Julia Hippisley-Cox's research while affiliated with University of Oxford and other places
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Publications (137)
Background
There is an increasing demand for mental health services for young people, which may vary across the year.
Objective
To determine whether there are seasonal patterns in primary care antidepressant prescribing and mental health issues in adolescents and young adults.
Methods
This cohort study used anonymised electronic health records fr...
Background:
Identifying female individuals at highest risk of developing life-threatening breast cancers could inform novel stratified early detection and prevention strategies to reduce breast cancer mortality, rather than only considering cancer incidence. We aimed to develop a prognostic model that accurately predicts the 10-year risk of breast...
Immunocompromised individuals face increased risks of severe COVID-19 outcomes, underscoring the importance of receiving COVID-19 vaccination. However, there's a lack of comprehensive real-world data on their COVID-19 vaccine uptake, effectiveness, and safety profile. We analysed data in the QResearch UK database from 01/12/2020 to 11/04/2022. We i...
Background:
Methods to identify patients at increased risk of oesophageal cancer are needed to better identify those for targeted screening. We aimed to derive and validate novel risk prediction algorithms (CanPredict) to estimate the 10-year risk of oesophageal cancer and evaluate performance against two other risk prediction models.
Methods:
P...
Background:
Weather and seasons, or stressful periods associated with their education could affect young people's mental health. Members of a young person's advisory group asked us to investigate whether there are particular periods in the year when adolescents have more mental health issues.
Aim:
To examine whether there are different seasonal...
Objectives
To derive and validate risk prediction algorithms (QCOVID4) to estimate the risk of covid-19 related death and hospital admission in people with a positive SARS-CoV-2 test result during the period when the omicron variant of the virus was predominant in England, and to evaluate performance compared with a high risk cohort from NHS Digita...
Introduction:
At the start of the COVID-19 pandemic there was an urgent need to identify individuals at highest risk of severe outcomes, such as hospitalisation and death following infection. The QCOVID risk prediction algorithms emerged as key tools in facilitating this which were further developed during the second wave of the COVID-19 pandemic...
Objective
To develop a clinically useful model that estimates the 10 year risk of breast cancer related mortality in women (self-reported female sex) with breast cancer of any stage, comparing results from regression and machine learning approaches.
Design
Population based cohort study.
Setting
QResearch primary care database in England, with ind...
Background
Liver cancer has one of the fastest rising incidence and mortality rates among all cancers in the UK, but it receives little attention. This study aims to understand the disparities in epidemiology and clinical pathways of primary liver cancer and identify the gaps for early detection and diagnosis of liver cancer in England.
Methods
Th...
Over time, the performance of clinical prediction models may deteriorate due to changes in clinical management, data quality, disease risk and/or patient mix. Such prediction models must be updated in order to remain useful. Here, we investigate methods for discrete and dynamic model updating of clinical survival prediction models based on refittin...
Background:
Lung cancer is the second most common cancer in incidence and the leading cause of cancer deaths worldwide. Meanwhile, lung cancer screening with low-dose CT can reduce mortality. The UK National Screening Committee recommended targeted lung cancer screening on Sept 29, 2022, and asked for more modelling work to be done to help refine...
Objectives
Uptake of influenza, pneumococcal and shingles vaccines in older adults vary across regions and socioeconomic backgrounds. In this study, we study the coverage and factors associated with vaccination uptake, as well as refusal in the unvaccinated population and their associations with ethnicity, deprivation, household size and health con...
Background: HBV is the leading global cause of cirrhosis and primary liver cancer. However, the UK HBV population has not been well characterised, and estimates of UK HBV prevalence and/or incidence vary widely between sources. We aimed to i) extract and summarise existing national HBV prevalence estimates, ii) add a new estimate based on primary c...
Heterogeneous studies have demonstrated ethnic inequalities in the risk of SARS-CoV-2 infection and adverse COVID-19 outcomes. This study evaluates the association between ethnicity and COVID-19 outcomes in two large population-based cohorts from England and Canada and investigates potential explanatory factors for ethnic patterning of severe outco...
Introduction
Dysmenorrhoea affects up to 70%–91% of adolescents who menstruate, with approximately one-third experiencing severe symptoms with impacts on education, work and leisure. Dysmenorrhoea can occur without identifiable pathology, but can indicate underlying conditions, including congenital genital tract anomalies or endometriosis. There is...
Background:
People with blood cancers have increased risk of severe outcomes from COVID-19 and were prioritised for vaccination.
Methods:
Individuals in the QResearch database aged 12 years and above on 1st December 2020 were included in the analysis. Kaplan-Meier analysis described time to COVID-19 vaccine uptake in people with blood cancer and...
Background
The COVID-19 pandemic has affected millions of people globally with major health, social and economic consequences, prompting development of vaccines for use in the general population. However, vaccination uptake is lower in some groups, including in pregnant women, because of concerns regarding vaccine safety. There is evidence of incre...
Importance
Evidence indicates that preexisting neuropsychiatric conditions confer increased risks of severe outcomes from COVID-19 infection. It is unclear how this increased risk compares with risks associated with other severe acute respiratory infections (SARIs).
Objective
To determine whether preexisting diagnosis of and/or treatment for a neu...
Objective
To evaluate the benefit of combining polygenic risk scores with the QCancer-10 (colorectal cancer) prediction model for non-genetic risk to identify people at highest risk of colorectal cancer.
Design
Population based cohort study.
Setting
Data from the UK Biobank study, collected between March 2006 and July 2010.
Participants
434 587...
Background and research aim
The incidence and mortality of liver cancer have been increasing in the UK in recent years. However, liver cancer is still under-studied. The Early Detection of Hepatocellular Liver Cancer (DeLIVER-QResearch) project aims to address the research gap and generate new knowledge to improve early detection and diagnosis of p...
Introduction
This study aims to explore the impact of COVID-19 vaccination on critical care by examining associations between vaccination and admission to critical care with COVID-19 during England's Delta wave, by age group, dose, and over time.
Methods
We used linked routinely-collected data to conduct a population cohort study of patients admitt...
Objectives
To explore associations between COVID-19 vaccination and admission to critical care with COVID-19 in England, by age group, dose, and over time. ApproachWe conducted a population cohort study by linking the Case Mix Programme national clinical audit of adult intensive care to the National Immunisation Management System, combined with pop...
Background
Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association...
OBJECTIVE: To assess the risk of COVID-19 death following infection from Omicron BA.1 relative to Delta (B.1.617.2). DESIGN: Retrospective cohort study. SETTING: England, UK, 1 December 2021 to 30 December 2021. PARTICIPANTS: 1,035,149 people aged 18-100 years who tested positive for SARS-CoV-2 in the national surveillance programme, and had an inf...
Background: Myocarditis is more common after severe acute respiratory syndrome coronavirus 2 infection than after COVID-19 vaccination, but the risks in younger people and after sequential vaccine doses are less certain.
Methods: A self-controlled case series study of people ages 13 years or older vaccinated for COVID-19 in England between December...
Sotrovimab is a neutralising monoclonal antibody (nMAB), currently administrated in England to treat extremely clinically vulnerable COVID-19 patients. Trials have shown it to have mild or moderate side effects, however safety in real-world settings has not been yet evaluated. We used national databases to investigate its uptake and safety in commu...
To (a) derive and validate risk prediction algorithms (QCovid4) to estimate risk of COVID-19 mortality and hospitalisation in UK adults with a SARS-CoV-2 positive test during the Omicron pandemic wave and (b) evaluate performance with earlier versions of algorithms developed in previous pandemic waves and the high-risk cohort identified by NHS Digi...
Background: HBV is the leading global cause of cirrhosis and primary liver cancer. However, the UK HBV population has not been well characterised, and estimates of UK HBV prevalence and/or incidence vary widely between sources. We summarised datasets that are available to represent UK CHB epidemiology, considering differences between sources, and d...
Objective:
To assess the risk of covid-19 death after infection with omicron BA.1 compared with delta (B.1.617.2).
Design:
Retrospective cohort study.
Setting:
England, United Kingdom, from 1 December 2021 to 30 December 2021.
Participants:
1 035 149 people aged 18-100 years who tested positive for SARS-CoV-2 under the national surveillance...
Background:
A high BMI has been associated with a reduced immune response to vaccination against influenza. We aimed to investigate the association between BMI and COVID-19 vaccine uptake, vaccine effectiveness, and risk of severe COVID-19 outcomes after vaccination by using a large, representative population-based cohort from England.
Methods:...
Objective
Prior studies identified clinical factors associated with increased risk of pancreatic ductal adenocarcinoma (PDAC). However, little is known regarding their time-varying nature, which could inform earlier diagnosis. This study assessed temporality of body mass index (BMI), blood-based markers, comorbidities and medication use with PDAC r...
BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used...
Objectives
To develop and validate the QCancer2 (10-year risk) lung model for estimation of future risk of lung cancer and to compare the model performance against other prediction models for lung cancer screening
Design
open cohort study using linked electronic health records (EHRs) from the QResearch database (1 January 2005 – 31 March 2020)
Se...
Introduction
The QCOVID algorithm is a risk prediction tool for infection and subsequent hospitalisation/death due to SARS-CoV-2. At the time of writing, it is being used in important policy-making decisions by the UK and devolved governments for combatting the COVID-19 pandemic, including deliberations on shielding and vaccine prioritisation. Ther...
Objective
To confirm the symptoms and signs for motor neuron disease (MND) in the Red Flag tool; to quantify the extent to which the key symptoms and signs are associated with MND; and to identify additional factors which may be helpful within the primary care setting in recognition of possible MND and triggering timely referral to neurology specia...
Importance:
Individuals surviving severe COVID-19 may be at increased risk of neuropsychiatric sequelae. Robust assessment of these risks may help improve clinical understanding of the post-COVID syndrome, aid clinical care during the ongoing pandemic, and inform postpandemic planning.
Objective:
To quantify the risks of new-onset neuropsychiatr...
Background
HBV is the leading global cause of cirrhosis and primary liver cancer. The virus’s attributable disease burden in the UK is concentrated in vulnerable populatons including ethinic minorities, people experiencing homelessness and people born in high-prevalence countries. Despite this the UK HBV population has not been well characterised,...
Objective
To investigate childhood, teenage and young adult cancer diagnostic pathways during the first wave of the COVID-19 pandemic in England.
Design
Population-based cohort study.
Setting and participants
QResearch, a nationally representative primary care database, linked to hospital admission, mortality and cancer registry data, was used to...
Background
Studies report an increased risk of self-harm or suicide in people prescribed mirtazapine compared with other antidepressants.
Objectives
To compare the risk of serious self-harm in people prescribed mirtazapine versus other antidepressants as second-line treatments.
Design and setting
Cohort study using anonymised English primary care...
Introduction
Breast cancer is the most common cancer and the leading cause of cancer-related death in women worldwide. Risk prediction models may be useful to guide risk-reducing interventions (such as pharmacological agents) in women at increased risk or inform screening strategies for early detection methods such as screening.
Methods and analys...
Objective
To assess the risk of death involving COVID-19 following infection from Omicron (B.1.1.539/BA.1) relative to Delta (B.1.617.2).
Design
Retrospective cohort study.
Setting
England, UK, 1 December 2021 to 25 January 2022.
Participants
1,035,163 people aged 18-100 years who tested positive for SARS-CoV-2 in the national surveillance progr...
Background:
Smoking is a risk factor for most respiratory infections, but it may protect against SARS-CoV-2 infection. The objective was to assess whether smoking and e-cigarette use were associated with severe COVID-19.
Methods:
This cohort ran from 24 January 2020 until 30 April 2020 at the height of the first wave of the SARS-CoV-2 epidemic i...
Background:
Guidelines recommend that GPs give patients lifestyle advice to manage hypertension and diabetes. Increasing evidence shows that this is an effective and practical treatment for these conditions, but it is unclear whether GPs offer this support.
Aim:
To investigate trends in the percentage of patients with hypertension/diabetes recei...
Introduction
COVID-19 risk prediction algorithms can be used to identify at-risk individuals from short-term serious adverse COVID-19 outcomes such as hospitalisation and death. It is important to validate these algorithms in different and diverse populations to help guide risk management decisions and target vaccination and treatment programs to t...
Background
Studies have reported an increased risk of mortality among people prescribed mirtazapine compared to other antidepressants. The study aimed to compare all-cause and cause-specific mortality between adults prescribed mirtazapine or other second-line antidepressants.
Methods
This cohort study used English primary care electronic medical r...
Objective: This study uses three linked datasets to provide an estimate of incidence of motor neuron disease (MND) in England from 1998 to 2019. Comparison is made to previous British studies. It examines age at diagnosis and ethnicity of those affected.
Methods: The literature was searched for studies of MND incidence in Great Britain from 1995 to...
Although myocarditis and pericarditis were not observed as adverse events in coronavirus disease 2019 (COVID-19) vaccine trials, there have been numerous reports of suspected cases following vaccination in the general population. We undertook a self-controlled case series study of people aged 16 or older vaccinated for COVID-19 in England between 1...
Background and research aim
The incidence and mortality of liver cancer have been increasing in recent years in the UK. However, liver cancer is still under-studied. The Early De tection of Hepatocellular Liver Cancer (DeLIVER-QResearch) project aims to address the research gap and generate new knowledge to improve early detection and diagnosis of...
Background and research aim: Lung cancer is a research priority in the UK. Early diagnosis of lung cancer can improve patients' survival outcomes. The DART-QResearch project is part of a larger academic-industrial collaborative initiative, using big data and artificial intelligence to improve patient outcomes with thoracic diseases. There are two g...
Background
Pancreatic cancer continues to have an extremely poor prognosis in part due to late diagnosis. 25% of pancreatic cancer patients have a prior diagnosis of diabetes, and hence identifying individuals at risk of pancreatic cancer in those with recently diagnosed type 2 diabetes may be a useful opportunity to identify candidates for screeni...
In an updated self-controlled case series analysis of 42,200,614 people aged 13 years or more, we evaluate the association between COVID-19 vaccination and myocarditis, stratified by age and sex, including 10,978,507 people receiving a third vaccine dose. Myocarditis risk was increased during 1-28 days following a third dose of BNT162b2 (IRR 2.02,...
Objective
To estimate the association between untreated, community acquired, respiratory tract infections and bleeding in oral anticoagulant users.
Design
Self-controlled case series.
Setting
General practices in England contributing data to the Clinical Practice Research Datalink GOLD.
Participants
1208 adult users of warfarin or direct oral an...
Objective:
To systematically identify and compare the performance of prognostic models providing estimates of survival or recurrence of localised renal cell cancer (RCC) in patients treated with surgery with curative intent.
Materials and methods:
We performed a systematic review (PROSPERO CRD42019162349). We searched Medline, EMBASE and the Coc...
Emerging reports of rare neurological complications associated with COVID-19 infection and vaccinations are leading to regulatory, clinical and public health concerns. We undertook a self-controlled case series study to investigate hospital admissions from neurological complications in the 28 days after a first dose of ChAdOx1nCoV-19 (n = 20,417,75...
Background
The QCovid algorithm is a risk prediction tool that can be used to stratify individuals by risk of COVID-19 hospitalisation and mortality. Version 1 of the algorithm was trained using data covering 10.5 million patients in England in the period 24 January 2020 to 30 April 2020. We carried out an external validation of version 1 of the QC...
Apart from high-risk scenarios such as the presence of highly penetrant genetic mutations, breast screening typically comprises mammography or tomosynthesis strategies defined by age. However, age-based screening ignores the range of breast cancer risks that individual women may possess and is antithetical to the ambitions of personalised early det...
Objective
To assess the risks of developing dementia associated with different types and durations of menopausal hormone therapy.
Design
Two nested case-control studies.
Setting
UK general practices contributing to QResearch or the Clinical Practice Research Datalink (CPRD), using all links to hospital, mortality, and social deprivation data.
Pa...
Background
Conflicting evidence has emerged regarding the relevance of smoking on risk of COVID-19 and its severity.
Methods
We undertook large-scale observational and Mendelian randomisation (MR) analyses using UK Biobank. Most recent smoking status was determined from primary care records (70.8%) and UK Biobank questionnaire data (29.2%). COVID-...
Objective
While population screening programs for cancer colorectal (CRC) have proven benefit, risk-stratified approaches may improve screening outcomes further. To date, genome-wide polygenic risk scores (PRS) for CRC have not been integrated with non-genetic risk factors. We aimed to evaluate several genome-wide approaches, and the benefit of add...
Objectives
To derive and validate risk prediction algorithms to estimate the risk of covid-19 related mortality and hospital admission in UK adults after one or two doses of covid-19 vaccination.
Design
Prospective, population based cohort study using the QResearch database linked to data on covid-19 vaccination, SARS-CoV-2 results, hospital admis...
Objective:
To assess the association between covid-19 vaccines and risk of thrombocytopenia and thromboembolic events in England among adults.
Design:
Self-controlled case series study using national data on covid-19 vaccination and hospital admissions.
Setting:
Patient level data were obtained for approximately 30 million people vaccinated in...
Background:
Oral prednisolone is the mainstay treatment for bullous pemphigoid, an autoimmune blistering skin disorder affecting older people. Treatment with moderate-to-high doses is often initiated in secondary care, but then continued in primary care.
Aim:
To describe long-term oral prednisolone prescribing in UK primary care for adults with...
Introduction:
Hormone replacement therapy (HRT) can help women experiencing menopausal symptoms, but usage has declined due to uncertainty around risks of cancer and some cardiovascular diseases (CVD). Moreover, improved cancer survival rates mean that more women who survive cancer go on to experience menopausal symptoms. Understanding these relat...
Acknowledgment: The authors thank the EMIS (Egton Medical Information Systems) practices that contribute to the database as well as the University of Nottingham and University of Oxford for expertise in establishing, developing, and supporting the QResearch database. QResearch acknowledges funding from the Nottingham Biomedical Research Centre fund...
Importance
Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear.
Objective
To investig...
Background
A more transmissible variant of SARS-CoV-2, the variant of concern 202012/01 or lineage B.1.1.7, has emerged in the UK. We aimed to estimate the risk of critical care admission, mortality in patients who are critically ill, and overall mortality associated with lineage B.1.1.7 compared with non-B.1.1.7. We also compared clinical outcomes...
Background
Public policy measures and clinical risk assessments relevant to COVID-19 need to be aided by risk prediction models that are rigorously developed and validated. We aimed to externally validate a risk prediction algorithm (QCovid) to estimate mortality outcomes from COVID-19 in adults in England.
Methods
We did a population-based cohort...
Background
Obesity is a major risk factor for adverse outcomes after infection with SARS-CoV-2. We aimed to examine this association, including interactions with demographic and behavioural characteristics, type 2 diabetes, and other health conditions.
Methods
In this prospective, community-based, cohort study, we used de-identified patient-level...
Introduction
Recent evidence suggests that ethnic minority groups are disproportionately at increased risk of hospitalisation and death from SARS-CoV-2 infection. Population-based evidence on potential explanatory factors across minority groups and within subgroups is lacking. This study aims to quantify the association between ethnicity and the ri...
