive effect of aspirin for colorectal cancer (CRC) is now well established. However, the dose and duration of aspirin use necessary for this effect is still unclear. Two very large US RCTs using low dose aspirin (325 and 100 mg alt. die) found no reduction in CRC incidence after 10 years follow-up, but a recent meta-anal...

To the Editor In their paper published in this issue of Heart ( see page 491 ), de la Iglesia et al 1 describe the performance of ASSIGN and Framingham algorithms in comparison to the original QRISK equations. Readers may be interested that the QRISK2 algorithm was published in February 20092 and made available as free open source software in Apri...

Following the confirmation of the first two cases of pandemic influenza on 27 April 2009 in the United Kingdom (UK), syndromic surveillance data from the Health Protection Agency (HPA)/QSurveillance and HPA/NHS Direct systems were used to monitor the possible spread of pandemic influenza at local level during the first phase of the outbreak. During...

In this proof-of-concept paper we describe the framework, process, and preliminary results of combining data from European electronic healthcare record (EHR) databases for large-scale monitoring of drug safety. Aggregated demographic, clinical, and prescription data from eight databases in four countries (Denmark, Italy, Netherlands, the UK) were p...

The EU-ADR project aims to exploit different European electronic healthcare records (EHR) databases for drug safety signal detection. In this paper we report the preliminary results concerning the comparison of signal detection between EU-ADR network and two spontaneous reporting databases, the Food and Drug Administration and World Health Organiza...

To develop, validate, and evaluate a new QRISK model to estimate lifetime risk of cardiovascular disease. Prospective cohort study with routinely collected data from general practice. Cox proportional hazards models in the derivation cohort to derive risk equations accounting for competing risks. Measures of calibration and discrimination in the va...

People with mental health problems are more likely to die prematurely than the general population but no study has examined this in individuals with diabetes. To compare survival rates in people with diabetes with and without schizophrenia or bipolar disorder. A total of 43,992 people with diabetes were drawn from the QRESEARCH database population...

To determine whether antipsychotic drugs are associated with an increased risk of venous thromboembolism, and to examine risks by type of antipsychotic, potency, and dose. Population based nested case-control study. The UK QResearch primary care database. Patients (cases) with a first ever record of venous thromboembolism between 1 January 1996 and...

The United Kingdom (UK) has several national syndromic surveillance systems. The Health Protection Agency (HPA)/NHS Direct syndromic surveillance system uses pre-diagnostic syndromic data from a national telephone helpline, while the HPA/QSurveillance national surveillance system uses clinical diagnosis data extracted from general practitioner (GP)...

Patients with chronic obstructive pulmonary disease (COPD) constitute a substantial burden to healthcare services. Analysis of national healthcare datasets offers the possibility to advance understanding about the changing epidemiology of COPD. To investigate the epidemiology of physician-diagnosed COPD in general practice. Cross-sectional study. A...

Chronic Kidney Disease is a major cause of morbidity and interventions now exist which can reduce risk. We sought to develop and validate two new risk algorithms (the QKidney Scores) for estimating (a) the individual 5 year risk of moderate-severe CKD and (b) the individual 5 year risk of developing End Stage Kidney Failure in a primary care popula...

To derive and validate risk algorithms so that the risks of four clinical outcomes associated with statin use can be estimated for individual patients. Prospective open cohort study using routinely collected data from 368 QResearch general practices in England and Wales to develop the scores. The scores were validated using two separate sets of pra...

Variables used in adjusted hazard ratios

To quantify the unintended effects of statins according to type, dose, and duration of use. Prospective open cohort study using routinely collected data. 368 general practices in England and Wales supplying data to the QResearch database. 2 004 692 patients aged 30-84 years of whom 225 922 (10.7%) were new users of statins: 159 790 (70.7%) were pre...

Introduction Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin remain the most common cause of life-threatening iatrogenic pathology. Risks are age-dependent and can be reduced by switching to a selective cyclooxygenase (COX)-2 inhibitor or co-prescription of a proton pump inhibitor (PPI). The UK National Institute for Health and Clinical...

Smoking represents the most important cause of avoidable morbidity and mortality in the economically developed world. The UK has recently introduced a range of initiatives aiming to reduce smoking prevalence and smoking-related health inequalities. To investigate the epidemiology of smoking in UK general practice. Cross-sectional study. A total of...

The overall objective of the EU-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in...

PurposeData mining on electronic health records (EHRs) has emerged as a promising complementary method for post-marketing drug safety surveillance. The EU-ADR project, funded by the European Commission, is developing techniques that allow mining of EHRs for adverse drug events across different countries in Europe. Since mining on all possible event...

To develop and validate two new fracture risk algorithms (QFractureScores) for estimating the individual risk of osteoporotic fracture or hip fracture over 10 years. Prospective open cohort study with routinely collected data from 357 general practices to develop the scores and from 178 practices to validate the scores. General practices in England...

Certain conditions are established as risk factors for community-acquired pneumonia. There are a number of other conditions that may also be risk factors, but information on these is limited. To determine new independent risk factors for community-acquired pneumonia using a very large primary care database. Nested case-control study. Four hundred a...

The prevalence of eczema, particularly in younger children, increased substantially over the second half of the 20th century. Analysis of primary healthcare data-sets offers the possibility to advance understanding about the changing epidemiology of eczema. To investigate recent trends in the recorded incidence, lifetime prevalence, prescribing and...

To develop and validate a new diabetes risk algorithm (the QDScore) for estimating 10 year risk of acquiring diagnosed type 2 diabetes over a 10 year time period in an ethnically and socioeconomically diverse population. Prospective open cohort study using routinely collected data from 355 general practices in England and Wales to develop the score...

The co-existence of allergic conditions, food allergy, eczema, allergic rhinitis, asthma and anaphylaxis is thought to be increasing. Analysis of primary healthcare data-sets offers the possibility to advance understanding about the changing epidemiology of multiple allergic disorders. To investigate recent trends in the recorded incidence, lifetim...

To investigate recent trends in the recorded incidence, lifetime prevalence and prescribing of symptom relief medication for allergic rhinitis in England. Analysis of primary healthcare datasets. The UK prevalence of allergic rhinitis has increased very significantly over recent decades. Analysis of primary healthcare datasets offers the possibilit...

To develop and validate version two of the QRISK cardiovascular disease risk algorithm (QRISK2) to provide accurate estimates of cardiovascular risk in patients from different ethnic groups in England and Wales and to compare its performance with the modified version of Framingham score recommended by the National Institute for Health and Clinical...

Analysis of primary healthcare datasets offers the possibility to increase understanding of the epidemiology of acute uncommon conditions such as anaphylaxis, but these datasets remain under-exploited. Aim: To investigate recent trends in the recorded incidence, lifetime prevalence and prescribing of adrenaline for anaphylaxis in England. QRESEARCH...

Around 1% of the UK population has diabetes that is either undiagnosed or unrecorded on practice disease registers. To estimate the number of people in UK primary care databases with biochemical evidence of undiagnosed diabetes. To develop simple practice-based search techniques to support early recognition of diabetes. Cross-sectional survey of 3...

The UK has had a pneumococcal polysaccharide vaccination (PPV) programme for groups at higher risk of invasive disease since 1992. This paper presents data from a sample of primary-care practices (Q-RESEARCH) of PPV uptake in patients according to their risk status. Of 2.9 million registered patients in 2005, 2.1% were vaccinated with PPV in the pr...

To assess the performance of the QRISK score for predicting cardiovascular disease (CVD) in an independent UK sample from general practice and compare with the Framingham score. Prospective open cohort study. UK general practices contributing to the THIN and QRESEARCH databases. COHORT: The THIN validation cohort consisted of 1.07 million patients,...