BMJ Open (Apr 2025)

Replicating a COVID-19 study in a national England database to assess the generalisability of research with regional electronic health record data

  • ,
  • Andrew Thompson,
  • Rui Providência,
  • Matthew Sperrin,
  • Swapna Mandal,
  • Ashley Akbari,
  • James Farrell,
  • Pia Hardelid,
  • Ruth Gilbert,
  • Christopher Tomlinson,
  • John Macleod,
  • Humaira Hussein,
  • Kamlesh Khunti,
  • Naveed Sattar,
  • Antony Palmer,
  • Munir Pirmohamed,
  • Rocco Friebel,
  • Mira Hidajat,
  • Colin Berry,
  • Richard Williams,
  • Johnny Downs,
  • Anthony Khawaja,
  • Cathie Sudlow,
  • Adnan Tufail,
  • Samira Bell,
  • Vahe Nafilyan,
  • Ann John,
  • Anvesha Singh,
  • Kazem Rahimi,
  • Frank Kee,
  • Tim Wilkinson,
  • Shirley Sze,
  • Nick Hall,
  • Hector Chinoy,
  • Elizabeth A Ellins,
  • Gianni Angelini,
  • Massimo Caputo,
  • Serban Stoica,
  • Alan Carson,
  • Dorothea Nitsch,
  • Sarah Steeg,
  • David Osborn,
  • Joseph Firth,
  • Christina Pagel,
  • Harry Hemingway,
  • Mamas Mamas,
  • Julia Hippisley-Cox,
  • Kim Kavanagh,
  • Ronan Lyons,
  • Ernest Wong,
  • Philip Stone,
  • Hayley Evans,
  • Katherine Sleeman,
  • Sebastian Vollmer,
  • Julian Halcox,
  • Dexter Canoy,
  • Mohamed Mohamed,
  • Amar Shah,
  • Ioanna Tzoulaki,
  • Gareth Davies,
  • Athina Spiliopoulou,
  • Anna Hansell,
  • Emanuele Di Angelantonio,
  • Suzanne Mason,
  • John Danesh,
  • Elijah Behr,
  • Eva Morris,
  • Riyaz Patel,
  • Glen Martin,
  • Bilal Mateen,
  • Evan Kontopantelis,
  • Pedro Machado,
  • Katherine Brown,
  • Tasanee Braithwaite,
  • Maya Buch,
  • Paz Tayal,
  • Jianhua Wu,
  • Simon Williams,
  • Bernard Keavney,
  • Ajay Shah,
  • Krishnaraj Rathod,
  • Alastair Proudfoot,
  • Fu Siong Ng,
  • Manuel Gomes,
  • Arunashis Sau,
  • Jonathan Sterne,
  • Michelle Williams,
  • John Cleland,
  • Theresa McDonagh,
  • Jocelyn Friday,
  • Steffen Petersen,
  • Rupert Payne,
  • Angela Wood,
  • Mark Green,
  • David Jenkins,
  • Akshay Shah,
  • Jayati Das-Munshi,
  • Alexandru Dregan,
  • Niels Peek,
  • Mark Ashworth,
  • Angela Henderson,
  • Elsie Horne,
  • Mehrdad Mizani,
  • David Hughes,
  • Robert Aldridge,
  • Katharine Looker,
  • Reecha Sofat,
  • Norman Briffa,
  • Sonya Crowe,
  • Katie Harron,
  • Amanda Marchant,
  • Elena Nikiphorou,
  • Vasa Curcin,
  • Deborah Kinnear,
  • Craig Melville,
  • Neil Davies,
  • Marion Bennie,
  • Adrian Heald,
  • David Cromwell,
  • Daniel Bromage,
  • Terry Quinn,
  • John Dennis,
  • Lorna Fraser,
  • Sandosh Padmanabhan,
  • Stephen McKeever,
  • Anna Bone,
  • Tom Palmer,
  • Camille Carroll,
  • Christian Schnier,
  • Linxin Li,
  • Rachel Denholm,
  • Sarah Cook,
  • Julia Townson,
  • Dan Jones,
  • John Nolan,
  • Frederick Ho,
  • Felix Greaves,
  • Sara Khalid,
  • Gayan Perera,
  • Baljean Dhillon,
  • Antonio Cannatà,
  • Clare Gillies,
  • Samuel Kim,
  • Nathalie Conrad,
  • Abraham Olvera-Barrios,
  • Roy Schwartz,
  • Lamiece Hassan,
  • Jennifer Quint,
  • Wen Shi,
  • Nazrul Islam,
  • Craig Smith,
  • Spiros Denaxas,
  • Lynn Morrice,
  • Qi Huang,
  • Sharmin Shabnam,
  • Parag Gajendragadkar,
  • Gareth Williams,
  • Fiona Pearce,
  • Hannah Whittaker,
  • John Ford,
  • Benedict Michael,
  • Alastair Denniston,
  • Florian Falter,
  • Rouven Priedon,
  • William Whiteley,
  • Geneviève Cezard,
  • Jane Lyons,
  • Fatemeh Torabi,
  • Laura North,
  • Helen Colhoun,
  • Majel McGranahan,
  • Stephen Kaptoge,
  • Alistair Jones,
  • Martin Rutter,
  • Laura Pasea,
  • Eoin McKinney,
  • Alasdair Warwick,
  • Max Lyon,
  • Rebecca Reynolds,
  • Amanj Kurdi,
  • Seb Bacon,
  • Jessica Barrett,
  • Joseph Newman,
  • Muhammad Rashid,
  • Annemarie Docherty,
  • Joanna Davies,
  • Deepti Gurdasani,
  • Natasha Chilman,
  • Kate McAllister,
  • Sarah Onida,
  • Carole Morris,
  • Samantha Ip,
  • Venexia Walker,
  • Alvina Lai,
  • Alex Handy,
  • Alun Davies,
  • Arun Pherwani,
  • Ashkan Dashtban,
  • Caroline Dale,
  • Caroline Rogers,
  • Claire Lawson,
  • Dan O’Connell,
  • Daniel Harris,
  • David Brind,
  • Deborah Lawler,
  • Deborah Lowe,
  • Eloise Withnell,
  • Ewan Birney,
  • Fabian Falck,
  • George Nicholson,
  • Gwenetta Curry,
  • Haoting Zhang,
  • Harry Wilde,
  • Hoda Abbasizanjani,
  • Honghan Wu,
  • Jennifer Beveridge,
  • Johan Thygesen,
  • Jon Boyle,
  • Kate Cheema,
  • Ken Li,
  • Livia Pierotti,
  • Lucy Wright,
  • Mark Barber,
  • Mary Joan Macleod,
  • Michalis Katsoulis,
  • Mike Inouye,
  • Moritz Gerstung,
  • Myer Glickman,
  • Naomi Herz,
  • Paula Lorgelly,
  • Qiuju Li,
  • Raph Goldacre,
  • Rohan Takhar,
  • Ruwanthi Kolamunnage-Dona,
  • Safa Salim,
  • Seamus Kent,
  • Sonya Babu-Narayan,
  • Spencer Keene,
  • Thomas Lawrence,
  • Tianxiao Wang,
  • Eleanor Walsh,
  • Antonella Delmestri,
  • Jill Pell,
  • David Powell,
  • Ross Forsyth,
  • Teri-Louise North,
  • Richard Fitzgerald,
  • Yi Mu,
  • Kerrie Stevenson,
  • Shane Johnson,
  • Richard Chin,
  • Luisa Zuccolo,
  • Elias Allara,
  • Caroline Jackson,
  • Hannah Harrison,
  • Peter Bath,
  • Tom Yates,
  • Jon Shelton,
  • Carin Van Doorn,
  • Maria Sudell,
  • Matthew Bown,
  • Tom Pape,
  • Tim Chico,
  • Robert Fletcher,
  • Mevhibe Hocaoglu,
  • Owen Pickrell,
  • Andrew Constantine,
  • Andrew Mason,
  • Cameron Razieh,
  • Steven Kerr,
  • James Sheppard,
  • David Selby,
  • Emeka Chukwusa,
  • Rachel Cripps,
  • Paul Madley-Dowd,
  • Patrick Bidulka,
  • Nuria Sanchez,
  • Martha Elwenspoek,
  • Tanja Mueller,
  • Daniel King,
  • Han-I Wang,
  • Tim Dong,
  • Shubhra Sinha,
  • Jeremy Chan,
  • George Tilston,
  • Verónica Cabreira,
  • Simon Ellershaw,
  • Simon Frain,
  • Ruth Norris,
  • Huw Strafford,
  • Nushrat Khan,
  • Daniel Morales,
  • Yoryos Lyratzopoulos,
  • Jennifer Rossdale,
  • Filip Sosenko,
  • Sarah Wang,
  • Flavien Hardy,
  • Johannes Heyl,
  • Petter Brodin,
  • Becky White,
  • Dominic Oliver,
  • Camille Harrison,
  • Stephanie Lax,
  • Shishir Rao,
  • Mohammad Mamouei,
  • Libor Pastika,
  • Benjamin Zuckerman,
  • Samaira Khan,
  • Thomas Porter,
  • Kurt Taylor,
  • Charlotte Parbery-Clark,
  • Simone Croft,
  • Jadene Lewis,
  • Ravi Shankar,
  • Yogini Chudasama,
  • Lars Murdock,
  • Melissa Webb,
  • Nida Ahmed,
  • Tapiwa Tungamirai,
  • Renin Toms,
  • Rochelle Knight,
  • Alexia Sampri,
  • Ruth Watkinson,
  • Laila Tata,
  • Lisa Pennells,
  • Catriona Harrison,
  • Thomas Bolton,
  • Ana Torralbo,
  • Fionna Chalmers,
  • Anna Stevenson,
  • Stelios Boulitsakis Logothetis,
  • Andrew Lambarth,
  • Ferran Espuny-Pujol,
  • Arun Karthikeyan Suseeladevi,
  • Rony Arafin,
  • Zainab Karim,
  • Martina Slapkova,
  • Rosie Hinchliffe,
  • Annette Jackson,
  • Jemma Austin,
  • Zach Welshman,
  • Costas Kallis,
  • Juliette Unwin,
  • Alistair Marsland,
  • Sara Holloway,
  • Adejoke Oluyase Abdel Douiri,
  • Charles Wolfe Ben Bray,
  • Javiera Leniz Martelli,
  • Richard Killick,
  • Arturo de la Cruz,
  • Adam Hollings,
  • Angeliki Antonarou,
  • Daniel Schofield,
  • Elizabeth Kelly,
  • Jake Kasan,
  • Nickie Wareing,
  • Russell Healey,
  • Shoaib Ali Ajaib,
  • Vandana Ayyar-Gupta,
  • Xinkai Wang,
  • Ami Banerjee,
  • Chu Siyu,
  • Emma Whitfield,
  • Eva Keller,
  • Evaleen Malgapo,
  • Floriaan Schmidt,
  • Freya Allery,
  • Jinge Wu,
  • Louise Choo,
  • Luca Grieco,
  • Matt Sydes,
  • Tuankasfee Hama,
  • Waty Lilaonitkul,
  • Dann Mitchell Ben Gibbison,
  • Ewan Walker,
  • Yueying Li,
  • Carmen Petitjean,
  • Chimweta Chilala,
  • Chriselda Oliver,
  • Elena Raffetti,
  • Isabel Walter,
  • Katie Saunders,
  • Rutendo Mapeta,
  • Xilin Jiang,
  • Xiyun Jiang,
  • Yanfan Li,
  • Alice Hosking,
  • Claire Tochel,
  • Joe Mellor,
  • Luke Blackbourn,
  • Niamh McLennan,
  • Clea du Toit,
  • Dennis Tran,
  • Salil Deo,
  • Lana Bojanic,
  • Aashna Uppal,
  • Ben Lacey Ben Goldacre,
  • Dani Prieto-Alhambra,
  • Salma Chaudhry,
  • Harry WatsonIrene Higginson,
  • Richardson Richardson,
  • Marcos delPozoBanos,
  • Andrej Ivanovic Ana-Catarina Pinho-Gomes,
  • Sam Quill,
  • Yat YiFan,
  • Marwa Al Arab,
  • David Moreno Martos,
  • Huan WangIfy Mordi,
  • Carlos Sanchez Soriano,
  • Huayu Zhang,
  • Miguel Bernabeu Llinares,
  • Francesco ZaccardiIain Squire,
  • Marta Pineda Moncusi,
  • Seyed Alireza Hasheminasab,
  • Zeinab Bidel Taleshmekaeil,
  • Jen-Yu AmyChang Marie-Louise Zeissler,
  • Christina vander Feltz-Cornelis

DOI
https://doi.org/10.1136/bmjopen-2024-093080
Journal volume & issue
Vol. 15, no. 4

Abstract

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Objectives To assess the degree to which we can replicate a study between a regional and a national database of electronic health record data in the UK. The original study examined the risk factors associated with hospitalisation following COVID-19 infection in people with diabetes.Design A replication of a retrospective cohort study.Setting Observational electronic health record data from primary and secondary care sources in the UK. The original study used data from a large, urbanised region (Greater Manchester Care Record, Greater Manchester, UK—2.8 m patients). This replication study used a national database covering the whole of England, UK (NHS England’s Secure Data Environment service for England, accessed via the BHF Data Science Centre’s CVD-COVID-UK/COVID-IMPACT Consortium—54 m patients).Participants Individuals with a diagnosis of type 1 diabetes or type 2 diabetes prior to a positive COVID-19 test result. The matched controls (3:1) were individuals who had a positive COVID-19 test result, but who did not have a diagnosis of diabetes on the date of their positive COVID-19 test result. Matching was done on age at COVID-19 diagnosis, sex and approximate date of COVID-19 test.Primary and secondary outcome measures Hospitalisation within 28 days of a positive COVID-19 test.Results We found that many of the effect sizes did not show a statistically significant difference, but that some did. Where effect sizes were statistically significant in the regional study, then they remained significant in the national study and the effect size was the same direction and of similar magnitude.Conclusions There is some evidence that the findings from studies in smaller regional datasets can be extrapolated to a larger, national setting. However, there were some differences, and therefore replication studies remain an essential part of healthcare research.