Richard Hubbard

University of Nottingham | Notts · Division of Epidemiology and Public Health

Background and objective: With the introduction of the antifibrotic drugs targeting progressive pulmonary fibroses, it becomes imperative to provide reliable contemporary estimates of the most common interstitial lung diseases. We then aimed at providing contemporary estimates of the incidence and survival of idiopathic pulmonary fibrosis (IPF), hy...

We quantified the proportion of diagnoses of pulmonary fibrosis (PF) among 25 136 people with lung cancer and 250 583 matched controls and compared the natural history of lung cancer in people with and without PF. Diagnoses of PF were more common in people with lung cancer than those without (1.5% vs 0.8%, OR 1.97; 95% CI 1.77 to 2.21). Within peop...

Background There is no standard definition of respiratory-related hospitalisation, a common endpoint in idiopathic pulmonary fibrosis (IPF) clinical trials. As diverse aetiologies and complicating comorbidities can present similarly, external adjudication is sometimes employed to achieve standardisation of these events. Methods An algorithm for re...

Early changes in lung cancer care can affect survival. Given the decrease in diagnosis during lockdowns, we calculated their impact on survival using National Lung Cancer Audit data. Percentage survival and HRs for death were compared between 2019 and lockdown periods of 2020. Decreased survival was observed from the first national lockdown onwards...

Lung cancer has the highest cancer mortality rate in the UK. Most patients are diagnosed at an advanced stage because common symptoms for lung cancer such as cough, pain, dyspnoea and anorexia are also present in other diseases. This partly attributes towards the low survival rate. Therefore, it is crucial to screen high risk patients for lung canc...

Objectives: To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the second wave of the COVID-19 pandemic in England, and describe the impact of corticosteroids on outcomes. Methods: Hospital Episode Statistics data were used to identify people alive 01 August...

Rationale Idiopathic pulmonary fibrosis (IPF) is a devastating disease characterized by limited treatment options and high mortality. A better understanding of the molecular drivers of IPF progression is needed. Objectives To identify and validate molecular determinants of IPF survival. Methods A staged genome-wide association study was performed...

Background: The Covid-19 pandemic has caused significant disruption to healthcare services and delivery worldwide. The impact of the pandemic and associated national lockdowns on lung cancer incidence in England has yet to be assessed. Research question: What was the impact of the first year of the Covid-19 pandemic on the incidence and presenta...

Rationale Idiopathic pulmonary fibrosis (IPF) is a devastating disease characterized by limited treatment options and high mortality. Novel therapies and prognostic biomarkers are needed. Objective To identify and validate molecular determinants of IPF survival. Methods A staged genome-wide association study (GWAS) was performed using paired geno...

Accurately explaining perioperative mortality and risk to patients is an essential part of shared decision making. In the case of lung cancer surgery, the currently available multivariable mortality prediction tools perform poorly, and could mislead patients. Using data from 2004 to 2012, this group has previously produced data tables for 90-day po...

Introduction More than 2,700 people are diagnosed with mesothelioma each year in the UK. Survival from mesothelioma is poor and to ensure service users’ perspectives are incorporated in designing the most effective strategies to improve healthcare in England, the English Cancer Patient Experience Survey (CPES) is carried out annually in people diag...

Objectives To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the first wave of the COVID-19 pandemic in England compared with the general population. Methods We used Hospital Episode Statistics to identify all people alive 01 March 2020 with ICD-10 codes for...

Objectives: To calculate the rates of COVID19 infection and COVID19 related death among people with rare autoimmune rheumatic diseases (RAIRD) during the first wave of the COVID19 pandemic in England compared to the general population. Methods: We used Hospital Episode Statistics to identify all people alive 01 March 2020 with ICD10 codes for RAIRD...

The concept of cure from cancer is important to patients, but can be difficult to communicate in terms that are meaningful. This is because there are a number of definitions of cure that are applied by clinicians, patients and the public, and by policymakers that have a different meaning and significance. In this article, we provide a narrative rev...

Introduction Optimal management of people with advanced non-small cell lung cancer (NSCLC) depends on accurate identification of predictive markers. Yet, real world data in this setting is limited. We describe the impact, timeliness and outcomes of molecular testing for patients with advanced NSCLC and good performance status in England. Methods I...

Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal D...

Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared to the general population, and compared to their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demog...

Objectives: We conducted a systematic review and meta-analysis of survival following treatment recommended by the European Society of Medical Oncology for SCLC in order to determine a benchmark for novel therapies to be compared with. Materials and methods: Randomized controlled trials and observational studies reporting overall survival followi...

Background Approximately 15%–20% of all non-small cell lung cancer (NSCLC) cases present with stage I disease. Surgical resection traditionally offers the best chance of a cure but some patients will not have this treatment due to older age, comorbidities or personal choice. Stereotactic ablative radiotherapy (SABR) has become an established curati...

Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrativ...

Introduction Data from the National Lung Cancer Audit (NLCA) often show variation in outcomes between lung cancer units which are not entirely explained by case mix. We explore the association between the organisation of services and patient outcome. Methods Details of service provision were collected via an electronic survey in June 2017. An over...

Background We have previously shown that the incidence of idiopathic pulmonary fibrosis (IPF) in the UK is on the rise and that some individuals with IPF may be symptomatic up to five years prior to diagnosis. The aim of our study was to investigate recording of spirometry, in particular Forced Vital Capacity (FVC) amongst incident cases of IPF in...

Purpose: Health services across the world utilise advanced practice in cancer care. In the UK, lung cancer nurse specialists (LCNS) are recognised as key components of quality care in national guidelines, yet access to LCNS contact is unequal and some responsibilities are reportedly left undone. We assess whether any variation in working practices...

Introduction The National Lung Cancer Audit has collected data for over 10 years demonstrating gradually rising resection rates in the UK. The Clinical Outcomes Programme (COP) uses national audit data to publish quality measures at the level of individual consultants. The lung cancer COP focusses on activity at individual surgeon level, and on sur...

Background Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder with a variable disease trajectory. The aim of this study was to assess potential biomarkers to predict outcomes for people with IPF. Methods PROFILE is a large prospective longitudinal cohort of treatment-naive patients with IPF. We adopted a two-stage discovery and v...

Background: People with granulomatosis with polyangiitis (GPA) commonly described long delays before diagnosis. Aim: To study the natural history of GPA prior to diagnosis using primary care data, and determine whether clinical features could be identified to help earlier diagnosis. Design: Case-control study using the Clinical Practice Resear...

In 2014, the method of data collection from NHS trusts in England for the National Lung Cancer Audit (NLCA) was changed from a bespoke dataset called LUCADA (Lung Cancer Data). Under the new contract, data are submitted via the Cancer Outcome and Service Dataset (COSD) system and linked additional cancer registry datasets. In 2014, trusts were give...

Objective: To estimate the incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK. Methods: We conducted a historical cohort study using data from the Clinical Practice Research Datalink and Hospital Episode Statistics (HES). We calculated incidence rate ratios, adjusted for age, gender and ethnicity, using Poisson reg...

Background We have previously demonstrated that people with idiopathic pulmonary fibrosis (IPF) are more likely to have a prothrombotic state and that people with IPF and a prothrombotic state have a higher risk of death at a year’s follow up. The aim of this study was to establish the impact of clotting abnormalities on the natural history of IPF...

Background We performed an analysis of UK respiratory disease epidemiology covering 2004–2012. Findings pertaining to COPD are presented here. Methods Prevalence and incidence rates were estimated from The Health Intelligence Network database representing ∼5 per cent of the population. Mortality figures came from official government statistics. WH...

Introduction and objectives The last comprehensive survey of UK respiratory disease epidemiology was the British Thoracic Society’s 2006 Burden of Lung Disease report. We performed an analysis covering 2004–2012. Findings pertaining to IPF are presented here. Methods Prevalence and incidence rates were estimated from a primary care database (the H...

Introduction In 2014, the contract to deliver the National Lung Cancer Audit (NLCA) was awarded to the Royal College of Physicians. Data were previously submitted using a bespoke dataset (LUCADA), but will now be submitted via the nationally mandated Cancer Outcome and Services Dataset (COSD) and linked to additional cancer registry datasets. For p...

Introduction The National Lung Cancer Audit has collected data for over 10 years demonstrating gradually rising resection rates in the UK. The Clinical (formerly Consultant) Outcomes Programme (COP) is an NHS England initiative, managed by HQIP, using national audit data to publish quality measures at the level of individual consultants. The lung c...

Introduction The National Lung Cancer Audit (NLCA) has collected data for over 10 years, but in early 2015 a transition to using the Cancer Outcomes and Services Dataset (COSD) and cancer registration was begun and has now entirely superseded the legacy LUCADA dataset. An online portal (CancerStats) has been developed with a bespoke section providi...

BACKGROUND: Venous thromboembolism (VTE) is a potentially preventable cause of death in people with lung cancer. Identification of those most at risk and high-risk periods may provide the opportunity for better targeted intervention. METHODS: We conducted a cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statis...

International guidelines and new targeted therapies for idiopathic pulmonary fibrosis have increased the need for accurate diagnosis of interstitial lung disease (ILD), which may lead to more surgical lung biopsies. This study aimed to assess the risk of this procedure in patients from the UK. We used Hospital Episodes Statistics data from 1997 to...

Background: The incidence of idiopathic pulmonary fibrosis (IPF) is increasing, but little is known about the onset of its symptoms. These may be mistaken for manifestations of chronic obstructive pulmonary disease (COPD) and heart failure. Aims and Objectives: To determine for how long IPF cases are symptomatic, in terms of presentation to their g...

Background: The last comprehensive survey of UK respiratory disease epidemiology was the British Thoracic Society's 2006 report. We have performed an analysis covering 2008-2012. Methods: Prevalence and incidence rates were estimated from a primary care database representing ∼ 5 per cent of the population. Mortality figures were derived from offic...

Background There are limited data on the burden of cardiovascular comorbidities in people with bronchiectasis. Our cross-sectional study estimates the burden of pre-existing diagnoses of coronary heart disease (CHD) and stroke in people with bronchiectasis compared with the general population. The historical cohort study investigates if individuals...

Introduction: Many patients with cancer die in an acute hospital bed, which has been frequently identified as the least preferred location, with psychological and financial implications. This study looks at place and cause of death in patients with lung cancer and identifies which factors are associated with dying in an acute hospital bed versus a...

Introduction: International guidelines and new targeted therapies for idiopathic pulmonary fibrosis have increased the need for accurate diagnosis of interstitial lung disease, which may lead to more surgical lung biopsies. This study aims to assess the risk of this procedure in patients from the United Kingdom. Methods: We used Hospital Episodes S...

Objectives: We aimed to estimate the incidence of ANCA-associated vasculitis in the UK and how this varied by ethnic group. Methods: We identified incident cases of ANCA-associated vasculitis between March 2007 and June 2013 in the Nottingham-Derby urban area from medical records using multiple sources. We derived the denominator population from...

Background: Venous thromboembolism (VTE) is a potentially preventable cause of death in people with lung cancer. Identification of those most at risk and high-risk periods may provide the opportunity for better targeted intervention. Methods: We conducted a cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Sta...

Rationale: Surgical lung biopsy can help to determine a specific diagnosis in interstitial lung disease, but has associated risks. Most currently available mortality data are derived from case series and may not be generalizable to broader populations. Objectives: We aimed to assess in-hospital mortality following surgical lung biopsy for interst...

Lung function measures are used in the diagnosis of chronic obstructive pulmonary disease. In 38,199 European ancestry individuals, we studied genome-wide association of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC with 1000 Genomes Project (phase 1)-imputed genotypes and followed up top associations in 54,550 Eu...

Purpose: To develop a framework for identifying and incorporating candidate confounding interaction terms into a regularised cox regression analysis to refine adverse drug reaction signals obtained via longitudinal observational data. Methods: We considered six drug families that are commonly associated with myocardial infarction in observationa...

Introduction Whilst studies suggest increasing incidence and mortality from bronchiectasis in UK, there are sparse data on outcomes of individuals with bronchiectasis admitted to intensive care (ICU). We investigated trends in bronchiectasis admissions to ICU and estimated outcomes in patients with bronchiectasis admitted to ICU compared to a bette...

Background Hospital acquired pneumonia (HAP) is a common nosocomial condition, especially in the elderly population. We aimed to describe clinical and demographic features of patients diagnosed with HAP (excluding ventilator associated pneumonia) in a large teaching hospital and investigate the association of these features with 30 day mortality. M...

Much of the research in lung cancer is concerning survival or treatment rates and little is known about the rate of hospitalisation (emergency/elective) following the diagnosis of lung cancer. Newly diagnosed English patients from the National Lung Cancer Audit database (NLCA), 2007–2011, were linked with Hospital Episode Statistics (HES) data to p...

Introduction Surgical lung biopsy can help to achieve a specific diagnosis in interstitial lung disease, but has associated risks. Most currently available mortality data come from case series. Objective We aimed to assess in-hospital mortality following surgical lung biopsy for interstitial lung disease in a national secondary care dataset. Method...

Background: There are limited data on admission trends and outcomes of individuals with bronchiectasis admitted to intensive care (ICU). Using national critical care data, we analysed admissions to ICU and estimated outcomes in terms of mortality in individuals with bronchiectasis and chronic obstructive pulmonary disease (COPD) admitted to ICU....

Background: There are limited data on admission trends and outcomes of individuals with bronchiectasis admitted to intensive care (ICU). Using national critical care data, we analysed admissions to ICU and estimated outcomes in terms of mortality in individuals with bronchiectasis and chronic obstructive pulmonary disease (COPD) admitted to ICU. Me...

Background: Understanding the genetic basis of airflow obstruction and smoking behaviour is key to determining the pathophysiology of chronic obstructive pulmonary disease (COPD). We used UK Biobank data to study the genetic causes of smoking behaviour and lung health. Methods: We sampled individuals of European ancestry from UK Biobank, from the m...

Background: Understanding the genetic basis of airfl ow obstruction and smoking behaviour is key to determining the pathophysiology of chronic obstructive pulmonary disease (COPD). We used UK Biobank data to study the genetic causes of smoking behaviour and lung health. Methods: We sampled individuals of European ancestry from UK Biobank, from the...

Lung cancer surgery leads to long term survival for some patients but little is known about how patients decide whether to accept the associated surgical risks. The objective of this qualitative study was to explore patients' attitudes to the risks associated with lung cancer surgery. Fifteen patients with resectable lung cancer, recruited via mult...

Antenatal antiepileptic drug (AED) use has been found to be associated with increased major congenital anomaly (CA) risks. However whether such AED-associated risks were different according to periconceptional high dose (5mg daily) folic acid supplementation is still unclear. We included 258,591 singleton live-born children of mothers aged 15-44 ye...

Big longitudinal observational medical data potentially hold a wealth of information and have been recognised as potential sources for gaining new drug safety knowledge. Unfortunately there are many complexities and underlying issues when analysing longitudinal observational data. Due to these complexities, existing methods for large-scale detectio...

We report the findings of the first national lung cancer organisational audit. The results demonstrate marked variation in service provision and workload of some lung cancer specialists. For example, over half of the clinical nurse specialists report case volumes over recommended numbers. Some trusts have no access to key treatments such as video a...

As idiopathic pulmonary fibrosis emerges as an important public health problem, there is a need to coordinate data on incidence and mortality globally. This study aims to systematically assess all available studies to investigate the global burden of disease. Medline and Embase databases were searched systematically for all population-based studies...

Studies report that the risks of significant neurologic complications (including stroke, cerebral abscess, and migraine) and hemorrhagic sequelae are high in patients with hereditary hemorrhagic telangiectasia (HHT), and that life expectancy in this cohort is reduced. However, most published cohorts derive from specialist centers, which may be susc...

Malignant pleural mesothelioma (MPM) is an uncommon cancer with poor survival. We have used data collected for the UK National Lung Cancer Audit to assess current practice and to highlight regional variation in the management of mesothelioma patients, as well as to describe survival patterns in subgroups. Our data on 8740 cases seen in hospitals in...

Idiopathic pulmonary fibrosis, a progressive and inevitably fatal disorder, has a highly variable clinical course. Biomarkers that reflect disease activity are urgently needed to inform patient management and for use as biomarkers of therapeutic response (theragnostic biomarkers) in clinical trials. We aimed to determine whether dynamic change in m...

Background Non-Small cell lung cancer (NSCLC) in young adults is a rare but devastating illness with significant socio-economic implications, and studies of this patient subgroup are limited. Aim This study employed the National Lung Cancer Audit (NLCA) to compare the clinical features and survival of young adults with NSCLC with the older age grou...