Patient Episode Database For Wales Research Articles

Postprocedural Disorders of Eye and Adnexa Admissions Profile.

The aim of this study was to examine hospitalisation profiles related to postprocedural disorders of eye and adnexa in England and Wales. This was an ecological study using publicly available data extracted from the "Hospital Episode Statistics (HES) database" in England and the "Patient Episode Database for Wales (PEDW)" for the period between April 1999 and April 2020. Diagnostic code for postprocedural disorders of eye and adnexa (H59) was used to identify hospital admission. We used the chi-squared test to assess the difference between the hospital admission rates between 1999 and 2020. Hospital admission rate decreased by 6.3% [from 4.98 (95% CI 4.79-5.17) in 1999 to 4.67 (95% CI 4.50-4.84) in 2020 per 100,000 persons, trend test, p<0.05]. The most common hospital admissions causes were other postprocedural disorders of eye and adnexa "Chorioretinal scars after surgery for detachment." The age group 75 years and above accounted for 44.3% of the total number of admissions. Hospital admission rate among females decreased by 30.2% [from 5.90 (95% CI 5.61-6.19) in 1999 to 4.12 (95% CI 3.89-4.35) in 2020 per 100,000 persons]. Hospital admission rate among males increased by 30.2% [from 4.02 (95% CI 3.77-4.26) in 1999 to 5.23 (95% CI 4.97-5.49) in 2020 per 100,000 persons]. This study revealed that hospital admission rates for postprocedural disorders of the eye and adnexa decreased over the course of the study period. Eye and adnexa disorders accounted for the preponderance of hospital admissions among the elderly. Further research is required to identify risk factors that can be avoided.

Intraoperative and post-procedural complications and disorders of musculoskeletal system hospitalization profile in England and Wales

ProblemPost-operative complications cause suffering and death among patients who have undergone surgery, increase the length of hospital stay, and thus increase costs, moreover, they reduce the quality of life and life expectancy among patients who have left the hospital. The aim of this study was to explore the trend of hospital admission due to intraoperative and post-procedural complications and disorders of the musculoskeletal system in England and Wales during the past 21 years. MethodsA secular trends study was conducted using hospital admission data extracted from the Hospital Episode Statistics (HES) database in England and the Patient Episode Database for Wales (PEDW) for the period between April 1999 and April 2020. Hospital admissions were identified using the diagnostic code (M96). ResultsBetween 1999 and 2020, a total of 95,783 hospital admission episodes were recorded in England and Wales. Hospital admission rates increased by 6.42-fold [from 3.36 (95% CI 3.20–3.52) in 1999 to 24.92 (95% CI 24.52–25.32) in 2020 per 100,000 persons, p < 0.001]. The most prevalent hospital admissions causes were fracture of bone following insertion of orthopaedic implant, joint prosthesis, or bone plate, pseudarthrosis after fusion or arthrodesis, postlaminectomy syndrome, not elsewhere classified, and other post-procedural musculoskeletal disorders which accounted for 64.3%, 13.8%, 12.3%, and 8.5%, respectively. The age group 75 years and older accounted for 49.1% of the total number of hospital admissions. Females contributed to 62.2% of the total number of hospital admission. Female hospital admissions increased 7.63-fold [from 3.58 (95% CI 3.35–3.80) in 1999 to 30.85 (95% CI 30.23–31.48) in 2020 per 100,000 people]. The male hospital admission rate increased by 4.94 times [from 3.13 (95% CI 2.92–3.35) in 1999 to 18.62 (95% CI 18.13–19.11) in 2020 per 100,000 people]. ConclusionIntraoperative and post-procedural complications and disorders of musculoskeletal system hospital admissions increased in the past 20 years in England and Wales. More efforts should be directed towards reducing the risk of developing intraoperative and post-procedural complications. Elderly patients and females should be given higher emphasis regarding their risk of developing intraoperative and post-procedural complications and disorders of the musculoskeletal system.

Trend of Admissions Due to Chronic Lower Respiratory Diseases: An Ecological Study.

Objective: This study aimed to examine the trend of hospital admissions related to chronic lower respiratory diseases in England and Wales between 1999 and 2020. Method: This ecological analysis used data that were made accessible to the public and were taken from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) databases in England for the time span between April 1999 and April 2020. The patients were grouped into four age groups: under 15, 15−59, 60−74, and 75 years and above. Results: In 2020, there were 432,193 chronic lower respiratory disease hospital admissions, which increased from 239,606 in 1999. The hospital admission rate increased by 57.5% (from 459.54 (95% CI 457.71−461.38) in 1999 to 723.70 (95% CI 721.55−725.85) in 2020 per 100,000 people, p < 0.5). The majority of hospital admissions for chronic lower respiratory diseases were found to be directly linked to age (more prevalent in the 75+ age group). Moreover, female hospital admission rates for chronic lower respiratory diseases grew by 85.2% between 1999 and 2020, increasing from 445.45 (95% CI 442.92−447.97) to 824.96 (95% CI 821.73−828.19) per 100,000 people. Conclusion: The rate of hospital admissions due to chronic lower respiratory diseases has sharply increased during the past two decades. COPD was the most common cause for chronic lower respiratory disease admissions. Ageing was also found to be a factor in increased hospital admissions. Future studies are warranted to identify other risk factors of hospital admissions due to chronic lower respiratory diseases and specifically COPD.

Hospital Admissions Related to Infections and Disorders of the Skin and Subcutaneous Tissue in England and Wales.

Objectives: To investigate hospital admissions in England and Wales due to infections and diseases of the skin and subcutaneous tissue. Methods: Data from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) database in England for the years between April 1999 and April 2020 were used in this study. Using all the relevant diagnosis codes (L00–L99), hospital admissions related to various skin infections and diseases of the subcutaneous tissue were identified. Results: Hospital admissions for all causes increased overall by 78.8%, from 276,464 in 1999 to 494,433 in 2020, representing an increase in hospital admission rate of 56.1% (from 530.23 (95% CI 528.26–532.20) in 1999 to 827.92 (95% CI 825.62–830.22) per 100,000 people in 2020, p ≤ 0.05). The most prevalent diagnoses were disorders of the skin’s appendages, infections of the skin and subcutaneous tissue, and other disorders of the skin and subcutaneous tissue. Nearly half of all hospital admissions were for males and for patients between the ages of 15 and 59. In 2020, the hospital admission rate for males increased by 60.2%, from 540.16 (95% CI 537.32–543.01) per 100,000 people in 1999 to 865.10 (95% CI 861.76–868.44) in 2020. From 520.75 (95% CI 518.02–523.48) in 1999 to 791.03 (95% CI 787.86–794.19) in 2020, the hospital admission rate for females grew by 51.9%. Conclusion: Hospital admission due to infections and disorders of the skin and subcutaneous tissue increased during the past two decades in England and Wales. Further studies are needed to explore the risk factors associated with infections and disorders of the skin and subcutaneous tissue complications, and its associated admissions.

Hospital admissions due to vasomotor and allergic rhinitis in England and Wales between 1999 and 2019: an ecological study.

Allergic rhinitis is among the most prevalent chronic disorders in high-income countries. Its estimated cost is €30-€50 billion annually in the European Union and in the UK, it is approximately €1.8 billion per year. To study hospital admissions for vasomotor and allergic rhinitis in England and Wales during the past 20years. This was an ecological study using publicly available data extracted from the Hospital Episode Statistics (HES) database in England and the Patient Episode Database for Wales (PEDW). The trend in hospital admissions was assessed using a Poisson model. Admission rate increased by 2.14-fold [from 2.59 (95% CI 2.46-2.73) in 1999 to 8.16 (95% CI 7.93-8.39) in 2020 per 100,000 persons, trend test, p < 001]. The most prevalent hospital admission reasons were allergic rhinitis due to pollen, other allergic rhinitis, and unspecified allergic rhinitis, which accounted for 56.4%, 22.3%, and 15.7%, respectively. The age group 15-59years accounted for 69.5% of the total number of admissions. Admission rate between males increased by 2.25-fold. Admission rate between females increased by 2.02-fold. Vasomotor and allergic rhinitis are common cause of hospital admissions in England and Wales that showed a clear increase in the rate of their admissions in the past 20years. Allergic rhinitis due to pollen was the most dominant cause of admission, which warrants further investigation to identify its preventable risk factors and decrease the probability of the exacerbation of patients' cases and the need for hospitalization.

The association between immunosuppression and skin cancer in solid organ transplant recipients: a control-matched cohort study of 2,852 patients.

Skin cancer is more common in transplant recipients, although the quoted incidence is variable. This study investigated the incidence of skin cancer in solid organ transplant recipients (OTRs) in a national cohort and the effect of pharmacotherapeutic agents Transplant patients were identified from Patient Episode Database for Wales (PEDW) using Office of Population Census and Surveys Classifications of Interventions and Procedures-4 (OPCS-4) codes. Controls were matched to cases according to age, sex and socioeconomic status. Skin cancer data were obtained from linkage with other national data sources. Incidence was calculated per 100,000 person-years at risk (PYAR). Negative binomial regression was used to calculate adjusted incidence rate ratios (IRRs) for each organ type. During 2000-2018, 2,852 Welsh patients underwent solid organ transplantation. A total of 13,527 controls were matched from the general population. The incidence of skin cancer within the OTR cohort was 1203.2 per 100,000 PYAR vs 133.9 in the matched control group. Age, male gender and azathioprine use were all associated with an increased risk of skin cancer. Contemporary immunomodulators such as tacrolimus and mycophenolate were associated with a reduction in skin cancer risk when compared to their predecessors, cyclosporin and azathioprine. The highest adjusted IRR was observed in heart transplant recipients (IRR: 10.82; 95%CI: 3.64-32.19) and the lowest in liver transplant recipients (IRR: 2.86; 95%CI: 1.15-7.13). This study highlights the need for long-term routine skin cancer surveillance for all OTRs and the importance of using contemporary immunomodulators, when possible, for risk reduction.

PREDICTION OF MAJOR CARDIOVASCULAR AND CEREBROVASCULAR OUTCOMES FOR OLDER PEOPLE WITH HYPERTENSION AND FRAILTY: LINKED PRIMARY CARE ELECTRONIC HEALTH RECORDS COHORT STUDY

Objective: For older people, the association of blood pressure (BP) with cardiovascular outcomes may vary according to the degree of frailty. We investigated whether frailty improved the prediction of major adverse cardiovascular or cerebrovascular events (MACCE) among older people with hypertension treated for primary prevention. Design and method: Retrospective cohort study using population-scale electronic health record data from the Welsh Secure Anonymised Information Linkage (SAIL) databank, linked to hospital outcomes from Patient Episode Database for Wales (PEDW), and death outcomes from Office for National Statistics. Inclusion criteria were age &gt; 65 years, BP recorded in primary care in 2007, and diagnosis of hypertension. Exclusion criteria were established cardiovascular disease (stroke, myocardial infarction or heart failure). We extracted the minimum BP measurement on the day the patient first attended primary care in 2007, and BP-lowering treatment over one year prior. Cardiovascular risk was measured using QRISK-3, and frailty using the electronic frailty index (eFI). Time-to-event analysis measured first ever MACCE (stroke, myocardial infarction, heart failure or cardiovascular death) through 10-years follow-up. Results: The analytic cohort comprised 145,598 patients, registered in 502 general practices. The mean age was 75-years (SD 7); 62% were female; 17% were in the most deprived Townsend quintile. Using the QRISK-3 cardiovascular risk score, 29% (IQR 21 – 39) were predicted to suffer coronary heart disease or stroke over 10-years. The unadjusted risks for MACCE were all increased with increasing severity of frailty (Figure). Compared with robust participants, living with frailty was associated with significantly higher MACCE events despite adjustment for known cardiovascular risk factors (increased risk of 38% in mild frailty, 84% in moderate frailty and 117% in severe frailty). The addition of frailty to a model that was already adjusted for cardiovascular risk factors and BP-lowering treatment improved measures of model fit (AIC reduced from 248,829 to 247,409; BIC reduced from 249,023 to 247,579). Conclusions: Our study provides population-based evidence that the degree of frailty is a useful prognostic factor in older people who are at high risk of cardiovascular outcomes in the management of hypertension.

Assessing the health impacts of adults’ participation in sports: investigating the role of accessibility to sport facilities

The health benefits of individual and group participation in sports are well-known. While a positive association between participation in sport and self-assessed health has been reported for England and Scotland, research has been limited in Wales. In addition, research examining the relationship between levels of physical activity and the accessibility of sport facilities give inconsistent findings.&#x0D; This research project proposes to explore the potential association between the accessibility of sports facilities, sport participation and health. In particular, we will examine whether:&#x0D; &#x0D; Accessibility to sport facilities contributes to participation in sporting activities.&#x0D; Sports participation mediates the association between accessibility to sport facilities and health outcomes (as recorded in routine-health-records).&#x0D; The association between participation in sports and health is independent of individual characteristics such as gender, socio-economic characteristics.&#x0D; &#x0D; The data-sets used were: the Welsh Demographic Service Data (WDSD), the Patient Episode Database for Wales (PEDW), the Sport Wales Active Adults Survey (AAS) and Enhanced Recreational Database (ERD). Accessibility measures were derived from the SWERD, while the Charlson Comorbidity Index (CCI) was estimated as an indicator of general health based on PEDW data. The AAS was then linked to PEDW and the ERD. Appropriate regression analysis was applied based on the type of outcome explored.&#x0D; Preliminary results showed that 72% of the adults participated in sports in the 4 weeks prior to interview and 39% of them participated 3 or more times. Accessibility to sport facilities was significantly associated with outdoor sport activities rather than indoor activities. Distance to a sports hall was significantly associated with sport participation. Adults with a chronic condition based on CCI were less likely to participate in sports. The study provided a unique opportunity to explore the benefits of analysing linked administrative and survey data, therefore contributing to current research on sport participation/accessibility and health.

Characteristics and patient pathways of Lyme disease patients: a retrospective analysis of hospital episode data in England and Wales (1998\u20132015)

BackgroundLyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways.MethodsData from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population.ResultsWithin HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population.ConclusionsThese data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.

Mild-to-moderate renal pelvis dilatation identified during pregnancy and hospital admissions in childhood: An electronic birth cohort study in Wales, UK.

BackgroundChronic kidney disease (CKD) is a growing contributor to the global burden of noncommunicable diseases. Early diagnosis and treatment can reduce the severity of kidney damage and the need for dialysis or transplantation. It is not known whether mild-to-moderate renal pelvis dilatation (RPD) identified at 18–20 weeks gestation is an early indicator of renal pathology. The aim of this follow-up to the Welsh Study of Mothers and Babies was to assess the risk of hospital admission in children with mild-to-moderate antenatal RPD compared with children without this finding. We also examined how the natural history of the RPD (whether the dilatation persists in later pregnancy or postpartum) or its characteristics (unilateral versus bilateral) changed the risk of hospital admission.Methods/FindingsThis population-based cohort study included singleton babies born in Wales between January 1, 2009, and December 31, 2011 (n = 22,045). We linked ultrasound scan data to routinely available data on hospital admissions from the Patient Episode Database for Wales (PEDW). The outcome was a hospital admission for urinary tract causes (defined by an expert study steering group) in the first three years of life. We used Cox regression to model time to first hospital admission, according to whether there was evidence of RPD at the fetal anomaly scan (FAS) and/or evidence of dilatation in later investigations, adjusting for other predictors of admission. We used multiple imputation with chained equations to impute values for missing data. We included 21,239 children in the analysis. The risk of at least one hospital admission was seven times greater in those with RPD (n = 138) compared with those without (n = 21,101, conditional hazard ratio [cHR] 7.23, 95% confidence interval [CI] 4.31–12.15, p < 0.001). The risk of hospital admission was higher in children with RPD at the FAS and later dilatation (cHR 25.13, 95% CI 13.26–47.64, p < 0.001) and in children without RPD at the FAS who had later dilatation (cHR 62.06, 95% CI 41.10–93.71, p < 0.001) than in children without RPD (n = 21,057). Among children with RPD at the FAS but no dilatation in later pregnancy or postpartum, we did not find an association with hospital admissions (cHR 2.16, 95% CI 0.69–6.75, p = 0.185), except when the initial dilatation was bilateral (cHR 4.77, 95% CI 1.17–19.47, p = 0.029). Limitations of the study include small numbers in subgroups (meaning that these results should be interpreted with caution), that less severe outcomes (such as urinary tract infections [UTIs] managed in the community or in outpatients) could not be included in our analysis, and that obtaining records of radiological investigations later in pregnancy and postpartum was challenging. Our conclusions were consistent after conducting sensitivity analyses to account for some of these limitations.ConclusionsIn this large population-based study, children with RPD at the FAS had higher rates of hospital admissions when there was persistent dilatation in later pregnancy or postpartum. Our results can be used to improve counselling of parents and develop care pathways for antenatal screening programmes, including protocols for reporting and further investigation of RPD.

Feasibility of identifying important changes in care management resulting from cardiovascular magnetic resonance (CMR) using hospital episode data in patients who activate the primary percutaneous coronary intervention (PPCI) pathway

BackgroundWe determined whether it is feasible to identify important changes in care management resulting from cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway from hospital episode data, in order to construct a composite primary outcome (hypothesised to reduce the risk of major adverse cardiac-related events, MACE) to compare patients exposed to CMR or not.MethodsWe used Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW) to identify clinical events that reflected important changes in management in the year following the index admission in five subgroups of patients who activated the PPCI pathway recruited as part of a feasibility cohort study (n = 1655 with HES/PEDW data). For all subgroups, we identified frequency of events and time to the first event for each change in management.ResultsWe identified all clinical events (new diagnoses, additional diagnostic tests and procedures) except for medication prescriptions. Diagnostic tests were underestimated because most are carried out in outpatient clinics and outpatient datasets had missing procedure codes for 74% of patients (some tests done in hospital may also not be recorded). We successfully tabulated frequencies of events and distributions of times to first event for most changes in management by CMR status and in CMR / non CMR centres.ConclusionsIt is feasible to identify changes in care management between patients who have / do not have CMR within relevant patient subgroups. Further work to derive a weighting algorithm is required before attempting to combine the events in a composite endpoint.

The use of multi-sourced linked datasets in evaluating the Emergency Medical Retrieval and Transfer Service (EMRTS) CYMRU

ABSTRACT&#x0D; ObjectivesEMRTS launched in April 2015 which saw consultants join critical care practitioners on air ambulance missions and emergency response vehicles. EMRTS delivers pre hospital, Emergency Department equivalent critical care for people in Wales with life or limb threatening injuries or illness from scene to definitive care. The evaluation will compare patients treated by EMRTS to cases both pre-EMRTs and EMRTS-offline (at night or bad weather) in improving survival and functional and quality of life outcomes.&#x0D; ApproachThe evaluation will require the use of multiple datasets to follow patients from time of incident, throughout hospital care and to calculate post care health status. Electronic reporting forms will be used to measure incident details, patient vitals and all treatments/procedures pre hospital, creating the EMRTS dataset and cohort. Patients’ data will be linked to the Emergency Department Dataset (EDDS), Patient Episode Database for Wales (PEDW), Critical Care dataset, Trauma Audit and Research Network (TARN) and Intensive Care National Audit and Research Centre (ICNARC). TARN and ICNARC will provide data on patients transferred to English specialist care facilities.&#x0D; ONS (Office of National Statistics) and WDS (Welsh Demographic Service) data will be used for demographic and survival analysis.&#x0D; GIS techniques will be used on WAST (Welsh Ambulance Service Trust) data for time saved analysis in transferring patients to definitive care.&#x0D; Following discharge from hospital patients will be interviewed six months and one-year post incident for longer-term functional and quality of life outcomes.&#x0D; ResultsDatasets are currently being assembled for the service evaluation. Data will be encrypted and anonymized through NWIS (NHS Wales Informatics Service) to enable research through the Secure Anonymised Information Linkage (SAIL) facility. Results will include rate of survival, effect on length of hospital stay, time to definitive care, the use and appropriateness of EMRTs specific interventions and functional and quality of life outcomes.&#x0D; ConclusionsTo allow for data collection the service evaluation is still in the early stages and will be compared with local and international data.

Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales.

ObjectivesTo investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission.DesignDatabase analysis of 7 years’ hospital admissions using the Patient Episode Database for Wales (PEDW).Setting and participantsWales, UK, successive annual populations ∼2.8 million aged 0–74 years.Primary outcomeThe first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position.ResultsA total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18–19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10–14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages.ConclusionsDespite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of admission for violence are discussed.

Severe symptomatic aortic stenosis: medical therapy and transcatheter aortic valve implantation (TAVI)—a real-world retrospective cohort analysis of outcomes and cost-effectiveness using national data

ObjectivesDetermine the real-world difference between 2 groups of patients with severe aortic stenosis and similar baseline comorbidities: surgical turn down (STD) patients, who were managed medically prior to the availability...

Change in alcohol outlet density and alcohol-related harm to population health (CHALICE): a comprehensive record-linked database study in Wales

BackgroundExcess alcohol consumption has serious adverse effects on health and results in violence-related harm.ObjectiveThis study investigated the impact of change in community alcohol availability on alcohol consumption and alcohol-related harms to health, assessing the effect of population migration and small-area deprivation.DesignA natural experiment of change in alcohol outlet density between 2006 and 2011 measured at census Lower Layer Super Output Area level using observational record-linked data.SettingWales, UK; population of 2.5 million aged ≥ 16 years.Outcome measuresAlcohol consumption, alcohol-related hospital admissions, accident and emergency (A&amp;E) department attendances from midnight to 06.00 and violent crime against the person.Data sourcesLicensing Act 2003 [Great Britain.Licensing Act 2003. London: The Stationery Office; 2003. URL:www.legislation.gov.uk/ukpga/2003/17/contents(accessed 8 June 2015)] data on alcohol outlets held by the 22 local authorities in Wales, alcohol consumption data from annual Welsh Health Surveys 2008–12, hospital admission data 2006–11 from the Patient Episode Database for Wales (PEDW) and A&amp;E attendance data 2009–11 were anonymously record linked to the Welsh Demographic Service age–sex register within the Secure Anonymised Information Linkage Databank. A final data source was recorded crime 2008–11 from the four police forces in Wales.MethodsOutlet density was estimated (1) as the number of outlets per capita for the 2006 static population and the per quarterly updated population to assess the impact of population migration and (2) using new methods of network analysis of distances between each household and alcohol outlets within 10 minutes of walking and driving. Alcohol availability was measured by three variables: (1) the previous quarterly value; (2) positive and negative change over the preceding five quarters; and (3) volatility, a measure of absolute quarterly changes during the preceding five quarters. Longitudinal statistical analysis used multilevel Poisson models of consumption and Geographically Weighted Regression (GWR) spatial models of binge drinking, Cox regression models of hospital admissions and A&amp;E attendance and GWR models of violent crime against the person, each as a function of alcohol availability adjusting for confounding variables. The impact on health inequalities was investigated by stratifying models within quintiles of the Welsh Index of Multiple Deprivation.ResultsThe main finding was that change in walking outlet density was associated with alcohol-related harms: consumption, hospital admissions and violent crime against the person each tracked the quarterly changes in outlet density. Alcohol-related A&amp;E attendances were not clinically coded and the association was less conclusive. In general, social deprivation was strongly associated with the outcome measures but did not substantially modify the associations between the outcomes and alcohol availability. We found no evidence for an important effect of population migration.LimitationsLimitations included the absence of any standardised methods of alcohol outlet data collation, processing and validation, and incomplete data on on-sales and off-sales. We were dependent on the quality of clinical coding and administrative records and could not identify alcohol-related attendances in the A&amp;E data set.ConclusionThis complex interdisciplinary study found that important alcohol-related harms were associated with change in alcohol outlet density. Future work recommendations include defining a research standard for recording outlet data and classification of outlet type, the methodological development of residence-based density measures and a health economic analysis of model-predicted harms.FundingThe National Institute for Health Research Public Health Research programme. Additional technical and computing support was provided by the Farr Institute at Swansea University, made possible by the following grant:Centre for the Improvement of Population Health through E-records Research (CIPHER) and Farr Institute capital enhancement. CIPHER and the Farr Institute are funded by Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (grant reference MR/K006525/1).

TCT-183 Repeat Coronary Angiography in Patients with Previously Normal Coronary Arteries

Background: Coronary artery disease (CAD) is a major public and economic health problem. Coronary angiography is a gold standard for diagnosing CAD and is indicated in patients with 61–90% pre-test probability of the disease when the diagnosis cannot be made on clinical grounds alone and when revascularisation is being considered. The natural history of normal coronary angiogram is poorly understood. Objectives: To evaluate the progression of disease in patients with normal coronary angiography and to assess the overall survival and event-free survival from acute myocardial infarction (MI) in these patients. Methods: We interrogated the Central Cardiac Audit Database (CCAD) between November 2005 and December 2013 to identify patients with normal or ‘near-normal’ coronary angiography. Demographic, clinical and angiographic data was recorded. This database was linked with the Patient Episode Database for Wales (PEDW) and the datasets from the Office for National Statistics (for mortality) using the Secure Anonymised Information Linkage (SAIL) databank. This allowed for the extraction of information from all the sources above on the basis of the International Statistical Classification of Diseases (ICD-10) using the Structured Query Language (SQL). Results: Out of over 20,000 patients undergoing coronary angiography between November 2005 and December 2013, 5032 patients had normal coronaries and minor CAD. Of 5032 patients, 136 underwent repeat angiography, with 131 (96.3%) and 5 (3.7%) patients having two and three repeat investigations respectively. Mean time between procedures was 3.3 (±1.82) years. Of those 136 patients, at the median follow up of 6.8 years, no change in disease progression was demonstrated in 108 (79.4%) patients on the follow up studies. In the remaining 28 (20.6%) patients, normal coronaries progressed to minor CAD. No patients progressed beyond minor CAD. Patients with normal coronaries had significant better survival than patients with minor CAD (p 99.5% in both groups at the median of 5 years follow up. (p = 0.09) Conclusions: Normal coronary angiography and minor CAD is unlikely to progress to significant disease at 7 years and the incidence of MI in these patients is rare at 5 years. Therefore, repeating coronary angiography within at least 5 years is not indicated.

118 Repeat Coronary Angiography in Patients with Previously Normal Coronary Arteries

<h3>Background</h3> Coronary artery disease (CAD) is a major public and economic health problem. Coronary angiography is a gold standard for diagnosing CAD and is indicated in patients with 61–90% pre-test probability of the disease when the diagnosis cannot be made on clinical grounds alone and when revascularisation is being considered. The natural history of normal coronary angiogram is poorly understood. <h3>Objectives</h3> To evaluate the progression of disease in patients with normal coronary angiography and to assess the overall survival and event-free survival from acute myocardial infarction (MI) in these patients. <h3>Methods</h3> We interrogated the Central Cardiac Audit Database (CCAD) between November 2005 and December 2013 to identify patients with normal or ‘near-normal’ coronary angiography. Demographic, clinical and angiographic data was recorded. This database was linked with the Patient Episode Database for Wales (PEDW) and the datasets from the Office for National Statistics (for mortality) using the Secure Anonymised Information Linkage (SAIL) databank. This allowed for the extraction of information from all the sources above on the basis of the International Statistical Classification of Diseases (ICD-10) using the Structured Query Language (SQL). <h3>Results</h3> Out of over 20,000 patients undergoing coronary angiography between November 2005 and December 2013, 5032 patients had normal coronaries and minor CAD. Of 5032 patients, 136 underwent repeat angiography, with 131 (96.3%) and 5 (3.7%) patients having two and three repeat investigations respectively. Mean time between procedures was 3.3 (±1.82) years. Of those 136 patients, at the median follow up of 6.8 years, no change in disease progression was demonstrated in 108 (79.4%) patients on the follow up studies. In the remaining 28 (20.6%) patients, normal coronaries progressed to minor CAD. No patients progressed beyond minor CAD. Patients with normal coronaries had significant better survival than patients with minor CAD (p &lt; 0.05), but survival free from MI was &gt;99.5% in both groups at the median of 5 years follow up. (p = 0.09) <h3>Conclusions</h3> Normal coronary angiography and minor CAD is unlikely to progress to significant disease at 7 years and the incidence of MI in these patients is rare at 5 years. Therefore, repeating coronary angiography within at least 5 years is not indicated.

The rise of obstetric anal sphincter injuries (OASIS): 11-year trend analysis using Patient Episode Database for Wales (PEDW) data

The aim of this study was to establish the trend of obstetric anal sphincter injuries (OASIS) in Wales. A retrospective search of Patient Episode Database for Wales (PEDW) data was carried out. Data were available for 11 years from 1999 to 2009. The incidence of OASIS steadily increased from 1.81% in 1991 to 5.62% in 2009 (χ2 for trend p < 0.001), which is more than a three-fold increase. This was observed alongside a significant increase in resort to episiotomy (χ2, p < 0.001) and forceps delivery (χ2, p < 0.001), drop in the use of ventouse delivery (χ2, p < 0.001) as well as increase in caesarean delivery (χ2, p < 0.001) over the same period. This showed the incidence of OASIS in Wales to have risen significantly and steadily over the period 1999–2009. This necessitates a look to identify and deal with the cause(s) of this rise and monitor its future course.

Influence of social deprivation and air pollutants on serious asthma: Table 1–

To the Editors: Asthma is an important disorder worldwide, as a major cause of hospital admissions, medical consultations, prescriptions and impaired quality of life. The precise causes of asthma, although largely unknown, are multifactorial and involve a complex interaction of genetic and environmental factors. Although hospital admission rates are often increased for people in lower socioeconomic groups [1], little has been reported specifically for serious asthma ( i.e. prolonged admissions and/or death within 30 days). Evidence about the effects of air pollutants on the occurrence of serious asthma is also unclear [2]. We aimed to establish the hospital admission rate and case fatality for serious asthma, and whether admissions are associated more strongly with social deprivation or air pollutants. We used medical record linkage of inpatient data from the Patient Episode Database for Wales (PEDW) and mortality data from the National Health Service (NHS) Welsh Administrative Register. PEDW covers inpatient admissions to all NHS hospitals across 22 local health authorities in Wales, UK (population three million) and has been used as the basis of many previous published studies. We included all emergency admissions from April 1, 1999 to March 31, 2007 where asthma (ICD-10 codes J45 and J46) was the principal diagnosis at discharge. Patients of all ages with admissions lasting ≥3 days, or who died (from any cause) within 30 days, were classified as “serious” cases. We included all first “serious” admissions during the study period, and subsequent serious admissions providing they occurred >30 days after the preceding serious admission. We measured social deprivation and its seven domains using the Welsh Index of Multiple Deprivation 2005 [3]. Social deprivation scores were assigned to 1,896 lower super output areas (LSOAs) across Wales (average LSOA population 1,560) [3]. The LSOAs were ranked according to …

Head &amp; neck cancer incidence in Wales 1992‐‐2001

Introduction. There are 12 cancer registries. The process of cancer registration within the United Kingdom is similar. The Welsh Cancer Intelligence &amp; Surveillance Unit (WCISU) has published a report ‘Cancer Incidence in Wales 1992‐‐2001’. Objective. The aim of the study was to validate head and neck section of the report. Material and method. Data of cancer patients travels from the clinical notes through clinical coding to Patient Administration System (PAS) at each Trust, then to the Patient Episode Database for Wales (PEDW), and finally to WCISU. The processed data used for the publication of this report was retrieved from WCISU and was compared to that received from the clinical notes, PAS and PEDW. Results. 12% of the notes examined were inappropriately coded in terms of gross anatomical tumour site. If non‐melanoma skin cancers are included in the definition of Head and Neck Cancer 80% (17\,101) of the patients appear to not be included in the WCISU report. If skin cancer is excluded from the definition 57% (5750) of head and neck cancer patients appear to not be included. Conclusion. The definition of Head &amp; Neck Cancer appears to differ between clinicians and that used in the WCISU report. This difference will create an apparent gross underestimate in the true incidence of Head and Neck cancer in Wales when viewed from a clinical or workload perspective. It appears that this report could not be used for the present and future planning of Head &amp; Neck services in Wales.