Under-recognition of metabolic syndrome in North West London (2000-2023): a 23-year retrospective analysis
Rakesh Dattani1,2, Benjamin Pierce3, Gulam Muktadir3
1Institute of Global Health Innovation, Imperial College London, London, UK.
Introduction:
Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors associated with increased morbidity and mortality. Despite the rising prevalence of obesity, hypertension, dyslipidaemia and glucose dysregulation, MetS remains inconsistently recognised and coded within electronic health records (EHRs). We aimed to determine the extent of under-recognition of MetS within North West London (NWL) over a 23-year period.
Methods:
The Discover-NOW London Secure Data Environment dataset was retrospectively analysed between 1 January 2000 and 31 July 2023. Adults aged ≥18 years were identified as having MetS if coded within EHRs or if they met ≥3 of 5 American Heart Association (AHA) 2005 diagnostic criteria. An Extended AHA definition incorporating BMI and HbA1c was also applied to reflect routine clinical practice.
Results:
Among 2 096 480 adults registered in NWL during the study period, 975 individuals (0.04%) had a clinician-coded diagnosis of MetS. In contrast, 594 325 individuals (21.2%) met AHA-defined criteria and 875 993 (31.3%) met Extended AHA-defined criteria. Women, individuals of Black or Black British ethnicity, and those from more deprived areas were under-represented in the coded cohort relative to algorithm-defined cohorts.
Conclusion:
Metabolic syndrome is substantially under-recorded within routine clinical coding in NWL. Recognition of the true prevalence of MetS within healthcare datasets may support improved risk stratification, enable population-level surveillance, and facilitate evaluation of MetS-related morbidity and healthcare utilisation.
