A chronological map of 308 physical and mental health conditions from 4 million individuals in the English National Health Service

Abstract

Background: To effectively prevent, detect, and treat health conditions that affect people during their lifecourse, health-care professionals and researchers need to know which sections of the population are susceptible to which health conditions and at which ages. Hence, we aimed to map the course of human health by identifying the 50 most common health conditions in each decade of life and estimating the median age at first diagnosis.

Methods: We developed phenotyping algorithms and codelists for physical and mental health conditions that involve intensive use of health-care resources. Individuals older than 1 year were included in the study if their primary-care and hospital-admission records met research standards set by the Clinical Practice Research Datalink and they had been registered in a general practice in England contributing up-to-standard data for at least 1 year during the study period. We used linked records of individuals from the CALIBER platform to calculate the sex-standardised cumulative incidence for these conditions by 10-year age groups between April 1, 2010, and March 31, 2015. We also derived the median age at diagnosis and prevalence estimates stratified by age, sex, and ethnicity (black, white, south Asian) over the study period from the primary-care and secondary-care records of patients.

Findings: We developed case definitions for 308 disease phenotypes. We used records of 2 784 138 patients for the calculation of cumulative incidence and of 3 872 451 patients for the calculation of period prevalence and median age at diagnosis of these conditions. Conditions that first gained prominence at key stages of life were: atopic conditions and infections that led to hospital admission in children (<10 years); acne and menstrual disorders in the teenage years (10-19 years); mental health conditions, obesity, and migraine in individuals aged 20-29 years; soft-tissue disorders and gastro-oesophageal reflux disease in individuals aged 30-39 years; dyslipidaemia, hypertension, and erectile dysfunction in individuals aged 40-59 years; cancer, osteoarthritis, benign prostatic hyperplasia, cataract, diverticular disease, type 2 diabetes, and deafness in individuals aged 60-79 years; and atrial fibrillation, dementia, acute and chronic kidney disease, heart failure, ischaemic heart disease, anaemia, and osteoporosis in individuals aged 80 years or older. Black or south-Asian individuals were diagnosed earlier than white individuals for 258 (84%) of the 308 conditions. Bone fractures and atopic conditions were recorded earlier in male individuals, whereas female individuals were diagnosed at younger ages with nutritional anaemias, tubulointerstitial nephritis, and urinary disorders.

Interpretation: We have produced the first chronological map of human health with cumulative-incidence and period-prevalence estimates for multiple morbidities in parallel from birth to advanced age. This can guide clinicians, policy makers, and researchers on how to formulate differential diagnoses, allocate resources, and target research priorities on the basis of the knowledge of who gets which diseases when. We have published our phenotyping algorithms on the CALIBER open-access Portal which will facilitate future research by providing a curated list of reusable case definitions.

Funding: Wellcome Trust, National Institute for Health Research, Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Department of Health and Social Care (England), Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Institute for Social Care and Health Research, and The Alan Turing Institute.

Figure 1

Sex-standardised cumulative incidence (%) of the top 50 diseases and all cancers between April 1, 2010, and March 31, 2015, for individuals aged 1–9 years (A), 10–19 years (B), 20–29 years (C), 30–39 years (D), 40–49 years (E), 50–59 years (F), 60–69 years (G), 70–79 years (H), or 80 years or more (I) on April 1, 2010 AKI=acute kidney injury. BPH=benign prostatic hyperplasia. CIN=cervical intraepithelial neoplasia. CKD=chronic kidney disease. COPD=chronic obstructive pulmonary disease. GORD=gastro-oesophageal reflux disease. HDLC=high-density lipoprotein cholesterol. IBS=irritable bowel syndrome. ID=infectious disease. LDLC=low-density lipoprotein cholesterol. LRTI=lower respiratory tract infection. PCOS=polycystic ovary syndrome. PID=pelvic inflammatory disease. T1D=type 1 diabetes. T2D=type 2 diabetes. TIA=transient ischaemic attack. URTI=upper respiratory tract infection. UTI=urinary tract infection.

Figure 1

Sex-standardised cumulative incidence (%) of the top 50 diseases and all cancers between April 1, 2010, and March 31, 2015, for individuals aged 1–9 years (A), 10–19 years (B), 20–29 years (C), 30–39 years (D), 40–49 years (E), 50–59 years (F), 60–69 years (G), 70–79 years (H), or 80 years or more (I) on April 1, 2010 AKI=acute kidney injury. BPH=benign prostatic hyperplasia. CIN=cervical intraepithelial neoplasia. CKD=chronic kidney disease. COPD=chronic obstructive pulmonary disease. GORD=gastro-oesophageal reflux disease. HDLC=high-density lipoprotein cholesterol. IBS=irritable bowel syndrome. ID=infectious disease. LDLC=low-density lipoprotein cholesterol. LRTI=lower respiratory tract infection. PCOS=polycystic ovary syndrome. PID=pelvic inflammatory disease. T1D=type 1 diabetes. T2D=type 2 diabetes. TIA=transient ischaemic attack. URTI=upper respiratory tract infection. UTI=urinary tract infection.

Figure 1

Sex-standardised cumulative incidence (%) of the top 50 diseases and all cancers between April 1, 2010, and March 31, 2015, for individuals aged 1–9 years (A), 10–19 years (B), 20–29 years (C), 30–39 years (D), 40–49 years (E), 50–59 years (F), 60–69 years (G), 70–79 years (H), or 80 years or more (I) on April 1, 2010 AKI=acute kidney injury. BPH=benign prostatic hyperplasia. CIN=cervical intraepithelial neoplasia. CKD=chronic kidney disease. COPD=chronic obstructive pulmonary disease. GORD=gastro-oesophageal reflux disease. HDLC=high-density lipoprotein cholesterol. IBS=irritable bowel syndrome. ID=infectious disease. LDLC=low-density lipoprotein cholesterol. LRTI=lower respiratory tract infection. PCOS=polycystic ovary syndrome. PID=pelvic inflammatory disease. T1D=type 1 diabetes. T2D=type 2 diabetes. TIA=transient ischaemic attack. URTI=upper respiratory tract infection. UTI=urinary tract infection.

Figure 1

Sex-standardised cumulative incidence (%) of the top 50 diseases and all cancers between April 1, 2010, and March 31, 2015, for individuals aged 1–9 years (A), 10–19 years (B), 20–29 years (C), 30–39 years (D), 40–49 years (E), 50–59 years (F), 60–69 years (G), 70–79 years (H), or 80 years or more (I) on April 1, 2010 AKI=acute kidney injury. BPH=benign prostatic hyperplasia. CIN=cervical intraepithelial neoplasia. CKD=chronic kidney disease. COPD=chronic obstructive pulmonary disease. GORD=gastro-oesophageal reflux disease. HDLC=high-density lipoprotein cholesterol. IBS=irritable bowel syndrome. ID=infectious disease. LDLC=low-density lipoprotein cholesterol. LRTI=lower respiratory tract infection. PCOS=polycystic ovary syndrome. PID=pelvic inflammatory disease. T1D=type 1 diabetes. T2D=type 2 diabetes. TIA=transient ischaemic attack. URTI=upper respiratory tract infection. UTI=urinary tract infection.

Figure 1

Sex-standardised cumulative incidence (%) of the top 50 diseases and all cancers between April 1, 2010, and March 31, 2015, for individuals aged 1–9 years (A), 10–19 years (B), 20–29 years (C), 30–39 years (D), 40–49 years (E), 50–59 years (F), 60–69 years (G), 70–79 years (H), or 80 years or more (I) on April 1, 2010 AKI=acute kidney injury. BPH=benign prostatic hyperplasia. CIN=cervical intraepithelial neoplasia. CKD=chronic kidney disease. COPD=chronic obstructive pulmonary disease. GORD=gastro-oesophageal reflux disease. HDLC=high-density lipoprotein cholesterol. IBS=irritable bowel syndrome. ID=infectious disease. LDLC=low-density lipoprotein cholesterol. LRTI=lower respiratory tract infection. PCOS=polycystic ovary syndrome. PID=pelvic inflammatory disease. T1D=type 1 diabetes. T2D=type 2 diabetes. TIA=transient ischaemic attack. URTI=upper respiratory tract infection. UTI=urinary tract infection.

Figure 2

Median age at first record for diseases with median age of diagnosis at or before 40 years, stratified by sex (A) and ethnicity (B) CIN=cervical intraepithelial neoplasia. IBS=irritable bowel syndrome. ID=infectious disease. OCD=obsessive-compulsive disorder. PCOS=polycystic ovary syndrome. PID=pelvic inflammatory disease. T1D=type 1 diabetes. URTI=upper respiratory tract infection.

Figure 3

Median age at first record for diseases with median age of diagnosis between 40–60 years, stratified by sex (A) and ethnicity (B) For the key for the disease categories refer to figure 2. GORD=gastro-oesophageal reflux disease. HDLC=high-density lipoprotein cholesterol. HOCM=hypertrophic obstructive cardiomyopathy. ID=infectious disease. LDLC=low-density lipoprotein cholesterol. NOS=not otherwise specified. PE=pulmonary embolism. SVT=supraventricular tachycardia. VTE=venous thromboembolism.

Figure 4

Median age at first record for diseases with median age of diagnosis after 60 years, stratified by sex (A) and ethnicity (B) For the key for the disease categories refer to figure 2. AAA=abdominal aortic aneurysm. AKI=acute kidney injury. AV=atrioventricular. BPH=benign prostatic hyperplasia. CHD=coronary heart disease. CKD=chronic kidney disease. COPD=chronic obstructive pulmonary disease. ID=infectious disease. LBBB=left bundle branch block. LRTI=lower respiratory-tract infection. MGUS= Monoclonal gammopathy of undetermined significance. NOS=not otherwise specified. PAD=peripheral arterial disease. RBBB=right bundle branch block. SIADH=syndrome of inappropriate antidiuretic hormone secretion. T2D=type 2 diabetes. TIA=transient ischaemic attack. UTI=urinary tract infection.

Figure 5

Number of diseases with reported case definitions and prevalences in the UK for each disease category from this study (A) or the Global Burden of Disease 2017 study (B)