The Linked CENTURY Study: linking three decades of clinical and public health data to examine disparities in childhood obesity

Abstract

BackgroundDespite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations. We report on the construction of the Linked CENTURY database, incorporating CENTURY (Collecting Electronic Nutrition Trajectory Data Using Records of Youth) Study data with birth certificates; and discuss the potential implications of combining clinical and public health data sources in examining the etiology of disparities in childhood obesity.MethodsWe linked the existing CENTURY Study, a database of 269,959 singleton children from birth to age 18 years with measured heights and weights, with each child’s Massachusetts birth certificate, which captures information on their mothers’ pregnancy history and detailed socio-demographic information of both mothers and fathers.ResultsOverall, 74.2 % were matched, resulting in 200,343 children in the Linked CENTURY Study with 1,580,597 well child visits. Among this cohort, 94.0 % (188,334) of children have some father information available on the birth certificate and 60.9 % (121,917) of children have at least one other sibling in the dataset.Using maternal race/ethnicity from the birth certificate as an indicator of children’s race/ethnicity, 75.7 % of children were white, 11.6 % black, 4.6 % Hispanic, and 5.7 % Asian. Based on socio-demographic information from the birth certificate, 20.0 % of mothers were non-US born, 5.9 % smoked during pregnancy, 76.3 % initiated breastfeeding, and 11.0 % of mothers had their delivery paid for by public health insurance. Using clinical data from the CENTURY Study, 22.7 % of children had a weight-for-length ≥ 95th percentile between 1 and 24 months and 12.0 % of children had a body mass index ≥ 95th percentile at ages 5 and 17 years.ConclusionsBy linking routinely-collected data sources, it is possible to address research questions that could not be answered with either source alone. Linkage between a clinical database and each child’s birth certificate has created a unique dataset with nearly complete racial/ethnic and socio-demographic information from both parents, which has the potential to examine the etiology of racial/ethnic and socioeconomic disparities in childhood obesity.

Racial differences in crossing major growth percentiles in infancy

“…We created the Linked CENTURY Study by linking each child's clinical record and birth certificate 5. Information from the birth certificate can help enhance clinical databases by filling in missing child race/ethnicity information and capturing information not routinely collected, such as maternal education 5.…”

“…The Linked CENTURY Study is a longitudinal clinical database of well-child visits for 200 343 singleton children through age 18 years linked to each child's Massachusetts birth certificate (74.2% of participants in the original CENTURY Study were linked) 5. While the original CENTURY Study contained children's clinical growth data, race/ethnicity was missing for 36% of participants, and linkage with birth certificates provided most of those missing data.…”

“…While the original CENTURY Study contained children's clinical growth data, race/ethnicity was missing for 36% of participants, and linkage with birth certificates provided most of those missing data. From each birth certificate we extracted data on maternal race, self-reported in the categories white, black, Asian/Pacific Islander, American Indian and other, which was available for 98.7% of the participants 5. For this analysis, we restricted the study population to white and black participants.…”

“…More details on the measurements are available elsewhere 5. We used height and weight measurements to calculate age-specific and sex-specific WFL percentiles for children <24.0 months and body mass index (BMI) percentiles for children aged 2–18 years based on the CDC growth charts from 2000 2.…”

The Combined Effect of Infant Birth Weight and Maternal Determinants of Health on the Development of Childhood Obesity: A Systematic Review

“…Currently, childhood obesity prevention largely revolves around instilling good health behaviors by educating parents on the importance of diet, exercise, and lifestyle factors [6]. While health behaviors are indisputably an important determinant in the development of obesity, literature also implicates factors that are more difficult to modify and address including genetics, fetal development, environment, and socioeconomic status [7][8][9].…”