ObjectivesThe aim of this study is to develop a predictive risk model (PRM) for school readiness measured at age 3 years using perinatal and early infancy data.Design and participantsThis paper describes the development of a PRM. Predictors were identified from the UK Millennium Cohort Study wave 1 data, collected when participants were 9 months old. The outcome was school readiness at age 3 years, measured by the Bracken School Readiness Assessment. Stepwise selection and dominance analysis were used to specify two models. The models were compared by the area under the receiver operating characteristic curve (AUROC) and integrated discrimination improvement (IDI).ResultsData were available for 9487 complete cases. At age 3, 11.7% (95% CI 11.0% to 12.3%) of children were not school ready. The variables identified were: parents’ Socio-Economic Classification, child’s ethnicity, maternal education, income band, sex, household number of children, mother’s age, low birth weight, mother’s mental health, infant developmental milestones, breastfeeding, parents’ employment, housing type. A parsimonious model included the first six listed variables (model 2). The AUROC for model 1 was 0.80 (95% CI 0.78 to 0.81) and 0.78 (95% CI 0.77 to 0.79) for model 2. Model 1 resulted in a small improvement in discrimination (IDI=1.3%, p<0.001).ConclusionsPerinatal and infant risk factors predicted school readiness at age three with good discrimination. Social determinants were strong predictors of school readiness. This study demonstrates that school readiness can be predicted by six attributes collected around the time of birth.
Aims: We describe the epidemiology of sexually transmitted infections (STIs) and HIV in people aged ⩾45 years in England and provide future projections about the burden of STIs in this age group. Methods: Analysis of national surveillance data in England from 2014 to 2019 for chlamydia, gonorrhoea, herpes, syphilis, anogenital warts and HIV was carried out. Time trends were assessed by the Poisson regression and reported using incidence rate ratios (IRRs). Two scenarios were modelled to predict the number of new STI diagnoses and associated costs in 2040. Results: In 2019, there were 37,692 new STI diagnoses in people ⩾45 years in England. Between 2014 and 2019, there was a significant increase in the rate of new STI diagnoses in men (IRR = 1.05, p = .05) and those aged 45–64 years (IRR = 1.04, p = .05). Absolute numbers of new STI diagnoses in men who have sex with men increased by 76% between 2014 and 2019 (IRR = 1.15, p < .001). In adults aged ⩾50 years, the number of episodes of care for HIV increased over time (age = 50–64 years, IRR = 1.10; age = 65+ years, IRR = 1.13; p <.001). The modelled scenarios predicted an increase in STI diagnoses and costs in older people by 2040. Conclusion: STI rates in England are increasing in people aged ⩾45 years. The population is ageing and older people will contribute an increasing burden to STI costs if this trend continues. The reasons for this trend are not fully understood and further longitudinal epidemiological research is needed. Sexual health promotion campaigns and healthcare interventions targeted at older people should be prioritised.
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