Completeness and representativeness of body mass index in children's electronic general practice records: Linked cross‐sectional study in an ethnically‐diverse urban population in the United Kingdom

Abstract

Summary Objective To assess completeness and accuracy of children's body mass index (BMI) recorded in general practice electronic health records (GP‐EHRs). Methods We linked National Child Measurement Programme (NCMP) records from 29 839 5‐year‐olds and 26 660 11‐year‐olds attending state schools in inner London to GP‐EHRs (95% linked; 49.1% girls). We estimated adjusted odds (aOR) of at least one GP‐BMI record by sex, ethnic background, area‐level deprivation, weight‐status and long‐term conditions. We examined within‐child BMI differences and compared obesity prevalence from these sources. Results 10.5% (2964/28330) and 26.0% (6598/25365) of 5‐ and 11‐year‐olds respectively had at least one GP‐BMI record. Underweight (aOR;95% CI:1.71;1.34,2.19), obesity (1.45;1.27,1.65), South Asian background (1.55;1.38,1.74), presence of a long‐term condition (8.15;7.31,9.10), and residence in deprived areas (Wald statistic 38.73; P‐value<0.0001) were independently associated with at least one GP‐BMI record. NCMP‐BMI and GP‐BMI differed by +0.45(95% Limits of Agreement −1.60,+2.51) and + 0.16(−2.86,+3.18) in 5‐ and 11‐year‐olds, respectively. The prevalence of obesity based on GP‐BMI was 18.2%(16.1,20.5) and 35.9%(33.9,38.0) in 5‐ and 11‐year‐olds respectively, compared to 12.9%(12.5,13.3) and 26.9%(26.4,27.4) based on NCMP‐BMI. Conclusion Child BMI is not comprehensively recorded in urban general practice. Linkage to school measurement records is feasible and enables assessment of health outcomes of obesity.

Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records

“…We used real-world linked primary care and school measurement data for a 6-year period in a geographically contiguous urban area with an ethnically diverse population, representative of the wider population in NEL. We have previously shown that school measurement data provide less biased and more accurate information about child weight status than primary care EHRs 22. We excluded musculoskeletal consultations before the date of school measurement to ensure the musculoskeletal outcomes were reported after the exposure of interest.…”

Supporting healthcare professionals to address child weight with parents: a qualitative study

“… 32 The present findings of the lack of HCPs’ knowledge of children’s weight management services would suggest that there is even greater need to improve communication between primary care and these services. In England, few children have BMI recorded in their primary care health record 33 and there is evidence that HCPs are not good at identifying children with excess weight using observation alone. 34 The NCMP provides objective data with high national coverage, 7 , 35 therefore the integration of these data into primary care records represents a key opportunity in supporting HCPs to address child weight with parents.…”

Is obesity more likely among children sharing a household with an older child with obesity? Cross-sectional study of linked National Child Measurement Programme data and electronic health records

“…We used linked school measurement programme records of weight status as we have previously shown that GP electronic health records do not contain accurate, up-to-date child measurement data and are biased to children at both extremes of the BMI distribution. 28 This resulted in exclusion of 30 552 school measurement programme participants who did not live with another school measurement programme participant in the 2013-2019 academic years.…”