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Article History

Received: 3 July 2025

Accepted: 24 February 2026

First Online: 4 March 2026

Declarations

:

: CPRD has NHS Health Research Authority (HRA) Research Ethics Committee (REC) approval to allow the collection and release of anonymised primary care data for observational research (NHS HRA REC reference number: 05/MRE04/87). Each year CPRD obtains Sect. 251 regulatory support through the HRA Confidentiality Advisory Group(CAG), to enable patient identifiers, without accompanying clinical data, to flow from CPRD contributing GP practices in England to NHS Digital, for the purposes of data linkage (CAG reference number: 21/CAG/0008). The protocol for this research was approved by CPRD’s Research Data Governance (RDG) Process (protocol number: 22_002514) and the approved protocol is available upon request. Linked pseudonymised data was provided for this study by CPRD. Data is linked by NHS Digital, the statutory trusted third party for linking data, using identifiable data held only by NHS Digital. Select general practices consent to this process at a practice level with individual patients having the right to opt-out. Further information on availing data is available in Additional file 1.

: No individual-level data is available within this publication; all data are summary statistics. In addition, CPRD policy dictates that no table cell may report fewer than five events to protect participants’ identities.

: Mixed competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/and declare: AEI has received institutional grants from the British Heart Foundation (BHF). ELG has nothing to disclose. CK has nothing to disclose. UT is supported by research grants from the Medical Research Council, Royal Society and NIHR Imperial Biomedical Research Centre. UT is a freelance research editor at the British Medical Journal. HM is an employee of AstraZeneca and owns shares and stock options of AstraZeneca. JKQ has been supported by institutional research grants from the Medical Research Council, NIHR, Health Data Research, GSK, BI, AZ, Insmed, Sanofi and received personal fees for advisory board participation, consultancy or speaking fees from GlaxoSmithKline, Evidera, Chiesi, AstraZeneca. This research was supported by the NIHR Imperial Biomedical Research Centre (BRC).