GP’s who contribute to the THIN® data panel are helping to inform life-changing medical research. On World Hepatitis Day we take a look at how insights from THIN data are helping us better understand the impact of this disease on our populations’ health.
Hepatitis is one of the leading causes of death globally, killing more people each year than AIDS and malaria combined. In 2016, every government in the world made a commitment to eliminate viral hepatitis by 2030. Yet today, the World Hepatitis Alliance estimates that worldwide 290 million people are unknowingly living with viral hepatitis, which is why the theme of this year’s World Hepatitis Day on 28th July, is “Find the missing millions”.
Undiagnosed and Untreated
Despite the global pledge to eliminate viral hepatitis, the number of deaths is on the increase – with 1.75 million new hepatitis C infections annually. It is estimated that eliminating hepatitis B and hepatitis C by 2030 would prevent approximately 36 million infections and save 10 million lives.
One of the keys to achieving this elimination is through research to help better understand patient pathways and influence improvements in diagnosis and treatment. Our healthcare systems capture huge volumes of data across millions of touchpoints – most notably clinical consultations in Primary Care. Information captured at this crucial intersection between patient and doctor has huge value when it is coded, structured, anonymised and analysed at scale. The Health Improvement Network, THIN® is recognised to offer one of the most reliable and respected sources of primary care data in the world, with a data set so rich that it brings huge value to healthcare organisations, evidenced through over 1,300 peer reviewed scientific publications. Over 850 practices across our 4 nations have contributed to THIN® with approximately 350 practices continuing to contribute today, providing a longitudinal data set comprising 19 million anonymised patient records.
According to analysis of THIN® data, 90,011 patients have a diagnosis of hepatitis*. 55% of these are male, 45% female, with the average age of diagnosis 45 for men and 47 for women. When it comes to vaccinations, however, the gender split is reversed: while 8,338 patients had at least one hepatitis vaccination in 2019, 55% were female.
Increased diagnosis of hepatitis is one of the key actions demanded by the World Hepatitis Alliance, alongside complete birth dose of hepatitis B vaccine and increase in treatment. Delving into the THIN® data reveals 5,344 patients have at least one Hepatitis B Antibody test in THIN® - 63% of these are women; while 32,277 patients have at least one SH-antigen (hepatitis B) test in THIN®, 77% of these are women.
In the UK, alcoholic hepatitis is also common and, again, often unrecognised by sufferers. Analysis of the THIN® database confirms that 62% of active patients with a diagnosis of hepatitis have at least one alcohol measurement in THIN®.
THIN® data also helps us better understand comorbidities, with analysis revealing how hepatitis can also affect other aspects of health. For example, the chronic form of the hepatitis C virus (HCV) has been shown to be a risk factor for the development of both type 1 and type 2 diabetes. Analysis of THIN® data reveals 12% of active patients with a diagnosis of hepatitis also have a diagnosis of diabetes in THIN®. There is also growing awareness of the incidence of both Chronic Obstructive Pulmonary Disease (COPD) and hepatitis, with Brazilian researchers investigating the prevalence of Hepatitis C in patients with COPD, discovering the prevalence of Hepatitis C infection in COPD patients was 7.5%, compared to 0.41% prevalence of Hepatitis C infection in blood donors.
In addition to demonstrating a significantly greater likelihood of Hepatitis C infection in those with COPD than the general blood donation population, this research also revealed that patients with COPD had more severe lung disease when they also were infected with Hepatitis C. These findings are confirmed by data from the THIN® database: 6% of active patients with a diagnosis of hepatitis also have a diagnosis of COPD in THIN®.
Another notable comorbidity for hepatitis is depression - particularly with Hepatitis B, which is transmitted through contact with the blood or other body fluids, such as saliva, semen and vaginal fluid, of an infected person. The Hepatitis B Positive Trust receives significant contact from people fearing ongoing transmission of the virus. Analysis of THIN® data confirms the high incidence of depression: 30% of active patients with a diagnosis of hepatitis also have a diagnosis of depression in THIN®.
Contributing to Improved Health
The World Hepatitis Alliance estimates that annual deaths will drop by 65% and 10 million lives will be saved by 2030 if countries meet a set of prevention and treatment targets. With the pressure facing health services globally as a result of COVID-19, the use of epidemiological health data such as THIN® will play an important role in understanding progress identifying the missing millions with hepatitis, how prevention and treatment are being delivered and the implication on population health.
Primacy Care data is being utilised to inform patient pathways across a range of disease areas and enabling better understanding of local health economies. GPs contributing to THIN® as a panel member have a chance to inform life-changing medical research, supporting research crucial to gaining insights and developing policies, and helping to highlight trends in clinical effectiveness within the NHS. All of this information feeds back to GP practices, ensuring they have the knowledge they need to deliver the best care experience for each patient.
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* Hepatitis includes patients with hepatitis A,B,C,E, hepatitis B with/without hepatitis D, chronic hepatitis and alcoholic hepatitis.