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  • A de-identified version of the SLaM EHR called the Clinical Record Interactive Search (CRIS) system [13] was used as a data source for this study. Ethical approval as an anonymised database for secondary analysis was originally granted in 2008, and renewed for a further 5 years in 2013 (Oxford C Research Ethics Committee, reference 08/H0606/71+5). The study presented in this paper has been approved by the CRIS Oversight Committee [13]. For our analysis, we assembled a subset of records on 203,427 patients registered in the CRIS database between November 2008 and May 2015: 101,549 males and 101,813 females (65 with gender not recorded). Overall, there were 562,726 primary and secondary diagnoses recorded in structured fields for these patients, employing 2,531 unique ICD10 codes. We noted however, that not all diagnoses were recorded at their lowest (most specific) level of hierarchy, so as well as ‘F20.0—paranoid schizophrenia’ there are also cases of ‘F20 –Schizophrenia’, for example. To address this issue, we trimmed each code to its decimal point (i.e. taking only its letter and the following two digits). Since several diagnosis codes could be recorded for a patient, and the same diagnosis may be recorded several times on different dates for the same patient, we calculated overall and unique case counts for each code. In this paper, we explore how unique diagnoses recorded for at least 100 unique patients were distributed across different genders and ethnicities and if there were any significant differences in their prevalence. We performed two statistical analyses, one comparing genders, and a second comparing ethnic groups. In both cases, we took the same cohort of 203,427 patients, but had to remove 65 patients from the gender analysis where no gender was recorded, and 29,559 patients from the ethnicity analysis where ethnicity was absent. While a detailed ethnic category was specified for each patient, we have aggregated them into four ethnic groups. The ‘White’ ethnic group includes ‘British’, ‘Irish’, and ‘Any other white background’ ethnic categories. The ‘Black’ group includes ‘African’, ‘Caribbean’, and ‘Any other black background’ categories. The ‘Asian’ group refers to ‘Bangladeshi’, ‘Chinese’, ‘Indian’, ‘Pakistani’, and ‘Any other Asian background’. The ‘Other’ ethnicity group includes patients with mixed backgrounds, such as ‘White and Asian’, ‘White and Black African’, ‘White and Black Caribbean’ and ‘Any other mixed backgrounds’. To test statistical significance of diagnostic enrichment for a given gender and ethnic group, we calculated p-values for each diagnostic code generated from Chi-square scores. Since multiple comparisons were involved in the testing (110 codes for 2 and 4 categories of gender and ethnicity respectively), we also calculated q-values by adjusting each p-value using the False Discovery Rate Benjamini-Hochberg method [31]. We performed this analysis at two different levels of the ICD10 code hierarchy: the third level (codes trimmed to letter and the following two digits) and the highest level (trimmed to include letter only). The first analysis informs about differences in the population across various mental health condition, while the second shows differences across the codes that belong to chapters other than ‘V—Mental and Behavioural Disorders’.
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