Burden and impact of chronic cough in UK primary care: a dataset analysis.
Burden and impact of chronic cough in UK primary care: a dataset analysis.
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DOI：
10.1136/bmjopen-2021-054832
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发表时间：
2021-12-17
期刊：
影响因子：
2.9
通讯作者：
Levy ML
中科院分区：
文献类型：
--
作者：
Hull JH;Langerman H;Ul-Haq Z;Kamalati T;Lucas A;Levy ML
慢性咳嗽(CC)是一种使人虚弱的呼吸道症状，现在越来越多地被认为是一种独立的疾病实体。这项研究评估了初级保健环境中CC的负担。横断面、回顾性队列研究。发现来自伦敦西北部的数据集，该数据集链接了初级和二级保健的编码数据。指标日期描述CC持续≥8周，并作为CC诊断日期的替代。数据是从2015年1月至2019年9月期间提取的，年龄18岁，咳嗽持续≥8周或咳嗽药物处方的个人。确定了人口统计特征、合并症和服务使用成本，包括进行的调查和开出的治疗。在2例 -109- -430例(2%)队列中，43例 -453例确诊为CC。智商中位数为 岁(41-87岁)。在队列中，31%的人没有记录的合并症，26%的人被诊断为哮喘，17%的人患有慢性阻塞性肺疾病，12%的人患有鼻炎，15%的人患有反流。CC的患病率在女性中较高(57%)，在65-74 年龄范围内最高。在CC诊断指标日之前和之后的12个月内进行的所有检查的次数都有所增加，特别是初级保健胸片和肺活量测定的检查次数分别从6535次增加到12次 880和从5791次增加到8720次。伴随而来的是与CC相关的医疗保健使用成本的增加。在没有相关合并症的情况下，三分之一的人患有CC，这突显了承认CC本身是一种疾病的重要性。在CC指数日期之后的一年中，所有合并症的总门诊费用都增加了，但随着年龄的增加而有显著差异。相关联的初级保健数据集可以更早地发现CC患者，以便进行专科诊所转诊和有针对性的治疗。
Chronic cough (CC) is a debilitating respiratory symptom, now increasingly recognised as a discrete disease entity. This study evaluated the burden of CC in a primary care setting. Cross-sectional, retrospective cohort study. Discover dataset from North West London, which links coded data from primary and secondary care. The index date depicted CC persisting for ≥8 weeks and was taken as a surrogate for date of CC diagnosis. Data were extracted for individuals aged ≥18 years with a cough persisting ≥8 weeks or cough remedy prescription, between Jan 2015 and Sep 2019. Demographic characteristics, comorbidities and service utilisation cost, including investigations performed and treatments prescribed were determined. CC was identified in 43 453 patients from a total cohort of 2 109 430 (2%). Median (IQR) age was 64 years (41–87). Among the cohort, 31% had no recorded comorbidities, 26% had been given a diagnosis of asthma, 17% chronic obstructive pulmonary disease, 12% rhinitis and 15% reflux. Prevalence of CC was greater in women (57%) and highest in the 65–74 year age range. There was an increase in the number of all investigations performed in the 12 months before and after the index date of CC diagnosis, and in particular for primary care chest X-ray and spirometry which increased from 6535 to 12 880 and from 5791 to 8720, respectively. This was accompanied by an increase in CC-associated healthcare utilisation costs. One-third of individuals had CC in the absence of associated comorbidities, highlighting the importance of recognising CC as a condition in its own right. Overall outpatient costs increased in the year after the CC index date for all comorbidities, but varied significantly with age. Linked primary-care datasets may enable earlier detection of individuals with CC for specialist clinic referral and targeted treatment.
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