Linked routine data can replace randomised control trials, think tank hears

^{Professor Wright is using linked data to tackle childhood obesity and improve frailty care}

There was a big challenge around how the health sector harnesses the huge amount of data it holds and how it uses them to improve services, said Professor John Wright, chief investigator with the Born in Bradford project.

At the King’s Fund’s annual conference on 29 November, he said: ‘Once you have that routine data linkage, there are lots of cool, novel methods and quasi-experimental approaches you can take using routine data.’

Electronic frailty index

He told the event about Born in Bradford’s electronic frailty index which was using linked data to improve care. It took about 70 different measurements from a primary care record – such as comorbidity, medicines and disability – and was highly predictive of different levels of frailty in older people.

‘We are using it to test whether we can provide more coordinated care, de-prescribing and to inform prognosis,’ he said.

The next step is to do the same for childhood obesity. ‘Childhood obesity is the biggest public health problem we have at the moment and, despite everything we try to do about it, levels are still rising.

‘We showed how actually it’s pregnancy and the first year of life that is the critical period in the development of childhood obesity. Yet all our childhood obesity interventions are targeted at school children. It’s too late. We need to be doing it upstream.’

Professor Wright said his programme wanted to move from 30,000 people to cover the entire Bradford population of 500,000.

Early on, he found that people had wanted their data to be used for altruistic reasons. Now, he is trying to link up datasets across Bradford, using primary care, secondary care and community care, education and social services data.

Born in Bradford

For the past 10 years, Born in Bradford has tracked the lives of more than 30,000 Bradfordians to find out what influences the health and wellbeing of families.

The information collected is being used to find the causes of common childhood illnesses, conditions and to explore the mental and social development of the 13,500 children involved in the programme.

One of its first studies linked air pollution in the city to birth weight, using routine maternity records. The research found a very strong association with air quality, particularly with fine particulate matter produced by diesel vehicles.

‘Nobody wants to give up their car, especially in Bradford,’ said Professor Wright.

‘But if you can give people data about the high levels of pollution their children are breathing in, which is causing cognitive impairment and affecting women in pregnancy, then maybe you can start a social movement to get people to do things differently.’