National Health Service Central Register Research Articles

Case register study of suicide risk in mental disorders.

There have been few large-scale studies of long-term suicide risk in mental disorders in the UK. To estimate the long-term risk of suicide in psychiatric patients. A sample of 7921 individuals was identified from the Salford Psychiatric Case Register. Mortality by suicide or undetermined external cause during a follow-up period of up to 18 years was determined using the NHS Central Register; suicide risks were estimated as rate ratios. Suicide risk was increased more than ten-fold in both genders: the rate ratio for males was 11.4; for females it was 13.7. The risk was highest in young patients, but high risk continued into late life. The diagnoses with the highest risk were schizophrenia, affective disorders, personality disorder and (in males) substance dependence. Risk was also associated with recent initial contact and number of admissions but not comorbidity. The suicide risks estimated in this study are generally higher than those previously reported, notably in schizophrenia and personality disorder, and in previous in-patients. Patients with these high-risk diagnoses, an onset of illness within the previous 1-3 years, or more than one previous admission should be regarded as priority groups for suicide prevention by mental health services.

The feasibility of using a postal survey method to assess the health and development of 7 year old children of different birth weight.

STUDY OBJECTIVE: To test the feasibility of using a postal survey to assess health and development in 7 year old children of different birth weights and to examine the response...

Childhood leg length and adult mortality: follow up of the Carnegie (Boyd Orr) Survey of Diet and Health in Pre-war Britain.

OBJECTIVE: To investigate the relation between childhood height, its components--leg length and trunk length--and mortality in adulthood. DESIGN: Cohort study based on the Carnegie (Boyd Orr) Survey of diet and...

Childhood energy intake and adult mortality from cancer: the boyd orr cohort study

Objective: To examine the relation between energy intake in childhood and adult mortality from cancer.Study design: Cohort study.Setting: 16 rural and urban centres in England and Scotland.Subjects: 3834 people who...

Best-Link Matching of Scottish Health Data Sets

Methods are described used to link the Community Health Index and the National Health Service Central Register (NHSCR) in Scotland to provide a basis for a national patient index. The linkage used a combination of deterministic and probability matching techniques. A best-link principle was used by which each Community Health Index record was allowed to link only to the NHSCR record with which it achieved the highest match weight. This strategy, applied in the context of two files which each covered virtually the entire population of Scotland, increased the accuracy of linkage approximately a thousand-fold compared with the likely results of a less structured probability matching approach. By this means, 98.8% of linkable records were linked automatically with a sufficient degree of confidence for administrative purposes.

Cumulative incidence of foot complications in patients first attending a UK diabetes clinic in 1982–1985: a 12-year prospective study

We followed-up all patients ( n = 985) first attending the St Thomas' Hospital diabetes clinic in 1982–1985 for a 12-year period, in order to study the cumulative incidence of lower extremity complications. All patients had a standard computerized visit (includes detailed and structured examination of the lower limbs) at the bascline visit. We linked up our patient computer database to the NHS Central Register to relocate patients no longer attending our clinic and to identify patients who had died. Information on lower extremity complications was available on 818 patients (85.4%) in 1995. This was obtained by patient review (52%), questionnaire (18%), death certificates, case notes and other sources in patients who had died (30%). Lower extremity events (ulcers or amputations) were a cause of morbidity and mortality in 7.3% of diabetic patients followed-up over a mean 12-year interval. The estimated annual incidence of foot ulcers and amputations was 0.4% and 0.2% respectively.

Linking a hospital diabetes database and the National Health Service Central Register: a way to establish accurate mortality and movement data.

We have established a records linkage between 'Diabeta' (the computerized clinical records system in the Diabetes Unit of St Thomas' Hospital) and the National Health Services Central Register (NHSCR) of the United Kingdom. Over 7000 diabetic patient records have been collected since 1973. Demographic data on all diabetic patients were retrieved and submitted to the NHSCR via a floppy disk. A matching system (automatic or manual) was used by the NHSCR to identify deceased patients and the most recent demographic data was provided on patients alive. This linkage resulted in an update of 91% of records in Diabeta. The findings of the update included: (1) 86% of diabetic patient's death had not been notified to the hospital and were not recorded on Diabeta. Mortality can now be assessed accurately as an outcome measure in our diabetic population. (2) Provision of the NHS number to Diabeta, as before it was not available on many patients seen in the hospital. The NHS number is a key patient identifier which can be used to exchange information within the NHS-wide network. (3) Diabetes was recorded as a cause of death in only 36% of death certificates. Analyses of death certificates alone must thus give poor information about mortality in diabetes. (4) Geographical location of patients on the database was updated, enabling tracing of patients for long-term studies and analyses of movement.

Audit of ascertainment of deaths to children born in Cumbria, UK, 1950-89 through the NHS central register.

STUDY OBJECTIVE: To evaluate the completeness of notification of deaths by the National Health Service Central Register (NHSCR) for England and Wales. DESIGN: Deaths for a birth cohort were ascertained...

Submissiveness and protection from coronary heart disease in the general population: Edinburgh Artery Study

Type A behaviour and, more specifically, hostility and anger have been associated with increased risk of coronary heart disease (CHD). But less attention has been paid to other features of personality. Our aim was to assess whether a submissiveness trait, which is independent of hostility, was related to future risk of CHD in the general population. The Edinburgh Artery Study is a cohort study of a random sample of 809 men and 783 women aged 55 to 74 years. At the baseline examination in 1988, we administered the Bedford-Foulds Personality Deviance Scales. The participants were followed up for 5 years for cardiovascular events. Criteria to define events were adapted from the American Heart Association. Events were ascertained from the information and Statistics Division of the Scottish Office Home and Health Department, general practitioners, the UK National Health Service Central Register, annual questionnaires to the participants, and the second examination at the end of follow-up. During follow-up, 57 (7.0%) men and 28 (3.6%) women had non-fatal myocardial infarctions; 25 (3.1%) men and 8 (1.0%) women had fatal myocardial infarctions; and 48 (5.9%) men and 41 (5.2%) women developed angina pectoris. We found that mean submissiveness scores were significantly higher in men and women who did not have a non-fatal myocardial infarction than in those who did (18.88 [SE 0.15] vs 17.70 [0.40], p = 0.023 in men; 20.76 [0.17] vs 18.18 [0.86], p = 0.002 in women). In multiple logistic-regression models, submissiveness remained independently associated with risk of myocardial infarction in women only; a decreased risk of both non-fatal myocardial infarction (relative risk 0.59 [95% CI 0.40-0.85]) and, to a lesser extent, total myocardial infarction (0.69 [0.27-0.96]), was associated with an increase of 1 SD in submissiveness. The personality trait of submissiveness may be protective against non-fatal myocardial infarction, particularly in women. A better understanding is required of the complicated effects of personality on CHD development.

British motor neuron disease twin study.

OBJECTIVES: To investigate the cause of sporadic motor neuron disease (MND) by twin study, so allowing (1) estimation of the genetic contribution, and (2) collection of matched pairs for a...

Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants.

OBJECTIVES: To examine patterns of cause specific mortality in NHS hospital consultants according to their specialty and to assess these in the context of potential occupational exposures. METHODS: A historical...

Systematic identification of twins by computerised searches of NHS patient registers in the UK.

OBJECTIVES: This study aimed to assess the feasibility, sensitivity, and specificity of a systematic search of the NHS central register for twins of the same sex. DESIGN, SETTING, AND SUBJECTS:...

The Creation of a Database of Children of Workers at a Nuclear Facility: An Exercise in Record Linkage

Abstract We constructed a database containing birth certificate details of all 261,176 live births and 4059 stillbirths in Cumbria, in northwest England, from 1950 to 1989 for use as an epidemiological tool to examine the health of those who had parents employed at the nuclear installation, Sellafield, in particular in relation to the occupational radiation dose which the parents might have received while working there before their children were conceived. A computer database containing personal details of all 25,514 individuals employed at Sellafield over this period is maintained at Sellafield for epidemiological research purposes. A computer linkage exercise was carried out to match parents in the Cumbrian births database with these Sellafield employees. Ambiguous links were resolved by a clerical team who had access to paper records at Sellafield containing further employee details. Using the National Health Service Central Register, death, cancer, and emigration registrations occurring among the Cumb...

Survival following the onset of scleroderma: results from a retrospective inception cohort study of the UK patient population.

Scleroderma is a multisystem disease which in many populations is reported to have a substantially reduced survival. One problem with many of the published studies is the inclusion of patients with differing lengths of disease at baseline, with the possibility of left censorship bias. The aim was to determine the survival and its predictors in a cohort of scleroderma patients with new onset of disease. All 283 new patients referred to one of the authors (CMB) who had a reported disease onset after 1 January 1982 were studied. Detailed clinical and laboratory information at baseline and at 1 yr were extracted from the structured records. Vital status as at 1 December 1993 was determined using the UK's NHS Central Register. Expected numbers of deaths were obtained by applying local age and sex all-cause mortality rates. In total, there were 1871 person-years of follow-up with crude mortality rates of 3.9 and 2.6%/year, respectively, in males and females. The mortality rate remained approximately constant over the first 10 yr of follow-up. In comparison with expected survival, based on the age distribution of the cohort, there was an overall 4-fold increased mortality rate in this group which was higher in females [standardized mortality ratio (SMR) 4.6, 95% CI 3.2-6.2] than in males (SMR 3.2, 95% CI 1.8-5.0). Analysis of cause-specific mortality showed that 79% of the excess deaths were scleroderma related, but this proportion was substantially lower in males than in females (67% vs 83.9%). These data confirm the increased mortality rate associated with scleroderma, but these rates are lower than those reported from other centres. Females have a higher age-adjusted mortality which is reflected in the different pattern of mortality between the sexes.

Lifecourse exposure and later disease: a follow-up study based on a survey of family diet and health in pre-war Britain (1937–1939)

There is an increasing interest in the origins of adult disease in early life. The elucidation of such explanations of current morbidity and mortality must depend upon the follow-up of previously established cohorts. This paper describes the design of and background to such a follow-up of one of the richest data sources for this type of research: Sir John Boyd Orr's survey of diet and health in pre-war Britain. 1,352 families from 16 centres in England and Scotland were surveyed; 3,762 children aged up to 19 years from these families were examined. Socio-economic information and detailed one week dietary diary records are available for all families. Detailed medical examinations (including anthropometry) were undertaken on children in 14 of the centres. Most of the information is cross-sectional although 1,322 children were examined on two or more occasions one year apart to assess the effects of dietary supplementation. Dietary records were retrieved for 1,343 (99.3%) of the families. Medical examination records were found for 3,560 (94.6%) of the children who were examined in the survey and attempts have been made to trace 4,973 children who were either examined or whose family participated in the dietary survey. The data demonstrate relationships between family food expenditure and height in childhood and housing conditions. Eighty-five per cent (4211/4973) of the children have been traced and flagged on the National Health Service Central Register, Southport. The characteristics of those traced do not differ significantly from those we have been unable to trace although untraced females were slightly heavier. To date 696 (16.5%) of the cohort have died. The cohord will be used to investigate the relationship between diet, nutritional status (height, weight, cristal height), health and social circumstances in childhood, and mortality and morbidity in adulthood.

Birthweight and health and development at the age of 7 years

This study was set up to compare the frequency of health, educational and behavioural problems in a geographically defined birth cohort of 7-year-old children grouped by weight at birth. The study design was based on a multi-stage postal survey, with sampling stratified by birthweight. It took place in the four counties of Oxfordshire, Buckinghamshire, Berkshire and Northamptonshire which make up the former Oxford region. We studied 1319 live births to women resident in the former Oxford region in 1985, including all those with birthweights under 1500 g, or whose weight was not recorded, and a sample of those who weighed 1500-2499 g, and of those who weighed 2500 g or more at birth. The children in the sample were traced through the National Health Service Central Register (NHSCR) and self-administered questionnaires were sent to their parents, general practitioners (GP) and teachers. Of the 1169 children who were alive at the age of 7 years and were successfully traced, 805 (75%) were followed up by postal survey. The use of health services, and of additional educational support was higher, and school performance was poorer among children who had weighed less than 1500 g at birth than among children who had weighed 2500 g or more, with the rates for children who had weighed 1500-2499 g falling in between. This survey method identifies the higher rate of health and educational problems in children weighing under 2500 g at birth, particularly those with birthweight under 1500 g, compared with other children. The method could be developed to provide a way of monitoring any changes over time in the prevalence of these problems. This information can be used to assess the health and educational needs of 7-year-old children in the population.

Time series migration in Britain: the context for 1991 census analysis.

"An administrative register, the National Health Service Central Register (NHSCR), is used by the Census Office (OPCS) to produce counts of NHS patients re-registering in different Family Health Service Authorities (FHSAs) in England and Wales. These movement data can be used to establish how unique or typical the migration occurring in the year prior to the Census was in relation to that for the whole decade. This paper examines national, regional and local examples of the information that can be extracted from a database system called TIMMIG that provides access to an NHSCR migration time series and a parallel series of mid-year population estimates. In advance of the publication of Special Migration Statistics, a preliminary comparison is made between the levels of in-migration to FHSA areas recorded in the NHSCR and in the 1991 Census."

Late mortality in elderly patients surviving acute peptic ulcer bleeding.

Acute peptic ulcer bleeding is associated with a substantial short term mortality but it is generally assumed that in the modern era of effective medical treatment the longer term prognosis is good. This study evaluated 487 patients aged over 60 years who were discharged from Nottingham University and City Hospitals after admission for acute peptic ulcer bleeding during 1986-91 and 480 age and sex matched community controls. Follow up information was obtained from hospital and general practitioner records and from the National Health Service central register. Mortality was compared with control mortality and with rates expected for England and Wales. During a mean follow up of 34 months 142 (29%) of 487 patients died compared with 58 (12%) of 480 community controls and with 81.5 deaths expected (observed/expected (O/E) = 1.74, 95% confidence limits (CL) 1.5 to 2.1). Six years after admission the actuarial survival estimate was only 50% for ulcer patients compared with 76% for community controls and 69% expected. The increased mortality was similar in men and women and was greatest in the 60-74 year age group. Much of the excess mortality was accounted for by deaths from cancer (O/E 34/19.7 = 1.73; CL 1.2 to 2.4), from respiratory disease (O/E 28/10.9 = 2.57; CL 1.7 to 3.7), and in men from vascular disease (O/E 31/22.4 = 1.38; CL 0.9 to 2.0). Eight deaths resulted from recurrent ulcer complications and four deaths from gastric cancers undetected at the index admission. In conclusion, patients discharged after peptic ulcer bleeding had a substantially reduced life expectancy. The increased mortality was predominantly due to a variety of smoking related diseases rather than recurrent peptic ulcer complications. Deaths from recurrent peptic ulcer complications were infrequent and were less than reported in earlier years possibly reflecting prolonged and widespread used of H2 receptor antagonists.

Age and inter-county net migration in Great Britain

The net migration patterns of four age groups are analysed using National Health Service Central Register (NHSCR) inter-county migration data for the periods 1987/88 and 1990/91. Age is shown to have an important bearing upon the relative importance of various determinants of migration. The effect of the movement from national boom to deep recession is also commented upon.

Mortality of butchers and cooks identified from the 1961 census of England and Wales.

To explore a suspected hazard of lung cancer in butchers and cooks. 4018 male butchers and 2062 male cooks were identified from the 1961 census of England and Wales. 4857 (79.9%) of these men were traced through the National Health Service Central Register, and 3518 deaths were recorded during follow up to the end of 1992. Mortality from lung cancer and other causes was compared with that of the general population by the person-years method. Mortality from all causes was significantly below that of the national population in both butchers (standardized mortality ratio (SMR) 0.94, 95% confidence interval (95% CI) 0.90-0.98) and cooks (SMR 0.89, 95% CI 0.84-0.95). When allowance was made for a latency of 20 years from entry to follow up, the deficit in butchers was reduced, but that in cooks persisted, and was largely explained by a shortfall of deaths from cancer and circulatory disease. Mortality from lung cancer was close to expectation in the butchers (SMR 1.01, 95% CI 0.90-1.13) and below expectation in the cooks (SMR 0.93, 95% CI 0.75-1.13). Cooks had increased mortality from cancers of the oral cavity (SMR 5.57) and pharynx (SMR 2.66). The findings provide no support for an occupational hazard of lung cancer in either butchers or cooks. The possibility of excess risk in sub-groups of these occupations cannot be discounted. The high rates of oral and pharyngeal cancer in cooks are probably a consequence of high alcohol consumption.