Gayasha Batheegama Gamarachchige
About
My research project
Data-driven solutions to address inequalities in Prostate Cancer: Using a UK-representative primary-care databaseProstate cancer identified as the most common type of cancer among the males in the UK is strongly affected by inequalities due to age, ethnicity, and deprivation. The burden on people and healthcare systems is expected to increase with ageing populations and environmental factors. Hence, data-driven, and evidence-based solutions are needed to combat inequalities and make necessary plans to improve healthcare services.
This study investigates inequalities in adherence to clinical guidelines to find which groups of men do not receive the recommended, high standard of healthcare and to understand the underlying factors affecting such disparities in diagnosis and treatment. The objectives of this study include developing a cohort profile to describe the cohort characteristics and inequalities in cancer diagnosis, clinical presentation and outcomes across age, ethnicity, geographical locality, socio-economic status, service delivery, and usage followed by the investigations of disparities and risk factors in each aspect of diagnosis, treatment, and outcomes of prostate cancer. Through this research, we will also propose recommendations for healthcare commissioners and policymakers on how to improve healthcare equality in this arena of prostate cancer.
This will be a population-based, observational research where retrospective cohort studies or matched case-control studies will be conducted to uncover trends in data. This secondary data project will utilize data from the Clinical Practice Research Datalink (CPRD), provided by the Brighton and Sussex Medical School, and will consist of 1.6 million primary-care longitudinal medical records and demographics with linkages for Cancer Registration (NCRAS), Hospital Episodes Statistics (HES) and Mortality data (ONS).
Supervisors
Prostate cancer identified as the most common type of cancer among the males in the UK is strongly affected by inequalities due to age, ethnicity, and deprivation. The burden on people and healthcare systems is expected to increase with ageing populations and environmental factors. Hence, data-driven, and evidence-based solutions are needed to combat inequalities and make necessary plans to improve healthcare services.
This study investigates inequalities in adherence to clinical guidelines to find which groups of men do not receive the recommended, high standard of healthcare and to understand the underlying factors affecting such disparities in diagnosis and treatment. The objectives of this study include developing a cohort profile to describe the cohort characteristics and inequalities in cancer diagnosis, clinical presentation and outcomes across age, ethnicity, geographical locality, socio-economic status, service delivery, and usage followed by the investigations of disparities and risk factors in each aspect of diagnosis, treatment, and outcomes of prostate cancer. Through this research, we will also propose recommendations for healthcare commissioners and policymakers on how to improve healthcare equality in this arena of prostate cancer.
This will be a population-based, observational research where retrospective cohort studies or matched case-control studies will be conducted to uncover trends in data. This secondary data project will utilize data from the Clinical Practice Research Datalink (CPRD), provided by the Brighton and Sussex Medical School, and will consist of 1.6 million primary-care longitudinal medical records and demographics with linkages for Cancer Registration (NCRAS), Hospital Episodes Statistics (HES) and Mortality data (ONS).
Publications
Primary care data in the UK are widely used for cancer research, but the reliability of recording key events like diagnoses remains uncertain. Although data linkage can improve reliability, its costs, time requirements, and sample size constraints may discourage its use. We evaluated accuracy, completeness, and date concordance of prostate cancer (PCa) diagnosis recording in Clinical Practice Research Datalink (CPRD) GOLD and Aurum compared to linked Cancer Registry (CR) and Hospital Episode Statistics (HES) Admitted Patient Care (APC) in England. Incident PCa diagnoses (2000-2016) for males aged ≥46 at diagnosis who remained registered with their General Practitioner (GP) by age 65 and were recorded in at least one data source were analysed. Accuracy was the proportion of diagnoses recorded in GOLD or Aurum with a corresponding record in CR or HES. Completeness was the proportion of CR or HES diagnoses with a corresponding record in GOLD or Aurum. The final cohorts for comparisons included 29,500 records for GOLD and 26,475 for Aurum. Compared to CR, GOLD was 86 % accurate and 65 % complete, while Aurum was 87 % accurate and 77 % complete. Compared to HES, GOLD was 76 % accurate and 60 % complete, and Aurum was 79 % accurate and 70 % complete. Concordance in diagnosis dates improved over time in both GOLD and Aurum, with 93 % of diagnoses recorded within a year compared to CR, and 66 % (GOLD) and 71 % (Aurum) compared to HES. Delays of 2-3 weeks in primary care diagnosis recording were observed compared to CR, whereas most diagnoses appeared at least 3 months earlier in primary care than in HES. Aurum demonstrated better accuracy and completeness for PCa diagnosis recording than GOLD. However, linkage to HES or CR is recommended for improved case capture. Researchers should address the limitations of each data source to ensure research validity.