{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T01:11:51Z","timestamp":1772500311444,"version":"3.50.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,4,18]],"date-time":"2019-04-18T00:00:00Z","timestamp":1555545600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["RP-PG-0407\u201310314"],"award-info":[{"award-number":["RP-PG-0407\u201310314"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["086091\/Z\/08\/Z"],"award-info":[{"award-number":["086091\/Z\/08\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["WT082178"],"award-info":[{"award-number":["WT082178"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["G0902393\/99558"],"award-info":[{"award-number":["G0902393\/99558"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/K006584\/1"],"award-info":[{"award-number":["MR\/K006584\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"name":"British Lung Foundation","award":["JRFG18-1"],"award-info":[{"award-number":["JRFG18-1"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2019,12]]},"DOI":"10.1186\/s12911-019-0805-0","type":"journal-article","created":{"date-parts":[[2019,4,18]],"date-time":"2019-04-18T09:07:39Z","timestamp":1555578459000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Identifying clinically important COPD sub-types using data-driven approaches in primary care population based electronic health records"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9138-3603","authenticated-orcid":false,"given":"Maria","family":"Pikoula","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer Kathleen","family":"Quint","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Nissen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Hemingway","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liam","family":"Smeeth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spiros","family":"Denaxas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,4,18]]},"reference":[{"key":"805_CR1","doi-asserted-by":"publisher","first-page":"e442","DOI":"10.1371\/journal.pmed.0030442","volume":"3","author":"CD Mathers","year":"2006","unstructured":"Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442.","journal-title":"PLoS Med"},{"key":"805_CR2","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1080\/15412555.2017.1286165","volume":"14","author":"JB Soriano","year":"2017","unstructured":"Soriano JB. An epidemiological Overview of chronic obstructive pulmonary disease: what can real-life data tell us about disease management? COPD J Chron Obstruct Pulmon Dis. 2017;14:S3\u20137.","journal-title":"COPD J Chron Obstruct Pulmon Dis"},{"key":"805_CR3","doi-asserted-by":"publisher","first-page":"771","DOI":"10.2147\/CLEP.S117867","volume":"8","author":"KJ Rothnie","year":"2016","unstructured":"Rothnie KJ, et al. Recording of hospitalizations for acute exacerbations of COPD in UK electronic health care records. Clin Epidemiol. 2016;8:771\u201382.","journal-title":"Clin Epidemiol"},{"issue":"9979","key":"805_CR4","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/S0140-6736(15)60693-6","volume":"385","author":"Prescott G Woodruff","year":"2015","unstructured":"Woodruff PG, Agusti A, Roche N, Singh D, Martinez FJ. Chronic obstructive pulmonary disease 2 current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management; 2015. p. 385. \n                    https:\/\/doi.org\/10.1016\/S0140-6736(15)60693-6","journal-title":"The Lancet"},{"issue":"9","key":"805_CR5","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1136\/thoraxjnl-2014-205507","volume":"69","author":"Alvar Agusti","year":"2014","unstructured":"Agusti A, Agust\u00ed A. The path to personalised medicine in. COPD. 2014. \n                    https:\/\/doi.org\/10.1136\/thoraxjnl-2014-205507\n                    \n                  .","journal-title":"Thorax"},{"key":"805_CR6","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1016\/S0140-6736(17)32136-0","volume":"390","author":"A Agust\u00ed","year":"2017","unstructured":"Agust\u00ed A, Celli B, Faner R. What does endotyping mean for treatment in chronic obstructive pulmonary disease? The Lancet. 2017;390:980\u20137.","journal-title":"The Lancet"},{"key":"805_CR7","doi-asserted-by":"publisher","first-page":"420134","DOI":"10.1155\/2014\/420134","volume":"2014","author":"P-R Burgel","year":"2014","unstructured":"Burgel P-R, Paillasseur J-L, Roche N. Identification of clinical phenotypes using cluster analyses in COPD patients with multiple comorbidities. Biomed Res Int. 2014;2014:420134.","journal-title":"Biomed Res Int"},{"key":"805_CR8","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s12931-015-0208-4","volume":"16","author":"LM Pinto","year":"2015","unstructured":"Pinto LM, et al. Derivation and validation of clinical phenotypes for COPD: a systematic review. Respir Res. 2015;16:50.","journal-title":"Respir Res"},{"key":"805_CR9","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1136\/thoraxjnl-2013-203601","volume":"69","author":"PJ Castaldi","year":"2014","unstructured":"Castaldi PJ, et al. Cluster analysis in the COPDGene study identifies subtypes of smokers with distinct patterns of airway disease and emphysema. Thorax. 2014;69:416\u201323.","journal-title":"Thorax"},{"key":"805_CR10","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1513\/AnnalsATS.201403-125OC","volume":"12","author":"SI Rennard","year":"2015","unstructured":"Rennard SI, et al. Identification of five chronic obstructive pulmonary disease subgroups with different prognoses in the ECLIPSE cohort using cluster analysis. Ann Am Thorac Soc. 2015;12:303\u201312.","journal-title":"Ann Am Thorac Soc"},{"issue":"4","key":"805_CR11","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1177\/1460458216675661","volume":"24","author":"Rodrigo Vazquez Guillamet","year":"2016","unstructured":"Vazquez Guillamet R, Ursu O, Iwamoto G, Moseley PL, Oprea T. Chronic obstructive pulmonary disease phenotypes using cluster analysis of electronic medical records. Health Informatics J. 2016:146045821667566. \n                    https:\/\/doi.org\/10.1177\/1460458216675661\n                    \n                  .","journal-title":"Health Informatics Journal"},{"issue":"5","key":"805_CR12","doi-asserted-by":"publisher","first-page":"1701034","DOI":"10.1183\/13993003.01034-2017","volume":"50","author":"Pierre-R\u00e9gis Burgel","year":"2017","unstructured":"Burgel P-R, et al. A simple algorithm for the identification of clinical COPD phenotypes. Eur Respir J. 2017;50(5):1701034. \n                    https:\/\/doi.org\/10.1183\/13993003.01034-2017","journal-title":"European Respiratory Journal"},{"key":"805_CR13","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1093\/ije\/dys188","volume":"41","author":"SC Denaxas","year":"2012","unstructured":"Denaxas SC, et al. Data resource profile: cardiovascular disease research using linked bespoke studies and electronic health records (CALIBER). Int J Epidemiol. 2012;41:1625\u201338.","journal-title":"Int J Epidemiol"},{"key":"805_CR14","doi-asserted-by":"publisher","unstructured":"Denaxas S, et al. UK phenomics platform for developing and validating EHR phenotypes: CALIBER. bioRxiv. 2019;539403. \n                    https:\/\/doi.org\/10.1101\/539403\n                    \n                  .","DOI":"10.1101\/539403"},{"key":"805_CR15","doi-asserted-by":"crossref","unstructured":"Rapsomaniki E, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1{\u00b7} 25 million people. Lancet. 2014;383.","DOI":"10.1016\/S0140-6736(14)60685-1"},{"key":"805_CR16","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1093\/ije\/dyv098","volume":"44","author":"E Herrett","year":"2015","unstructured":"Herrett E, et al. Data resource profile: clinical practice research datalink (CPRD). Int J Epidemiol. 2015;44:827\u201336.","journal-title":"Int J Epidemiol"},{"key":"805_CR17","doi-asserted-by":"publisher","first-page":"f2350","DOI":"10.1136\/bmj.f2350","volume":"346","author":"E Herrett","year":"2013","unstructured":"Herrett E, et al. Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study. BMJ. 2013;346:f2350.","journal-title":"BMJ"},{"key":"805_CR18","doi-asserted-by":"publisher","first-page":"e005540","DOI":"10.1136\/bmjopen-2014-005540","volume":"4","author":"JK Quint","year":"2014","unstructured":"Quint JK, et al. Validation of chronic obstructive pulmonary disease recording in the clinical practice research datalink (CPRD-GOLD). BMJ Open. 2014;4:e005540.","journal-title":"BMJ Open"},{"key":"805_CR19","unstructured":"NICE. Overview | Chronic obstructive pulmonary disease in over 16s: diagnosis and management | Guidance | NICE. \n                    https:\/\/www.nice.org.uk\/guidance\/ng115\n                    \n                  . (Accessed: 25 Feb 2019)."},{"issue":"676","key":"805_CR20","doi-asserted-by":"publisher","first-page":"e775","DOI":"10.3399\/bjgp18X699389","volume":"68","author":"Francis Nissen","year":"2018","unstructured":"Nissen F, et al. Concomitant diagnosis of asthma and COPD: a quantitative study in UK primary care. Br J Gen Pract. 2018. \n                    https:\/\/doi.org\/10.3399\/bjgp18X699389\n                    \n                  .","journal-title":"British Journal of General Practice"},{"key":"805_CR21","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1164\/rccm.200703-456SO","volume":"176","author":"KF Rabe","year":"2007","unstructured":"Rabe KF, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;176:532\u201355.","journal-title":"Am J Respir Crit Care Med"},{"key":"805_CR22","doi-asserted-by":"publisher","first-page":"e0153838","DOI":"10.1371\/journal.pone.0153838","volume":"11","author":"M Daskalopoulou","year":"2016","unstructured":"Daskalopoulou M, et al. Depression as a risk factor for the initial presentation of twelve cardiac, cerebrovascular, and peripheral arterial diseases: data linkage study of 1.9 million women and men. PLoS One. 2016;11:e0153838.","journal-title":"PLoS One"},{"key":"805_CR23","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1002\/ejhf.709","volume":"19","author":"S Koudstaal","year":"2017","unstructured":"Koudstaal S, et al. Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people methods and results. Eur J Heart Fail. 2017;19:1119\u201327.","journal-title":"Eur J Heart Fail"},{"key":"805_CR24","doi-asserted-by":"publisher","first-page":"e018331","DOI":"10.1136\/bmjopen-2017-018331","volume":"8","author":"JMIH Gho","year":"2018","unstructured":"Gho JMIH, et al. An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors. BMJ Open. 2018;8:e018331.","journal-title":"BMJ Open"},{"key":"805_CR25","doi-asserted-by":"publisher","first-page":"e110900","DOI":"10.1371\/journal.pone.0110900","volume":"9","author":"KI Morley","year":"2014","unstructured":"Morley KI, et al. Defining disease phenotypes using national linked electronic health records: a case study of atrial fibrillation. PLoS One. 2014;9:e110900.","journal-title":"PLoS One"},{"key":"805_CR26","volume-title":"English indices of deprivation 2015 - GOV.UK","author":"Ministri of Housing, C. & L. G","year":"2015","unstructured":"Ministri of Housing, C. & L. G. English indices of deprivation 2015 - GOV.UK. (2015). Available at: \n                    https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2015\n                    \n                  . (Accessed: 11 June 2018)."},{"key":"805_CR27","doi-asserted-by":"publisher","first-page":"e0151357","DOI":"10.1371\/journal.pone.0151357","volume":"11","author":"KJ Rothnie","year":"2016","unstructured":"Rothnie KJ, et al. Validation of the recording of acute exacerbations of COPD in UK primary care electronic healthcare records. PLoS One. 2016;11:e0151357.","journal-title":"PLoS One"},{"key":"805_CR28","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-10-0159-8_3","volume-title":"in 21\u201328","author":"Y Mori","year":"2016","unstructured":"Mori Y, Kuroda M, Makino N. in 21\u201328. Singapore: Springer; 2016. \n                    https:\/\/doi.org\/10.1007\/978-981-10-0159-8_3\n                    \n                  ."},{"issue":"5","key":"805_CR29","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/S2213-8587(18)30051-2","volume":"6","author":"Emma Ahlqvist","year":"2018","unstructured":"Ahlqvist E, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol. 2018. \n                    https:\/\/doi.org\/10.1016\/S2213-8587(18)30051-2\n                    \n                  .","journal-title":"The Lancet Diabetes & Endocrinology"},{"key":"805_CR30","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1145\/331499.331504","volume":"31","author":"AK Jain","year":"1999","unstructured":"Jain AK, Murty MN, Flynn PJ. Data clustering: a review. ACM Comput Surv. 1999;31:264\u2013323.","journal-title":"ACM Comput Surv"},{"key":"805_CR31","unstructured":"Choi SS, Cha SH, Tappert CC. A survey of Binary similarity and distance measures. J Syst Cybern INFORMATICS. 2010;8(1):43\u20138."},{"key":"805_CR32","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/0377-0427(87)90125-7","volume":"20","author":"PJ Rousseeuw","year":"1987","unstructured":"Rousseeuw PJ. Silhouettes: a graphical aid to the interpretation and validation of cluster analysis. J Comput Appl Math. 1987;20:53\u201365.","journal-title":"J Comput Appl Math"},{"key":"805_CR33","unstructured":"Breiman L, Friedman J, Stone CJ, Olshen RA. Classification and regression trees. Wadsworth Stat Ser. 1984. \n                    https:\/\/www.crcpress.com\/Classification-and-Regression-Trees\/Breiman-Friedman-Stone-Olshen\/p\/book\/9780412048418"},{"key":"805_CR34","volume-title":"European Respiratory Society international congress","author":"A Gayle","year":"2018","unstructured":"Gayle A, Axson E, Bloom C, Navaratnam V, Quint JK. Changing causes of mortality for people with chronic respiratory diseases. In: European Respiratory Society international congress; 2018."},{"issue":"1","key":"805_CR35","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1093\/ehjqcco\/qcv005","volume":"1","author":"Spiros C. Denaxas","year":"2015","unstructured":"Denaxas SC, Morley KI. Big biomedical data and cardiovascular disease research: opportunities and challenges. Eur Hear J-Qual Care Clin Outcome. 2015;1:9\u201316.","journal-title":"European Heart Journal - Quality of Care and Clinical Outcomes"},{"issue":"16","key":"805_CR36","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1093\/eurheartj\/ehx487","volume":"39","author":"Harry Hemingway","year":"2017","unstructured":"Hemingway H, et al. Big data from electronic health records for early and late translational cardiovascular research: challenges and potential. Eur Heart J. 2017. \n                    https:\/\/doi.org\/10.1093\/eurheartj\/ehx487\n                    \n                  .","journal-title":"European Heart Journal"},{"issue":"4","key":"805_CR37","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1164\/rccm.201710-2029OC","volume":"198","author":"Kieran J. Rothnie","year":"2018","unstructured":"Rothnie KJ, M\u00fcllerov\u00e1 H, Smeeth L, Quint JK. Natural history of COPD exacerbations in a general practice based COPD population. Am J Respir Crit Care Med rccm.201710-2029OC. 2018. \n                    https:\/\/doi.org\/10.1164\/rccm.201710-2029OC\n                    \n                  .","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"key":"805_CR38","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1136\/thoraxjnl-2016-209846","volume":"72","author":"PJ Castaldi","year":"2017","unstructured":"Castaldi PJ, et al. Do COPD subtypes really exist? COPD heterogeneity and clustering in 10 independent cohorts. Thorax. 2017;72:998\u20131006.","journal-title":"Thorax"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-019-0805-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12911-019-0805-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-019-0805-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T23:31:29Z","timestamp":1587079889000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-019-0805-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,18]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["805"],"URL":"https:\/\/doi.org\/10.1186\/s12911-019-0805-0","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,18]]},"assertion":[{"value":"30 November 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The protocol for this research was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol number 16_152Mn) prior to receipt of data. Generic ethical approval for observational research using the CPRD with approval from ISAC has been granted by a Health Research Authority (HRA) Research Ethics Committee (East Midlands \u2013 Derby, REC reference number 05\/MRE04\/87).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MP has nothing to disclose.JKQ reports grants from MRC, grants and personal fees from GSK, grants from Wellcome Trust, grants from The Health Foundation, grants from British Lung Foundation, grants and personal fees from Chiesi, grants and personal fees from BI, grants and personal fees from AZ, outside the submitted work.FN reports grants from GSK, outside the submitted work.HH has nothing to disclose.LM reports grants from Wellcome, grants from MRC, grants from NIHR, grants from GSK, grants from BHF, grants from Diabetes UK, outside the submitted work and is a Trustee of the British Heart Foundation.SD has nothing to disclose.The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Publisher\u2019s Note"}}],"article-number":"86"}}