# Welcome to the SangerTools package

This package has been created to provide convenient functions for working with population health data. It is specifically aimed at healthcare providers and services that focus on population health management.

Many of the functions are centered around the Master Patient Index format. Where each row is a patient and each column is an observation of that patient.

In the next sections we will take you through how you use the tool.

To load in the Master Patient Index attached to the SangerTools package follow these steps:


health_data <- SangerTools::master_patient_index
Sex Smoker Diabetes Dementia Obesity Age IMD_Decile Ethnicity Locality PrimaryCareNetwork
Female 1 0 0 0 17 7 White Gloucester City Tewkesbury, Newent and Staunton and West Cheltenham Medical
Female 0 0 0 0 31 1 White Stroud and Berkeley Vale North Cotswolds
Male 0 0 0 0 34 3 White Cheltenham The Forest of Dean
Female 0 0 0 0 62 9 White Gloucester City Rosebank & Bartongate
Female 0 0 0 0 37 4 White Cheltenham South Cotswolds
Female 0 0 0 0 57 9 White Cheltenham Cheltenham Central

The data contains:

• PseudoNHSNumber - A Pseudonymised NHS Patient Identifier
• Sex - The identifiable sex of the patient
• Smoker - Health Condition Flag: 1 denotes if the patient is a smoker
• Diabetes - Health Condition Flag: 1 denotes if the patient has diabetes
• Dementia - Health Condition Flag: 1 denotes if the patient has dementia
• Obesity - Health Condition Flag: 1 denotes if the patient is Obese
• Age - Age of the patient
• IMD_Decile - The decile of indices of multiple deprivation
• Ethnicity - The identifiable ethnicity of the patient}
• Locality - The region where the patient lives - sampled from Gloucestershire Clinical Commissioning Group (GCCG)
• PrimaryCareNetwork - The network of General Practioners that the patient is registered with - sampled from (GCCG)

With the data we can start to work with the function in the package.

## Age bands

It is common practice to transform continuous age values into a smaller set of categories.

There are two functions in the package for doing this.

• age_bandizer
• age_bandizer2

age_bandizer Uses a tidyverse philosophy of function creation with Non-Standard Evaluation. It will produce a new column with 5 year age bands as a factor.

age_bandizer2 uses Standard Evaluation and currently takes in puts of band size 2,5,10 & 20.

health_data <- SangerTools::age_bandizer(df = health_data,
Age_col = Age)

health_data <- SangerTools::age_bandizer_2(df = health_data,
Age_col = "Age",
Age_band_size = 5)
Age Ageband
17 15-19
31 30-34
34 30-34
62 60-64
37 35-39
57 55-59

## Generating a categorical column chart easily

The package makes it very simple to create a categorical column chart. This will be implemented in the next example:

# Group by Ethnicity
diabetes_df <- health_data %>%
dplyr::filter(Diabetes==1)

SangerTools::categorical_col_chart(df = diabetes_df,
grouping_var = Ethnicity)+
scale_fill_sanger()+
labs(title = "Diabetic Patients by Ethnicity",
subtitle = "Nearly All Diabetics are White",
x = NULL,
y = "Number of Patients") +
coord_flip() 


# Group by Sex
health_data %>%
dplyr::filter(Diabetes==1) %>%
SangerTools::categorical_col_chart(Sex) +
scale_fill_sanger()+
labs(title = "Diabetic Patients by Gender",
x = NULL,
y = "Number of Patients")  

It really is that simple to generate very nice looking proportional charts.

## Crude Prevalence

Here we will look at the crude rate of diabetes To obtain the crude prevalence rate, this can be achieved below:

 crude_prevalence <- SangerTools::crude_rates(df = health_data,
Condition =  Diabetes,
Locality)
#> Joining, by = "Locality"
Locality Cohort_Size Diabetes_Population Prevalence_1k
The Forest of Dean 941 54 57.38576
Gloucester City 2683 149 55.53485
Cheltenham 2524 137 54.27892
North Cotswolds 464 23 49.56897
Stroud and Berkeley Vale 1841 91 49.42966
Tewkesbury Newent and Staunton 649 24 36.97997
South Cotswolds 898 33 36.74833

## Age Standardised Rates

Let’s revisit the example above. Diabetes is highly confounded by age. Most diabetics will be diagnosed after the age of 40.


asr_prevalence <- SangerTools::standardised_rates_df(df = health_data,
Split_by = Locality,
Condition = Diabetes,
Population_Standard = NULL,
Granular = FALSE,
Ageband )
#> Joining, by = c("Locality", "Ageband")
#> Joining, by = "Ageband"
Locality Standardised_Rate_1k
The Forest of Dean 57.04463
Gloucester City 55.68534
Cheltenham 53.97917
Stroud and Berkeley Vale 49.30150
North Cotswolds 47.64903
South Cotswolds 36.60576
Tewkesbury Newent and Staunton 35.37544

Given that each of the Localities now has the population structure of the county as whole; we can see slight differences to the crude prevalence rates.

## Age Standardised Rates with User Defined Population Structure

We will use another dataset attached to the package; the UK population from the year 2018. This is broken down by 5 year age bands. For a user define population structure to integrate with standardised_rates_df ensure to change the name of the population column to Pop_Weight

## Load 2018 UK Population Structure


uk_pop18<- SangerTools::uk_pop_standard

names(uk_pop18) <- c("Pop_Weight","Ageband")
Pop_Weight Ageband
3,914,000 0-4
4,139,000 5-9
3,859,000 10-14
3,669,000 15-19
4,185,000 20-24
4,527,000 25-29

## UK Age Standardised Diabetes Prevalence

asr_uk <- SangerTools::standardised_rates_df(df = health_data,
Split_by = Locality,
Condition = Diabetes,
Population_Standard = uk_pop18,
Granular = FALSE,
Ageband )
#> Joining, by = c("Locality", "Ageband")
#> Joining, by = "Ageband"
Locality Standardised_Rate_1k
The Forest of Dean 49.58949
Gloucester City 49.57563
South Cotswolds 47.70326
Cheltenham 47.67118
North Cotswolds 42.12233
Stroud and Berkeley Vale 41.66005
Tewkesbury Newent and Staunton 30.12367

## Combining Results

To view both crude and standardised rates we can use dplyr::left_join

combined_rates <- crude_prevalence %>%
dplyr::left_join(asr_prevalence, by = c("Locality"))
Locality Cohort_Size Diabetes_Population Prevalence_1k Standardised_Rate_1k
The Forest of Dean 941 54 57.38576 57.04463
Gloucester City 2683 149 55.53485 55.68534
Cheltenham 2524 137 54.27892 53.97917
North Cotswolds 464 23 49.56897 47.64903
Stroud and Berkeley Vale 1841 91 49.42966 49.30150
Tewkesbury Newent and Staunton 649 24 36.97997 35.37544
South Cotswolds 898 33 36.74833 36.60576

Other functionality added into the package would be to use the multiple CSV reader and clipboard functions.

## Excel Clipboard function

This copies a data frame to the clipboard for you for then pasting into Excel sheets, or csvs, or raw text.


SangerTools::excel_clip(combined_rates)

There is the potential to read from multiple CSVs as well and then these can be fed into data frames.

To implement this function you would need to have a number of CSVs contained in a folder. To read these in, follow the below instructions:

file_path = 'my_file_path_where_csvs_are_stored'

message("This won't work without changing the variable input to a local file path with CSVs in")
}
#> This won't work without changing the variable input to a local file path with CSVs in

multiple_excel_reader is the equivalent for excel files; however please read function documentation page as both functions have a strict set of requirements for execute.

## Splitting Dataframes and Saving

split_and_save is a quick way to split a dataframe on a specified column into subsequent dataframes after which each of dataframes is dynamically written to a location choice

SangerTools::split_and_save(
df = health_data,
Split_by = "Locality",
file_path = "Inputs/",
prefix = NULL
)

## Results to SQL

Write your results to SQL Server ensuring that the table name appears as expected.

This function makes a number of assumptions and is limited in scope; please read documentation.

SangerTools::df_to_sql(df = combined_rates,
driver = "SQL SERVER",
server = "Org-sql-db",
database = "MyReports",
sql_table_name = "Diabetes_Prevalence",
overwrite = FALSE)

## See Brand Colours

This is an anonymous function and can be called without any arguments


show_brand_palette()

#> [1] "#9880BB" "#0061BA" "#3BBCD9" "#223873" "#71B72B"

## See More Colours

This is also an anonymous function; it will show an extended colour palette

show_extended_palette()

#>  [1] "#9880BB" "#0061BA" "#3BBCD9" "#223873" "#71B72B" "#D585BA" "#007761"
#>  [8] "#4D8076" "#00C9A7" "#4A4453" "#C27767" "#D5CABD"

## Closing

More functions are being added to this tool and a new version of the file will be released on CRAN very soon. Keep an eye out on the associated GitHub for updates.