Rodney Thornton Jackson (born 1954) is a New Zealand medically trained epidemiologist who has had lead roles in publicly funded research focussing on systems to effectively identify risk factors in the epidemiology of chronic diseases, in particular cardiovascular diseases (CVDs). This involved linking large cohort studies to regional and national electronic health databases and enabling the generation of new risk-prevention equations using web-based tools, such as the PREDICT model, to implement, monitor and improve risk assessment and management guidelines. Research on asthma in which Jackson participated influenced decisions made by the New Zealand Ministry of Health, and he has contributed to public debate on dietary risk factors for heart attacks and strokes. Following an evidence-based approach to identification of disparities in medical outcomes for different groups within the New Zealand population, Jackson took a position on racism in the medical sector. In 2020, he became a frequent commentator in the media on the approach of the New Zealand government to the COVID-19 pandemic. Since 1999, Jackson has been professor of epidemiology at the University of Auckland.
Education and career At the University of Auckland, Jackson obtained a Bachelor of Science (BSc) in 1974, and a Bachelor of Medicine, Bachelor of Surgery (MB ChB) in 1977. A postgraduate diploma in obstetrics and gynaecology (DipObst) was completed at Auckland in 1980, as was a postgraduate diploma in community health (DipComH) from the University of Otago in 1983. Jackson completed a Master of Medical Sciences (MMedSc) in community health at the University of Auckland in 1984, and a PhD in epidemiology at the same institution in 1989. He also trained in public health medicine, receiving his fellowship in public health medicine in 1990. Between 1990 and 1998, Jackson held roles as a senior lecturer and associate professor at University of Auckland, with a position in 1996 as visiting professor at the Centre for Evidence Based Medicine at the University of Oxford. From 1999 to 2003, Jackson was professor and head of the Department of Community Health, in the Faculty of Medical and Health Sciences, at Auckland. Since 2004, he has been professor of epidemiology, and served as head of the Section of Epidemiology and Biostatistics, in the School of Population Health, Faculty of Medical and Health Sciences, between 2004 and 2009.
Epidemiologic studies Integration of data Since around 2000, Jackson's main research has focused on integrating public health and healthcare epidemiology by linking individual and national data, scalable from individual patients to patient groups to entire populations. He initially established the PREDICT study and subsequently led the establishment of the VIEW research programs.
In 2011, Jackson co-authored an article in The New Zealand Medical Journal that challenged the manner in which New Zealand district health boards (DHBs) had managed the health needs of patients with long-term conditions. While the article acknowledged that some chronic diseases were preventable by "addressing shared risk factors, mainly tobacco use, unhealthy diet and physical inactivity...these interventions are dependent on several key factors; accurate identification of high-risk patients; systematic offering of interventions to these patients and; long-term self-management and maintenance." The paper suggested the use of information technology to provide a more patient-centred approach that linked data from the initial screening through to medical interventions and rehabilitation.
Jackson was involved in research in 2018 that created three data-based populations: a New Zealand population derived from Statistics New Zealand's Integrated Data Infrastructure (IDI), a 2013 census population and a 2013 Health Service Utilisation population. The aim of the research was to compare the differences in cardiovascular disease prevalence estimates derived from each of the cohorts. The data showed largest percentage differences between the IDI and the other populations for males and those aged from 15 to 34 years, but the largest differences were for people living in deprived areas, with ethnic distributing varying across the three cohorts. The study noted that the "Health Service Utilisation population generally overestimated cardiovascular disease prevalence, while the Census population generally underestimated it...[and concluded that]...The New Zealand IDI population is the most comprehensive and appropriate national cohort for use in health and social research."
In 2021, Jackson co-led a team that was funded by the Health Research Council of New Zealand to create an "anonymized register of cardiovascular and related risks to help combat the likes of diabetes, gout, obesity and heart failure" in the five-year VAREANZ (Vascular Risk Equity for All New Zealanders)research programme. A paper on the methodology to be used in this programme co-authored by Jackson noted that while there were some limitations to the data gathering, the strength of the programme was that the "datasets are ideal for examining variation across demographic or clinically-defined groups in the use of hospital services, outpatient clinics and pharmacotherapy or other research questions relating to treatment, outcomes and prognosis for CVD and related conditions."
PREDICT Since 2002, Jackson has co-led PREDICT, a large-scale cohort study of CVD risk prediction, which is now the world's largest prospective study of CVD in primary care with over 500,000 participants. Jackson and his team, in partnership with Enigma, a New Zealand company specialising in web solutions in healthcare, developed the web-based PREDICT decision support software for the assessment and management of CVD risk. The study provided clinical decision support for New Zealand primary care practitioners while also creating a research cohort, with every patient risk assessment being stored and linked to future hospitalisations and death using secure encryption methodology. In the 19th paper published about the study, it was stated that the use of the software had led to a "better understanding of the acceptability and impact of computerized decision support in primary care, data reliability and variations in risk factor profiles between ethnicities...[because]...the cohort was derived directly from routine practice with the authorisation to generate a single ethnicity classification across multiple databases...[so]...if a patient self-identifies as Māori in any of the linked databases, they will be classified as Māori.
Research published in 2018, used the PREDICT computer algorithm to develop equations relevant to patients in contemporary primary care, and documented the performance of these new equations to assess the risk profiles of a nationally representative cohort of New Zealanders. The effectiveness of the equations compared favorability to data gathered by the American College of Cardiology using the prediction equations currently in use at the time in that country.
Jackson participated in a 2020 study that documented the efficiency of a newly developed risk equation (PREDICT-2) in estimating the five-year risk of CVD event recurrence among patients aged 30–79 years with known atherosclerotic cardiovascular disease (ASCVD). The study showed that the PREDICT-2 risk equation complemented the PREDICT-1 risk scores for primary prevention of CVD because it was well calibrated to the New Zealand population and could "rationally and transparently target more intensive interventions to those at elevated CVD risk across the population."
The value of the PREDICT model was evidenced in a study on cardiovascular risk equations for diabetes patients from New Zealand and Chinese electronic health records (CREDENCE) study in 2021 which investigated cardiovascular risk in two large contemporary cohorts of people with type 2 diabetes from New Zealand and China. The study was designed to derive and evaluate CVD risk prediction models and equations in cohorts from both countries—one developed, one developing—to determine if the models were equally applicable. Both population studies were built on data from electronic health records, using PREDICT-T2D cohort for New Zealand and CHERRY-T2D cohort for China. The paper, co-authored by Jackson, recorded that there were "5926 (7.7% fatal) CVD events in the New Zealand cohort and 3650 (8.8% fatal) in the Chinese cohort but demonstrated that the most common types of CVD events differed significantly between the cohorts. The research results have implications for policy makers, clinicians and the public and will facilitate personalised management of cardiovascular risk in people with type 2 diabetes worldwide."
Other risk prediction projects In 2017 Jackson participated in a study to investigate integration of individual level data with data at a national level for a country's total adult population, to develop a synthetic national population model to predict the risk of cardiovascular disease. The study shows that it is possible to develop this model with "demographic and CVD-risk profiles using national census data, routine national hospitalisation and medication data and a large sub-national primary care dataset," and the researchers conclude that this would "inform CVD risk management guideline updates in New Zealand and elsewhere."
Jackson was involved in research in 2021 that assessed the value of a machine learning-based risk approach for cardiovascular disease risk prediction across the national population of New Zealand. The study concludes that the deep learning models performed well in terms of calibration and discrimination of the probability estimate, are readily available and "could be applied to large health administrative datasets to derive interpretable CVD risk prediction equations that are more accurate than traditional Cox proportional hazards models."
He took part in Research funded by Health Research Council of New Zealand, National Heart Foundation of New Zealand and Healthier Lives National Science Challenge, which focused on predicting cardiovascular risk in middle-aged adults with diabetes. A paper he co-authored, suggests that internationally doctors might be unnecessarily administering expensive drug treatments to patients with diabetes due to "over-estimating patients' risks of cardiovascular problems such as heart disease and stroke... [and that] these findings have clear international implications as increased diabetes screening will lead to the identification of many people with asymptomatic diabetes who were at low risk. Jackson commented that "for the first time, general practitioners here are able to use risk prediction equations developed in New Zealand and derived from New Zealand patients, ... [and] ...these are currently the most accurate equations in the world for predicting risk of heart attacks and strokes in people with diabetes."
Polypill project From 2006 to 2012, Jackson was a Co-Investigator on the Polypill project at University of Auckland. This involved bundling a group cardiovascular disease reduction drugs to give the flexibility to modify the daily dose of each drug. A report from the London School of Pharmacy, authored by Professor David Taylor said that this approach, when combined with other changes to lifestyle could be effective, and called for policies based on science "that encourage pharmaceutical companies to create polypills using older generic medicines."
VIEW and VAREANZ programmes