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Small area estimation (SAE) describes the use of Bayesian modelling of survey and administrative data in order to provide estimates of survey responses at a much finer level than is possible from the survey alone. Over the recent past, academic publications have mostly targeted the development of the methodology for SAE using small-scale examples. Only predictions on the basis of realistically sized samples have the potential to impact on governance and our contribution is to fill a niche by delivering such SAEs on a national scale through the use of a scaling method. The impact case study concerns the use of these small area predictions to develop disease-level predictions for some 8,000 GPs in England and so to produce a funding formula for use in primary care that has informed the allocation of billions of pounds of NHS money. The value of the model has been recognised in NHS guidelines. The methodology has begun to have impact in other areas, including the BIS `Skills for Life' survey.
Epidemiological research at Queen Mary, commissioned by the Department of Health, demonstrated a clear and causal link between exposure to environmental tobacco smoke and both ischaemic heart disease and lung cancer. The evidence contributed significantly to public and political debates on whether to ban smoking in public places. It informed the rebuttal of heavy tobacco industry lobbying and had a pivotal influence on changes in the law in Scotland (2006), England and Wales (2007), and Northern Ireland (2007), as well as in many countries outside UK, which led to highly significant reductions in environmental pollution from secondhand smoke. Many health benefits were subsequently attributed to the ban, notably a 17% reduction in incidence of acute myocardial infarction.
The Cambridge-led Emerging Risk Factors Collaboration (ERFC) is a global consortium involving individual-participant data on 2.5 million participants from 130 cohort studies. The ERFC has helped optimise approaches to cardiovascular disease (CVD) risk assessment by: 1) quantifying the incremental predictive value provided by assessment of risk factors 2) evaluating the independence of associations between risk factors and CVD and 3) addressing uncertainties related to the implementation of screening. ERFC publications on lipids, lipoproteins, and inflammation biomarkers have been cited by 9 guidelines published since 2010, including those of the European Society of Cardiology and the American Heart Association.
Onchocerciasis (river blindness) is a debilitating disease of major public health importance in the wet tropics. The African Programme for Onchocerciasis Control (APOC) seeks to control or eliminate the disease in 19 countries. Accurate mapping of Loiasis (eye-worm) was a requirement for implementation of APOC's mass-treatment prophylactic medication programme in order to mitigate against serious adverse reactions to the Onchocerciasis medication in areas also highly endemic for Loiasis. Model-based geostatistical methods developed at Lancaster were used to obtain the required maps and contributed to a change in practice of APOC in a major health programme in Africa. Our maps are used to plan the delivery of the mass-treatment programme to rural communities throughout the APOC countries, an estimated total population of 115 million.
Research at the University of Manchester (UoM) has developed new approaches, methods and algorithms to improve the statistical confidentiality practices of data stewardship organisations (DSOs), such as the UK's Office for National Statistics. The research and its products have had significant impacts on data dissemination practice, both in the UK and internationally, and have been adopted by national statistical agencies, government departments and private companies. The primary beneficiaries of this work are DSOs, who are able to both disseminate useful data products, and protect respondent confidentiality more effectively. Secondary beneficiaries are respondents, whose confidentiality is better protected, and the research community, as without `gold standard' disclosure risk analysis, data holders can be overcautious.
Research directed by Professor John Robertson at The University of Nottingham led to the launch, in 2009, of the world's first autoantibody blood test for the detection of early-stage lung cancer. The EarlyCDT-Lung test has been commercialised through the spin-out company Oncimmune. [text removed for publication]. EarlyCDT-Lung is now used clinically in North and South America, the UK and the Middle East, generating revenue and saving lives.
This case study concerns the research of Professor David Spiegelhalter on `funnel plot' methodology for comparing institutions. This system has now become the standard method within the National Health Service for comparing clinical outcomes, including hospital Trusts with apparently `outlying' mortality rates. In particular, mortality following children's heart surgery is analysed and presented using funnel plots, and Professor Spiegelhalter's work has been instrumental in handling high-profile cases such as surgery at Oxford Radcliffe Infirmary and Leeds General Infirmary.
Research within the Northern Ireland Barrett's oesophagus Register demonstrated that cancer risk in this disease was substantially lower than previously thought. It identified clinico-pathological characteristics and potential biomarkers that allow Barrett's patients to be stratified into those with higher and lower cancer risk. This research has influenced recommendations from Gastroenterological Associations in the UK and USA and resulted in altered clinical practice nationally and internationally, in which costly routine endoscopic surveillance is now targeted to Barrett's oesophagus patients with the highest cancer risk.
Clinical trials form a crucial step in translating fundamental medical research into improved healthcare. Many hundreds of trials are conducted every year, each involving hundreds, sometimes thousands, of patients. These trials are expensive, with costs as high as 20 or 30 thousand pounds per patient. Research in Bath on group sequential monitoring and the adaptive design of clinical trials has improved the conduct of clinical trials, leading to:
The impact of this research is economic (the business performance of pharmaceutical companies and businesses that support them), societal (by enhancing public health and by changing the policies adopted by regulators) and ethical (ensuring clinical trials remain safe, while bringing life-saving treatments into clinical use as rapidly as possible).
Our research has been applied directly by Aviva plc. to develop improved products in the general insurance market (e.g. household and car) and in the more specialised area of enhanced pension annuities. As a result, Aviva has become more competitive in these markets and customers are enjoying better value for money. In the case of enhanced annuities, the benefits are in the form of higher pension income for those accurately identified as facing shortened life expectancies. Aviva is the largest insurance company in the UK and the sixth largest in the world.