Incidence, treatment and recurrence of endometriosis in a UK-based population analysis using data from The Health Improvement Network and the Hospital Episode Statistics database

Abstract

Purpose: This retrospective study used medical records from The Health Improvement Network (THIN) and Hospital Episode Statistics (HES) database to evaluate endometriosis (incidence, treatment and need for recurrent invasive procedures) in the general UK population.

Materials and methods: Women aged 12–54 years between January 2000 and December 2010, with a Read code for endometriosis, were identified in THIN. Cases were validated by manual review of free-text comments in medical records and responses to physician questionnaires. False-negative cases were identified among women with Read codes for hysterectomy or dysmenorrhea. Prescriptions of medical therapies for endometriosis were identified in THIN. Cases of single and recurrent invasive procedures were identified in women with medical records in both THIN and HES.

Results: Overall, 5087 women had a Read code for endometriosis, corresponding to an incidence of 1.02 (95% confidence interval [CI]: 0.99–1.05) per 1000 person-years. After case validation, the estimate was 1.46 (95% CI: 1.43–1.50) per 1000 person-years. Medical therapy was prescribed to 55.5% of women with endometriosis in the first year after diagnosis. In total, 48.3% of women received invasive treatment during the study period; approximately one-fifth of these women required further invasive treatment, mainly in the 3 years after the index procedure.

Conclusions: Using Read codes as the only method to identify women with endometriosis underestimates incidence. Over half of women with recorded endometriosis are prescribed medical therapy in the first year after diagnosis. Women with diagnosed endometriosis are at risk of requiring recurrent invasive procedures.

Chinese abstract

目的：采用回顾性研究, 利用健康改善网络数据库（THIN）和医院事件统计数据库（HES）的医疗记录, 评估一般英国人群的子宫内膜异位症（发病率, 治疗和反复侵入性操作的必要性）。

材料和方法：在THIN数据库中收集2000年1月至2010年12月疾病编码为子宫内膜异位症的年龄在12至54岁之间的妇女。所有病例通过对医疗记录的自由文本评论的手工回顾和医生问卷调查的结果进行证实。假阴性病例为编码为子宫切除术或痛经的妇女。THIN数据库中子宫内膜异位症的药物治疗处方得到确定。通过THIN和HES数据库中的医疗记录确定单一及反复侵入性操作的病例。

结果：一共有5087名编码为子宫内膜异位症的妇女, 相当于发病率为1.02/1000人年（95%可信区间：0.99 - 1.05）。经过案例验证, 估计为1.46/1000人年（95% CI：1.43 - 1.50）。55.5%的子宫内膜异位症患者在诊断后的第一年内采用药物治疗。总共有48.3%的妇女在研究期间接受了侵入性治疗；约五分之一的妇女需要进一步侵入性治疗, 主要在检索过程之后的3年内。

结论：使用疾病编码作为唯一确定妇女子宫内膜异位症的方法低估了发病率。超过半数编码为子宫内膜异位症的患者在诊断后的第一年就开始进行药物治疗。诊断为子宫内膜异位症的妇女有需要反复侵入性操作的危险。

Keywords:

• Endometriosis
• The Health Improvement Network (THIN)
• Hospital Episode Statistics (HES)
• incidence
• medical therapy
• surgery
• recurrence

Acknowledgements

Lucy Ambrose DPhil, Elizabeth Perdeaux PhD and William Gattrell PhD of Oxford PharmaGenesis provided medical writing support, funded by Bayer AG.

Disclosure statement

L.C.S. is employed by CEIFE, which has received a research grant from Bayer AG for this work. E.L.-G. is an employee of the School of Medicine Universidad Autónoma de Madrid. R.S.-R. is an employee of Bayer AG (Germany). L.A.G.R. is employed by CEIFE and has been paid as a consultant for Bayer AG (Germany).

Additional information

Funding

This study was funded by Bayer AG.