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Can data from primary care medical records be used to monitor national smoking prevalence?
  1. Lisa Szatkowski1,
  2. Sarah Lewis2,
  3. Ann McNeill2,
  4. Yue Huang2,
  5. Tim Coleman1
  1. 1Division of Primary Care, Queen's Medical Centre, UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK
  2. 2Division of Epidemiology and Public Health, Nottingham City Hospital, UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK
  1. Correspondence to Lisa Szatkowski, Division of Primary Care, Queen's Medical Centre, UK Centre for Tobacco Control Studies, University of Nottingham, Derby Road, Nottingham NG7 2UH, UK; lisa.szatkowski{at}


Background Data from primary care records could potentially provide more comprehensive population-level information on smoking prevalence at lower cost and in a more timely fashion than commissioned national surveys. Therefore, we compared smoking prevalence calculated from a database of primary care electronic medical records with that from a ‘gold standard’ national survey to determine whether or not medical records can provide accurate population-level data on smoking.

Methods For each year from 2000 to 2008, the annual recorded prevalence of current smoking among patients in The Health Improvement Network (THIN) Database was compared with the ‘General Household Survey (GHS)-predicted prevalence’ of smoking in the THIN population, calculated through indirect standardisation by applying age-, sex- and region-specific smoking rates from the corresponding GHS to the THIN population.

Results Completeness of smoking data recording in THIN improved steadily in the study period. By 2008, there was good agreement between recorded smoking prevalence in THIN and the GHS-predicted prevalence; the GHS-predicted prevalence of current smoking in the THIN population was 21.8% for men and 20.2% for women, and the recorded prevalence was 22.4% and 18.9%, respectively.

Conclusions The prevalence of current smoking recorded within THIN has converged towards that which would be expected if GHS smoking rates are applied to the THIN population. Data from electronic primary care databases such as THIN may provide an alternative means of monitoring national smoking prevalence.

  • Smoking
  • primary healthcare
  • medical records
  • smoking RB

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  • Funding LS is supported by a Cancer Research UK PhD Studentship (grant number A9166). TC, SL and AM are members of the UK Centre for Tobacco Control Studies, a UK Clinical Research Collaboration (UKCRC) Public Health Research: Centre of Excellence. Funding from British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The original THIN primary care data were provided by the Epidemiology and Pharmacology Information Core (EPIC) (, and the data for this study were made available through the National Prevention Research Initiative (NPRI, Grant number: G0701100. Relevant NPRI funding partners: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Executive Health Department; The Stroke Association; Welsh Assembly Government and World Cancer Research Fund.

  • Competing interests None.

  • Ethics approval This study was approved by the Leicestershire and Rutland Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.