Avoidable mortality from respiratory tract infection and sudden unexplained death in children with chronic conditions: a data linkage study

Verfürden, Maximiliane L; Gilbert, Ruth; Sebire, Neil J.; Hardelid, Pia

doi:10.1136/archdischild-2017-314098

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…In the UK, national birth cohorts based on birth registration datasets, with follow-up from linked hospital admission and mortality records are routinely used for research in Scotland [11,12] and Wales [13]. In England, a whole-country birth cohort with rich information about the baby, mother and family could be developed by linking multiple data sources with information about birth and delivery (from Office for National Statistics [ONS] Birth Registration data, National Health Service [NHS] birth notification data, and Hospital Episode Statistics [HES], an administrative hospital dataset), with follow-up via linkage to hospital admission and mortality records.…”

Section: Introductionmentioning

confidence: 99%

Developing a national birth cohort for child health research using a hospital admissions database in England: The impact of changes to data collection practices

2020

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Background National birth cohorts derived from administrative health databases constitute unique resources for child health research due to whole country coverage, ongoing follow-up and linkage to other data sources. In England, a national birth cohort can be developed using Hospital Episode Statistics (HES), an administrative database covering details of all publicly funded hospital activity, including 97% of births, with longitudinal follow-up via linkage to hospital and mortality records. We present methods for developing a national birth cohort using HES and assess the impact of changes to data collection over time on coverage and completeness of linked follow-up records for children. Methods We developed a national cohort of singleton live births in 1998–2015, with information on key risk factors at birth (birth weight, gestational age, maternal age, ethnicity, area-level deprivation). We identified three changes to data collection, which could affect linkage of births to follow-up records: (1) the introduction of the “NHS Numbers for Babies (NN4B)”, an on-line system which enabled maternity staff to request a unique healthcare patient identifier (NHS number) immediately at birth rather than at civil registration, in Q4 2002; (2) the introduction of additional data quality checks at civil registration in Q3 2009; and (3) correcting a postcode extraction error for births by the data provider in Q2 2013. We evaluated the impact of these changes on trends in two outcomes in infancy: hospital readmissions after birth (using interrupted time series analyses) and mortality rates (compared to published national statistics). Results The cohort covered 10,653,998 babies, accounting for 96% of singleton live births in England in 1998–2015. Overall, 2,077,929 infants (19.5%) had at least one hospital readmission after birth. Readmission rates declined by 0.2% percentage points per annual quarter in Q1 1998 to Q3 2002, shifted up by 6.1% percentage points (compared to the expected value based on the trend before Q4 2002) to 17.7% in Q4 2002 when NN4B was introduced, and increased by 0.1% percentage points per annual quarter thereafter. Infant mortality rates were under-reported by 16% for births in 1998–2002 and similar to published national mortality statistics for births in 2003–2015. The trends in infant readmission were not affected by changes to data collection practices in Q3 2009 and Q2 2013, but the proportion of unlinked mortality records in HES and in ONS further declined after 2009. Discussion HES can be used to develop a national birth cohort for child health research with follow-up via linkage to hospital and mortality records for children born from 2003 onwards. Re-linking births before 2003 to their follow-up records would maximise potential benefits of this rich resource, enabling studies of outcomes in adolescents with over 20 years of follow-up.

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Section: Introductionmentioning

confidence: 99%

Developing a national birth cohort for child health research using a hospital admissions database in England: The impact of changes to data collection practices

2020

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“…Further work is needed to determine whether this is due to intercountry differences in the prevalence of chronic conditions, in the provision of healthcare for children with chronic conditions or in the recording of these conditions in hospitalisation records. Further comparison should also include information on what proportion of these deaths were expected (ie, whether RTI was part of terminal decline in child’s health, not possible to prevent) and what proportion were unexpected42.…”

Section: Discussionmentioning

confidence: 99%

Origins of disparities in preventable child mortality in England and Sweden: a birth cohort study

et al. 2019

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ObjectiveTo compare mortality in children aged <5 years from two causes amenable to healthcare prevention in England and Sweden: respiratory tract infection (RTI) and sudden unexpected death in infancy (SUDI).DesignBirth cohort study using linked administrative health databases from England and Sweden.Setting and participantsSingleton live births between 2003 and 2012 in England and Sweden, followed up from age 31 days until the fifth birthday, death or 31 December 2013.Main outcome measuresThe main outcome measures were HR for RTI-related mortality at 31–364 days and at 1–4 years and SUDI mortality at 31–364 days in England versus Sweden estimated using Cox proportional hazards models. We calculated unadjusted HRs and HRs adjusted for birth characteristics (gestational age, birth weight, sex and congenital anomalies) and socioeconomic factors (maternal age and socioeconomic status).ResultsThe English cohort comprised 3 928 483 births, 768 RTI-related deaths at 31–364 days, 691 RTI-related deaths at 1–4 years and 1166 SUDIs; the corresponding figures for the Swedish cohort were 1 012 682, 131, 118 and 189. At 31–364 days, unadjusted HR for RTI-related death in England versus Sweden was 1.52 (95% CI 1.26 to 1.82). After adjusting for birth characteristics, the HR reduced to 1.16 (95% CI 0.96 to 1.40) and for socioeconomic factors to 1.11 (95% CI 0.92 to 1.34). At 1–4 years, unadjusted HR was 1.58 (95% CI 1.30 to 1.92) and decreased to 1.32 (95% CI 1.09 to 1.61) after adjusting for birth characteristics and to 1.30 (95% CI 1.07 to 1.59) after further adjustment for socioeconomic factors. For SUDI, the respective HRs were 1.59 (95% CI 1.36 to 1.85) in the unadjusted model, and 1.40 (95% CI 1.20 to 1.63) after accounting for birth characteristics and 1.19 (95% CI 1.02 to 1.39) in the fully adjusted model.ConclusionInterventions that improve maternal health before and during pregnancy to reduce the prevalence of adverse birth characteristics and address poverty could reduce child mortality due to RTIs and SUDIs in England.

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“…These findings provide clear policy direction in terms of how to prevent childhood deaths: support women before and during pregnancy to improve birth outcomes. We have also demonstrated, using a birth cohort from Scotland, that children with chronic conditions are at increased risk of deaths from respiratory tract infection and, to a lesser extent, sudden unexpected deaths 19. These studies examined mortality in children less than 5 years old.…”

Section: Administrative Datamentioning

confidence: 90%

“…However, since one in four CDOP reviews takes longer than 12 months to complete,11 timeliness of CDOP reviews currently does not appear to be any better than for ONS mortality records. We have previously shown that indicating whether a death is expected would be extremely useful for indicating which deaths are amenable to healthcare intervention 19. Clinician reporting of deaths to CDOP as expected or unexpected could therefore be useful for filtering deaths for CDOP investigation and would provide important information that could be linked to death certificates.…”

Section: Administrative Datamentioning

confidence: 99%

Preventing child deaths: what do administrative data tell us?

2019

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Avoidable mortality from respiratory tract infection and sudden unexplained death in children with chronic conditions: a data linkage study

Cited by 6 publications

References 21 publications

Developing a national birth cohort for child health research using a hospital admissions database in England: The impact of changes to data collection practices

Developing a national birth cohort for child health research using a hospital admissions database in England: The impact of changes to data collection practices

Origins of disparities in preventable child mortality in England and Sweden: a birth cohort study

Preventing child deaths: what do administrative data tell us?

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