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Sarah Cook

My background is in epidemiology. My research to date has focused on chronic disease, health inequalities and behaviour change, particularly alcohol use.  I completed a PhD in epidemiology from the London School of Hygiene & Tropical Medicine which hazardous alcohol consumption in Russian men using factor analysis and structural equation modelling to investigate typologies of alcohol use and using these to study the Health and socio-economic impact of alcohol in a typical Russian City. My research showed the importance of including measures of the acute effects of alcohol such as drunkenness and hangover and above the more conventionally measured quantity of ethanol consumed when investigating the impact of alcohol use on people’s lives. Following this I worked on a large project investigating reasons for very high cardiovascular disease in Russia (the Know Your Heart Study) and co-ordinated data collection for cross-sectional studies in two field sites in Russia. In 2019 I was invited to be a visiting researcher at UiT, The Arctic University of Norway for a year and work with the Tromsø Study, a long running ongoing population survey of the people of Tromsø. I am currently based in the Respiratory Electronic Health Record Unit Group within the School of Public Health at Imperial College. 

Award Title: Mental Health Fellowship

Start Date: 1st October 2022

End Date: 31st March 2024

Location of Research: England   

Collaborating Organisations: University College London 

Project Title: Investigating health inequalities in people with alcohol use disorders and type 2 diabetes 

Brief Summary: 

Alcohol use disorders are mental health conditions related to alcohol. This umbrella term includes both alcohol dependence and harmful alcohol use. Type 2 diabetes is a common chronic condition where appropriate management and treatment is crucial for health outcomes. People with alcohol use disorders have approximately 5 times increased risk of mortality due to diabetes compared to the general population.  

It is important to understand if people with both alcohol use disorder and type 2 diabetes have 1) different health outcomes and 2) experience different treatment and management to people who do not have alcohol use disorder in order to understand if interventions are needed to target health inequalities for people living with alcohol use disorder and type 2 diabetes. 

The aim of this project is to identify whether people with alcohol use disorder and type 2 diabetes have differential health outcomes and treatment/management to people with type 2 diabetes who do not have alcohol use disorder. 

The specific objectives are:  

Objective 1) To quantify the incidence of (diabetes-specific) physical health and mental health outcomes in people with type 2 diabetes with alcohol use disorder compared to those without alcohol use disorder using electronic health records  

Objective 2) To explore whether there are differences in treatment and management of type 2 diabetes in people with alcohol use disorder compared to people without alcohol use disorder using electronic health records 


Study design 

Cohort study using routinely collected de-identified electronic health record data.  

Study population  

The primary data source is the Clinical Research Practice Datalink (CPRD) Aurum, a database containing routinely collected data on diagnoses, symptoms, procedures and prescriptions from primary care practices within England. For some study outcomes this data will be linked to Hospital Episode Statistics (HES) for England. 

Study Outcomes 

For objective 1 outcomes of interest are common mental disorders (depression and anxiety) and diabetes-specific outcomes such as diabetic eye and kidney disease. For objective 2 indicators of diabetes monitoring in primary care and markers of health service use such as consultation rates in primary care and hospital admissions pre and post diagnosis will be used to look at patient pathways through care since interactions with health services (or lack of them e.g. due to delays in help seeking, health care avoidance) is an important part of the research question. 

Analysis Plan 

For Objective 1 age- and sex-standardized incidence rates of outcomes will be calculated separately by each exposure category. Poisson regression modelling will be used to calculate hazard ratios for each exposure category with adjustment for key confounders (demographic factors which can be obtained through CPRD data (age, sex, ethnicity, socioeconomic status as measured through index of multiple deprivation, region), markers of disease severity and co-morbidities at time of diagnosis. For Objective 2 strategies for modelling health care pathways will use structural equation modelling and mediation analysis. Models will be adjusted for demographic factors which can be obtained through CPRD data (age, sex, ethnicity, socio-economic status, region). Adjustment and/or potential interaction by markers of disease severity and co-morbidities at time of diagnosis will be considered 

Benefits anticipated: Any differences in health outcomes and/or treatment and management in patients with type 2 diabetes and alcohol use disorder identified this will be important for informing clinical guidance and in developing interventions for improving physical and mental health outcomes for people with both conditions.