National administrative record linkage between specialist community drug and alcohol treatment data (the National Drug Treatment Monitoring System (NDTMS)) and inpatient hospitalisation data (Hospital Episode Statistics (HES)) in England: Design, method and evaluation

Emmert Roberts*, James C. Doidge, Katie L. Harron, Matthew Hotopf, Jonathan Knight, Martin White, Brian Eastwood, Colin Drummond

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Objectives: The creation and evaluation of a national record linkage between substance misuse treatment, and inpatient hospitalisation data in England. 

Design: A deterministic record linkage using personal identifiers to link the National Drug Treatment Monitoring System (NDTMS) curated by Public Health England (PHE), and Hospital Episode Statistics (HES) Admitted Patient Care curated by National Health Service (NHS) Digital. 

Setting and participants: Adults accessing substance misuse treatment in England between 1 April 2018 and 31 March 2019 (n=268 251) were linked to inpatient hospitalisation records available since 1 April 1997. 

Outcome measures: Using a gold-standard subset, linked using NHS number, we report the overall linkage sensitivity and precision. Predictors for linkage error were identified, and inverse probability weighting was used to interrogate any potential impact on the analysis of length of hospital stay. 

Results: 79.7% (n=213 814) people were linked to at least one HES record, with an estimated overall sensitivity of between 82.5% and 83.3%, and a precision of between 90.3% and 96.4%. Individuals were more likely to link if they were women, white and aged between 46 and 60. Linked individuals were more likely to have an average length of hospital stay ≥5 days if they were men, older, had no fixed residential address or had problematic opioid use. These associations did not change substantially after probability weighting, suggesting they were not affected by bias from linkage error. 

Conclusions: Linkage between substance misuse treatment and hospitalisation records offers a powerful new tool to evaluate the impact of treatment on substance related harm in England. While linkage error can produce misleading results, linkage bias appears to have little effect on the association between substance misuse treatment and length of hospital admission. As subsequent analyses are conducted, potential biases associated with the linkage process should be considered in the interpretation of any findings.

Original languageEnglish
Article numbere043540
JournalBMJ Open
Volume10
Issue number11
DOIs
Publication statusPublished - 26 Nov 2020

Bibliographical note

Funding Information: This paper represents independent research funded by the Medical Research Council (MRC), as part of the corresponding author’s MRC Addiction Research Clinical (MARC) Fellowship. The research was part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, and by the NIHR Collaboration for Leadership in Applied Health Research and Care South London (NIHR CLAHRC South London) now recommissioned as NIHR Applied Research Collaboration South London, and both CD and MH receive funding from an NIHR Senior Investigator award. KH is funded in part by the Wellcome Trust (grant number 212953/Z/18/Z) and benefits from infrastructure funded by NIHR GOSH BRC and Health Data Research UK.

The funders had no contribution to the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All authors were independent from funders had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The views expressed are those of the authors and not necessarily those of the MRC, the National Health Service (NHS), the NIHR, Public Health England (PHE) or the Department of Health and Social Care (DHSC).

MH is principal investigator of RADAR-CNS consortium—a public private partnership in collaboration with five pharma companies—Janssen, Biogen, UCB, MSD and Lundbeck, outside of the submitted work.

Open Access: https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Publisher Copyright: © Author(s) (or their employer(s)) 2020. Published by BMJ.

Citation: Roberts E, Doidge JC, Harron KL, et al. National administrative record linkage between specialist community drug and alcohol treatment data (the National Drug Treatment Monitoring System (NDTMS)) and inpatient hospitalisation data (Hospital Episode Statistics (HES)) in England: design, method and evaluation. BMJ Open 2020;10:e043540.

DOI: 10.1136/bmjopen-2020-043540

Keywords

  • epidemiology
  • public health
  • substance misuse

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