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Research article:

Can analyses of electronic patient records be independently and externally validated? Study 2: the Effect of Beta-Adrenoceptor Blocker Therapy on Cancer Survival; a Retrospective Cohort Study

Reference:

David a Springate, Darren M Ashcroft, Evangelos Kontopantelis, Tim Doran, Ronan Ryan, David Reeves(2015) Can analyses of electronic patient records be independently and externally validated? Study 2: the Effect of Beta-Adrenoceptor Blocker Therapy on Cancer Survival; a Retrospective Cohort Study. BMJ Open, doi: 10.1136/bmjopen-2014-007299

Link to fulltext article
Abstract
Objectives To conduct a fully independent and external validation of a research study based on one electronic health record database, using a different database sampling the same population. Design Retrospective cohort analysis of beta-blocker therapy and all-cause mortality in cancer patients. Setting Two UK national primary care databases (PCDs): the Clinical Practice Research Datalink (CPRD) and Doctors’ Independent Network (DIN). Participants CPRD data for 11302 cancer patients compared to published results from DIN for 3462 patients. Study period January 1997 to December 2006. Primary and secondary outcome measures All-cause mortality: overall; by treatment subgroup (betablockers only, beta-blockers plus other blood pressure lowering medicines (BPLM), other BPLMs only); and by cancer-site. Results Using CPRD, beta-blocker use was not associated with mortality (HR=1.03, 95%CI 0.93-1.14, vs patients prescribed other BPLMs only), but in DIN beta-blocker users had significantly higher mortality (HR=1.18, 95%CI 1.04 to 1.33). However, these hazard ratios were not statistically different (p=0.063), but did differ for patients on beta-blockers alone (CPRD=0.94, 95%CI 0.82-1.07; DIN=1.37, 95%CI 1.16-1.61; p<0.001). Results for nine individual cancer sites differed by study, but only significantly for prostate and pancreas cancers. Results were robust under sensitivity analyses, but we could not be certain that mortality was identically defined in both databases. Conclusions We found a complex pattern of similarities and differences between databases. Our finding that overall treatment effect estimates were not statistically different, adds to a growing body of evidence that different UK PCDs produce effect estimates comparable within statistical tolerance. However, some subgroup effects differed significantly and individually the two studies lead to different conclusions regarding the safety of beta-blockers for cancer patients. Single studies based on internally well-validated databases therefore do not guarantee generalisable results, especially for subgroups. In all cases, confirmatory studies using at least one other independent data source are strongly recommended.
Author for correspondence
David Reeves
Email for correspondence
david.reeves@manchester.ac.uk

Code list: smoking_status

151 codes in list

Code Coding system Description Entity type List name smoking_status cessation_advice
137..00 Read Tobacco consumption observation smoking_status NA 0
1371.00 Read Never smoked tobacco observation smoking_status 0 0
137..11 Read Smoker - amount smoked observation smoking_status 2 0
1371.11 Read Non-smoker observation smoking_status 0 0
1372.00 Read Trivial smoker - < 1 cig/day observation smoking_status 2 0
1372.11 Read Occasional smoker observation smoking_status 2 0
1373.00 Read Light smoker - 1-9 cigs/day observation smoking_status 2 0
1374.00 Read Moderate smoker - 10-19 cigs/d observation smoking_status 2 0
1375.00 Read Heavy smoker - 20-39 cigs/day observation smoking_status 2 0
1376.00 Read Very heavy smoker - 40+cigs/d observation smoking_status 2 0
1377.00 Read Ex-trivial smoker (<1/day) observation smoking_status 1 0
1378.00 Read Ex-light smoker (1-9/day) observation smoking_status 1 0
1379.00 Read Ex-moderate smoker (10-19/day) observation smoking_status 1 0
137a.00 Read Pipe tobacco consumption observation smoking_status 2 0
137A.00 Read Ex-heavy smoker (20-39/day) observation smoking_status 1 0
137b.00 Read Ready to stop smoking observation smoking_status 2 0
137B.00 Read Ex-very heavy smoker (40+/day) observation smoking_status 1 0
137c.00 Read Thinking about stopping smoking observation smoking_status 2 0
137C.00 Read Keeps trying to stop smoking observation smoking_status 2 0
137d.00 Read Not interested in stopping smoking observation smoking_status 2 0
137D.00 Read Admitted tobacco cons untrue ? observation smoking_status 2 0
137e.00 Read Smoking restarted observation smoking_status 2 0
137E.00 Read Tobacco consumption unknown observation smoking_status NA 0
137f.00 Read Reason for restarting smoking observation smoking_status 2 0
137F.00 Read Ex-smoker - amount unknown observation smoking_status 1 0
137g.00 Read Cigarette pack-years observation smoking_status NA 0
137G.00 Read Trying to give up smoking observation smoking_status 2 0
137h.00 Read Minutes from waking to first tobacco consumption observation smoking_status 2 0
137H.00 Read Pipe smoker observation smoking_status 2 0
137I.00 Read Passive smoker observation smoking_status NA 0
137J.00 Read Cigar smoker observation smoking_status 2 0
137K.00 Read Stopped smoking observation smoking_status 1 0
137L.00 Read Current non-smoker observation smoking_status 1 0
137M.00 Read Rolls own cigarettes observation smoking_status 2 0
137N.00 Read Ex pipe smoker observation smoking_status 1 0
137O.00 Read Ex cigar smoker observation smoking_status 1 0
137P.00 Read Cigarette smoker observation smoking_status 2 0
137P.11 Read Smoker observation smoking_status 2 0
137Q.00 Read Smoking started observation smoking_status 2 0
137Q.11 Read Smoking restarted observation smoking_status 2 0
137R.00 Read Current smoker observation smoking_status 2 0
137S.00 Read Ex smoker observation smoking_status 1 0
137T.00 Read Date ceased smoking observation smoking_status 1 0
137U.00 Read Not a passive smoker observation smoking_status NA 0
137V.00 Read Smoking reduced observation smoking_status 2 0
137W.00 Read Chews tobacco observation smoking_status NA 0
137X.00 Read Cigarette consumption observation smoking_status 2 0
137Y.00 Read Cigar consumption observation smoking_status 2 0
137Z.00 Read Tobacco consumption NOS observation smoking_status 2 0
13cA.00 Read Smokes drugs observation smoking_status NA 0
13p..00 Read Smoking cessation milestones observation smoking_status NA 1
13p0.00 Read Negotiated date for cessation of smoking observation smoking_status NA 1
13p1.00 Read Smoking status at 4 weeks observation smoking_status NA 1
13p2.00 Read Smoking status between 4 and 52 weeks observation smoking_status NA 1
13p3.00 Read Smoking status at 52 weeks observation smoking_status NA 1
13p4.00 Read Smoking free weeks observation smoking_status NA 1
13p5.00 Read Smoking cessation programme start date observation smoking_status NA 1
13WF.00 Read Family smoking history observation smoking_status NA 0
13WF100 Read Father smokes observation smoking_status NA 0
13WF.11 Read Smoker in the family observation smoking_status NA 0
13WF200 Read Mother smokes observation smoking_status NA 0
13WF300 Read Both parents smoke observation smoking_status NA 0
13WF400 Read Passive smoking risk observation smoking_status NA 0
13WI.00 Read Parents do not smoke observation smoking_status NA 0
13WK.00 Read No smokers in the household observation smoking_status NA 0
177..00 Read Smoke inhalation observation smoking_status NA 0
6791.00 Read Health ed. - smoking observation smoking_status NA 1
67A3.00 Read Pregnancy smoking advice observation smoking_status NA 1
67H1.00 Read Lifestyle advice regarding smoking observation smoking_status NA 1
745H.00 Read Smoking cessation therapy observation smoking_status NA 1
745H000 Read Nicotine replacement therapy using nicotine patches observation smoking_status NA 1
745H100 Read Nicotine replacement therapy using nicotine gum observation smoking_status NA 1
745H200 Read Nicotine replacement therapy using nicotine inhalator observation smoking_status NA 1
745H300 Read Nicotine replacement therapy using nicotine lozenges observation smoking_status NA 1
8B2B.00 Read Nicotine replacement therapy observation smoking_status NA 1
8B3f.00 Read Nicotine replacement therapy provided free observation smoking_status NA 1
8B3Y.00 Read Over the counter nicotine replacement therapy observation smoking_status NA 1
8BP3.00 Read Nicotine replacement therapy provided by community pharmacis observation smoking_status NA 1
8CAg.00 Read Smoking cessation advice provided by community pharmacist observation smoking_status NA 1
8CAL.00 Read Smoking cessation advice observation smoking_status NA 1
8H7i.00 Read Referral to smoking cessation advisor observation smoking_status NA 1
8HTK.00 Read Referral to stop-smoking clinic observation smoking_status NA 1
8I2I.00 Read Nicotine replacement therapy contraindicated observation smoking_status NA 0
8I39.00 Read Nicotine replacement therapy refused observation smoking_status NA 0
8I6H.00 Read Smoking review not indicated observation smoking_status NA 0
9hG..00 Read Exception reporting: smoking quality indicators observation smoking_status NA 0
9hG0.00 Read Excepted from smoking quality indicators: Patient unsuitable observation smoking_status NA 0
9hG1.00 Read Excepted from smoking quality indicators: Informed dissent observation smoking_status NA 0
9N2k.00 Read Seen by smoking cessation advisor observation smoking_status NA 1
9N4M.00 Read DNA - Did not attend smoking cessation clinic observation smoking_status NA 1
9OO..00 Read Anti-smoking monitoring admin. observation smoking_status NA 1
9OO1.00 Read Attends stop smoking monitor. observation smoking_status NA 1
9OO..11 Read Stop smoking clinic admin. observation smoking_status NA 1
9OO..12 Read Stop smoking monitoring admin. observation smoking_status NA 1
9OO2.00 Read Refuses stop smoking monitor observation smoking_status NA 1
9OO3.00 Read Stop smoking monitor default observation smoking_status NA 1
9OO4.00 Read Stop smoking monitor 1st lettr observation smoking_status NA 1
9OO5.00 Read Stop smoking monitor 2nd lettr observation smoking_status NA 1
9OO6.00 Read Stop smoking monitor 3rd lettr observation smoking_status NA 1
9OO7.00 Read Stop smoking monitor verb.inv. observation smoking_status NA 1
9OO8.00 Read Stop smoking monitor phone inv observation smoking_status NA 1
9OO9.00 Read Stop smoking monitoring delete observation smoking_status NA 1
9OOA.00 Read Stop smoking monitor.chck done observation smoking_status NA 1
9OOZ.00 Read Stop smoking monitor admin.NOS observation smoking_status NA 0
H310100 Read Smokers' cough observation smoking_status NA 0
SM7y200 Read Smoke inhalation observation smoking_status NA 0
SM7z.11 Read Smoke inhalation observation smoking_status NA 0
ZG23300 Read Advice on smoking observation smoking_status NA 1
ZRaM.00 Read Motives for smoking scale observation smoking_status NA 1
ZRh4.00 Read Reasons for smoking scale observation smoking_status NA 1
ZRh4.11 Read RFS - Reasons for smoking scale observation smoking_status NA 1
5020M OXMIS SMOKERS' THROAT observation smoking_status NA 0
5287MK OXMIS SMOKERS' MOUTH PATCHES observation smoking_status NA 0
9879MK OXMIS SMOKE INHALATION observation smoking_status NA 0
L5090B OXMIS PARENTS BOTH SMOKE observation smoking_status NA 0
L5091S OXMIS SMOKING STARTED observation smoking_status NA 1
T509 OXMIS SMOKER observation smoking_status 2 0
T5090OR OXMIS SMOKER OWN ROLLED observation smoking_status 2 0
T5090XC OXMIS SMOKER CIGARETTES observation smoking_status 2 0
T5091 OXMIS STOPPED SMOKING observation smoking_status 1 0
T5091ES OXMIS FORMER SMOKER observation smoking_status 1 0
T5091HS OXMIS EX HEAVY SMOKER observation smoking_status 1 0
T5092 OXMIS SMOKING ADVISED TO STOP observation smoking_status 2 1
T5092S OXMIS SMOKING WISHES TO STOP observation smoking_status 2 0
T5092SA OXMIS SMOKING WANTS TO STOP observation smoking_status 2 0
T5093 OXMIS SMOKER NON observation smoking_status 1 0
T5093N OXMIS SMOKED NEVER observation smoking_status 0 0
T5094F OXMIS SMOKER IN FAMILY observation smoking_status NA 0
T5094FS OXMIS FATHER SMOKES observation smoking_status NA 0
T5094MS OXMIS MOTHER SMOKES observation smoking_status NA 0
T5094PR OXMIS PASSIVE SMOKING RISK observation smoking_status NA 0
T509 SR OXMIS SMOKING RESTARTED observation smoking_status 2 0
T510 OXMIS EXCESSIVE SMOKING observation smoking_status 2 0
T510 HS OXMIS HEAVY SMOKER (20-PLUS PER DAY) observation smoking_status 2 0
T510 SE OXMIS SMOKING EXCESSIVE observation smoking_status 2 0
T510 SH OXMIS SMOKER HEAVY (20-PLUS PER DAY) observation smoking_status 2 0
T511 OXMIS SMOKER MODERATE (LESS THAN 20 PER DAY) observation smoking_status 2 0
T5112 OXMIS SMOKER (20 PER DAY) observation smoking_status 2 0
T5113 OXMIS SMOKER (15 PER DAY) observation smoking_status 2 0
T5114 OXMIS SMOKER (10 PER DAY) observation smoking_status 2 0
T5115 OXMIS SMOKER (LESS THAN 10 PER DAY) observation smoking_status 2 0
T5115M OXMIS SMOKER MILD (5 OR LESS PER DAY) observation smoking_status 2 0
T5116 OXMIS SMOKER(OCCASIONAL) observation smoking_status 2 0
T5117 OXMIS SMOKER (30 PER DAY) observation smoking_status 2 0
T512 OXMIS SMOKER PIPE observation smoking_status 2 0
T513 OXMIS SMOKER CIGARS observation smoking_status 2 0
Y0601JJ OXMIS CLINIC ANTI-SMOKING ATTENDANCE observation smoking_status NA 1
Y0601KA OXMIS SMOKING CLINIC ATTENDANCE observation smoking_status NA 1
Y060 J1 OXMIS STOP SMOKING GROUP observation smoking_status NA 1
Y060 JJ OXMIS CLINIC ANTI-SMOKING observation smoking_status NA 1
Y060 KA OXMIS SMOKING CLINIC observation smoking_status NA 1

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