The George Institute For Global Health
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Big Data in Healthcare

Missed opportunities in healthcare delivery

The key risk factors for cardiovascular disease (CVD) are well established, as are effective treatments involving blood pressure, cholesterol and glucose lowering. Yet CVD remains a leading cause of death and disability across the world, even in countries, such as the UK, where treatments are affordable to the vast majority.

This project will seek to uncover the extent of missed opportunities in health care delivery, with a focus on CVD. We plan to use data from CPRD, and other sources, to study – in the real world - how many patients are treated according to guidelines over time in England and Wales. This will include analyzing changes subsequent to new guidelines, in terms of health provision and disease outcomes. We will identify the characteristics of those who are undertreated over a range of clinical pathways. Our study team will include experienced clinicians both inside and outside Oxford.

 

Diabetes

Diabetes is a huge blight on the world’s health. Many data have been collected and many papers on the subject have been published, but few have attempted to pull the results together, in order to make better sense of the findings and produce reliable estimates of the associations with new diabetes and of the consequences of diabetes. Furthermore, little is known about how different types of excess body fat (e.g. central or general) affect diabetes or the likely optimum value of glucose to balance the risks of future CVD and hypoglycaemia.

In partnership with Johns Hopkins University in the US, we have thus instigated the Diabetes Mellitus – Prognosis Consortium which aims to pool results from all available prospective studies across the world. This collaboration is expected to run for several years, dependent on funding, with at least annual meetings of partners. We expect to publish on a range of sub-projects each year, according to a research plan which will be approved by all collaborators.

 

Chronic kidney disease

Although a common cause of death and disability, kidney disease is relatively understudied compared with other leading non-communicable diseases. Only recently has it been established that kidney function is an independent risk factor for CVD, and that the stages of kidney disease are more complex than originally thought. Several questions remain unanswered regarding such things as the role of excess weight in the progression to end-stage kidney disease and ethnic and socio-economic differences in the effects of risk factors.

This project will use existing data from the UK and Kadoori China biobanks and CPRD to investigate the links between obesity, diabetes, kidney disease and CVD or death. This work will be done in partnership with The Nuffield Department of Primary Care Health Sciences and the Nuffield Department of Population Health at the University of Oxford.

 

Musculoskeletal conditions

Injury is a key contributor to the global burden of disease, yet it is often completely ignored when health is discussed in global forums. The George Institute has a long history of injury research in its Australian office, which has established itself as a world leader in epidemiological and clinical research in this important area. Musculoskeletal conditions are one of the most prevalent types of injury, given that back pain, to give but one example, is so commonly suffered.

This program will seek to use routinely collected health data to study the distribution and determinants of musculoskeletal conditions in the UK and India. This will include elements of ‘missed opportunities’ as regards under-treatment. In addition, we seek to analyze the consequences of such conditions, for instance in relation to incident CVD. We plan to use data from CPRD and the UK Biobank, depending on obtaining access.