Data Resource Profile Update: CPRD GOLD

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Clinical Practice Research Datalink (CPRD) GOLD is a large and well-regarded UK primary care data source that was established in 1987 and is used in national and international research to generate real-world evidence. Since the last-published profile, CPRD GOLD has undergone significant changes that need to be documented. In the last 10 years, the CPRD GOLD regional distribution of currently contributing general practitioner (GP) practices has significantly shifted, resulting in many new practices joining from Scotland, Wales, and Northern Ireland, and fewer participating from England. These changes have affected the CPRD GOLD population size, regional coverage, and eligibility for data linkages. CPRD GOLD January 2024 contains >21.3 million historical and current patients (12.9 in England, 3.1 in Wales, 4.7 in Scotland, 0.7 in Northern Ireland). Of these, nearly 3 million are currently registered in a GP practice and represent ∼4.3% of the estimated current UK population (0.1% in England, 32.3% in Wales, 28.6% in Scotland, 16.2% in Northern Ireland). Patients currently registered in CPRD GOLD January 2024 are broadly representative of the UK population with respect to age and sex. Future studies using CPRD GOLD should consider this updated profile to avoid potential pitfalls in study design, data interpretation, and research conclusions. The National Health Service (NHS) has provided freely available healthcare for the UK population since it was launched in 1948 [1]. The digital collection of its primary care data started in the late 1980s with the purpose of managing general practitioner (GP) practices and patients, and over the years has generated extremely large data sources that are used for research purposes [2]. As, in the UK, GPs play the role of NHS gatekeepers, they are also responsible for patient hospital referrals and receive outcome documentation from secondary care, which allows this information to be coded into primary care records, further enhancing the capture of patient health events. When linkages to secondary care data, mortality, disease-based or treatment-based registries, and socioeconomic status (SES) information are available, the benefits of routinely collected data for evidence-based research may expand even further, exceeding the value of using individual datasets separately [3]. Clinical Practice Research Datalink (CPRD) is a not-for-profit, cost-recovery UK government research service delivered by the Medicines and Healthcare products Regulatory Agency (MHRA) with support from the National Institute for Health and Care Research (NIHR), as part of the Department of Health and Social Care [4]. CPRD collects data from three primary care electronic patient record (EPR) systems: Vision®, EMIS Web®, and TPP®. Vision® and EMIS Web® contribute to the observational databases CPRD GOLD, which includes practices across the UK, and CPRD Aurum, which hosts practices from England, respectively. Vision®, EMIS Web®, and TPP® underlie the CPRD Interventional Research services. The CPRD engagement team enrols GP practices by conducting outreach and recruitment activity across the UK. Practices using any of the supported software systems can join CPRD on a voluntary basis and can leave at any time, e.g. if they disenroll, close down, merge with another practice, or transfer to another software system. In the latter case, practices are encouraged to continue contributing to CPRD via the new system. CPRD GOLD, previously known as the General Practice Research Database and Value Added Medical Products Research Databank, is a large primary care data source that was established in 1987. Its history has been widely documented [5–8] and Vision®, originally produced by In Practice Systems, is now part of Cegedim Healthcare Solutions. CPRD GOLD has been recognized as one of the first and largest collections of anonymized electronic health records in the UK and worldwide [9]. CPRD GOLD provides longitudinal information about patients’ demographics, symptoms, conditions, referrals, vaccinations, prescriptions, measurements, and laboratory test results collected by participating GP practices, as part of their NHS care. While, in the raw data, clinical and prescribing information is coded by using Vision® bespoke coding systems (i.e. medcode and prodcode, respectively), CPRD provides dictionaries for their translation into standard coding systems (e.g. READ 3 [10] and dm+d [11], respectively). In 2015, the first data resource profile of CPRD GOLD was published [12] and its reference was added to the official CPRD GOLD documents on the CPRD website. In the last decade, there have been significant changes in CPRD GOLD due to the evolving market of primary care EPR systems in the UK. The Vision® software system, which underlies CPRD GOLD, went from controlling 10%–20% of the UK EPR market share in 2018 and 2019 to holding only 5%–10% between 2020 and 2022. Moreover, while, in 2022, Vision® held only 0–5% of the market share in England, it controlled 50%–60% in Wales, 40%–50% in Scotland, and 30%–40% in Northern Ireland [13]. This has resulted in many new GP practices joining CPRD GOLD from Scotland, Wales, and Northern Ireland, and fewer contributing from England. On the other hand, the use of EMIS Web® software has grown in England, with many practices now contributing to the CPRD Aurum database [14] instead of CPRD GOLD. These variations affect the CPRD GOLD population size, regional coverage, and eligibility for data linkages, as currently CPRD can only provide linked data at the patient level for England. This paper addresses these changes and provides information about the current characteristics of CPRD GOLD. This renewed profile will help researchers to better understand the present dataset, and therefore to tailor research questions and study designs to a greater degree, avoiding possible analyses pitfalls, results misinterpretations, or inaccurate conclusions. The CPRD GOLD January 2024 release [15] (hereinafter CPRD GOLD Jan-2024) has 364 currently contributing GP practices (7 in England, 110 in Wales, 207 in Scotland, and 40 in Northern Ireland). Over the last decade, the practice distribution in CPRD GOLD has changed considerably for each UK constituent country: England, Wales, Scotland, and Northern Ireland (Figure 1). Regional distribution data of currently contributing practices have been provided by CPRD since April 2018 (Supplementary data). Distribution of practices contributing to CPRD GOLD by country. The number of currently contributing GP practices in CPRD GOLD from England has decreased sharply over time, with a total proportional drop of 94.0% (from 118 GP practices in April 2018 to 7 in January 2024). Conversely, the numbers of GP practices from Wales, Scotland, and Northern Ireland have risen, with Scotland having the highest numbers of currently contributing practices. From April 2018 to January 2024, the UK constituent country distribution expressed as a percentage of all practices contributing to CPRD GOLD has changed from 43.4% to 1.9% in England, from 7.4% to 11.0% in Northern Ireland, from 24.6% to 30.2% in Wales, and from 24.6% to 56.9% in Scotland. CPRD GOLD Jan-2024 contains 984 historical and current GP practices from the four UK constituent countries [median of 19.1 (13.4–21.9) years of GP contribution], with coverage of >21.3 million patients. Of these, nearly 3 million are alive and currently registered in a contributing GP practice. Patients with indeterminate sex (N = 1137) or with year of birth prior to 1875 (N = 3) are excluded from the analyses. Key demographic information on current and total patients is presented in Table 1. Demographic characteristics of all acceptable (historical and current) registered patients in CPRD GOLD Jan-2024. Current patients are alive and registered in a GP practice contributing to CPRD GOLD Jan-2024. Demographic characteristics of all acceptable (historical and current) registe

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