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Big Data: Why Big is Beautiful Jill Pell

Big Data: Why Big is Beautiful Jill Pell. Scotland: a research laboratory. Population - 5.1 M Stable - net migration <10k Devolved health service Vast majority of healthcare from sole provider (NHS) Comprehensive, high quality data

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Big Data: Why Big is Beautiful Jill Pell

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  1. Big Data: Why Big is Beautiful Jill Pell

  2. Scotland: a research laboratory Population - 5.1 M Stable - net migration <10k Devolved health service Vast majority of healthcare from sole provider (NHS) Comprehensive, high quality data Significant investment in health informatics infrastructure, governance and capacity: Farr, ADRC, Urban Big Data Centre

  3. Data, data everywhere ….. Maternity records Breastfeeding Immunisation Growth Cause of death The data “life-cycle” Surgical procedures Development Investigations Screening Hospital admission GP / OPD attendance Medicines

  4. Health Sector Databases

  5. Trials & Cohort Studies • The gold standards • Increasing in number • Low hanging fruit harvested • Increasing in size • Therefore cost increasing Published RCTs per annum

  6. Since 1990, one new cohort per annum • ½ followed up for >20yrs • Includes: • Million Women Study • UK Biobank • £28M pa on the 34 largest, ongoing UK population cohort studies

  7. Using routine data as anadjunct to traditional methods • Increase VFM • Reducing costs • Providing additional information • Selection • Stratification • Exposures, confounders • Follow-up

  8. Randomised controlled trials Long-term follow-up of WOSCoPS All-cause mortality CHD mortality

  9. UK Biobank

  10. Using routine data to conduct studies Systematic review of 98 clinical trials: • 29% of potential subjects excluded by trials • A further 29% refuse to participate Melberg HO, Humphreys K. Ineligibility and refusal to participate in randomised trials of treatments for drug dependence. Drug Alcohol Rev 2010;29(2):193-201.

  11. Natural experiments “Back to sleep” campaign and SIDS Smoke-free legislation and preterm deliveries Smoke-free legislation and stroke: cerebral infarction vs intracerebral haemorrhage

  12. Health Service Research: Hospital volume of throughput and MACE 30 days post PCI Heart 2006;92:1667-72.

  13. Time of delivery and neonatal death

  14. Scottish Veterans Cohort Study • Retrospective cohort study • 57,000 veterans in Scotland born 1945-1985 • 173,000 individuals with no record of military service, matched for age, sex and postcode sector • Service entry/exit flagged on primary care records • Linked to acute/psychiatric hospitalisations, cancer registrations and deaths Peptic ulcer by length of service

  15. Individual and inter-generational linkage

  16. Inter-generational record linkagePregnancy complications and maternal/grandmaternal IHD

  17. New datasets Prescribing Information System (PIS) • Picture Archiving and CommunicaitonsSysem (PACS)

  18. Prescribing Information System (PIS) • Pharmaco-epidemiology; pharmaco-vigilence; precision medicine • Information on medicines prescribed, dispensed and reimbursed • Covers all NHS prescriptions dispensed in the community • Includes prescribed by GP, practice nurse, dentist and hospital • Does not cover hospital prescriptions dispensed in hospital • Covers whole Scottish population (5.2 million) • Includes prescriptions issued in England but dispensed in Scotland • 1993 - set up for budgeting/reimbursement – provided aggregated data • 2009 - achieved 100% CHI coverage – individual level data • Linkable to other databases • Currently (1993-2014) data on: • 507 million medications prescribed • 344 million medications dispensed • InFormation on • Prescriber • Dispenser • Medication – manufacturer, formulation, stregth, dose

  19. Potential uses • Drug as intervention • Outcomes • Clinical / cost effectiveness • Adverse outcomes / ADRs • Precision medicine • Interactions / sub-groups • Health services research • Patterns of usage; health inequalities • Factors associated with uptake/compliance • Drug as proxy of disease

  20. Wider determinants (and outcomes) of health

  21. Individual-level data EDUCATION PENSIONS HOUSING WORK SOCIAL SUPPORT CRIMINAL JUSTICE BENEFITS HEALTH

  22. Aggregated data • Pollution • Climate • Green space • Public transport • Leisure facilities • Tobacco/alcohol/fast-food outlets

  23. Education linkage • Annual pupil census • Record of special education need • Cause • Absenteeism / exclusion • Free school meals • SVQ – exam results • School leaver destination – job, HEI, unemployed

  24. + SMR 1/4/6 Mother SMR2 SMR11 CHS-P/PS SMR 1/4/6 SMR 1/4/6 ScotXeD Child + SCI/DC PIS PIS PIS

  25. Gestation of delivery and SEN Population attributable percentage Prevalence Odds ratio • Gestation overall 10% • Preterm 3.6% • Early term 5.5%

  26. Breech presentation

  27. Month of conception

  28. Results • 774,079 pupils across 2009-2013 • 3,363 (0.43%) pupils treated for diabetes • 46,403 (6.24%) asthma • 5,374 (0.69%) epilepsy • 7,488 (0.97%) ADHD • 5,386 (0.72%) depression

  29. Results - Education

  30. Subgroup analyses - Exclusions

  31. Big Data offers scope for Innovation using new methods to do the same things Innovation “plus” Using new methods to do new things

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