Validation of ethnicity in administrative hospital data in women giving birth in England: cohort study

Jardine, Jennifer; Frémeaux, Alissa; Coe, Megan; Gurol‐Urganci, Ipek; Pasupathy, Dharmintra; Walker, Kate

doi:10.1136/bmjopen-2021-051977

Cited by 9 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 81%

“…Routine ethnicity classification is in principle self-defined, but in reality may be assigned by the health professional completing the notification 30 with potential for misclassification. Misclassification has been found to be a particular issue for more granular mixed and other ethnic groups 31 ; here, we report on granular Asian and black ethnic groups where misclassification is Measurement of deprivation is limited to area level data on income deprivation. In addition, there is a lack of information in the birth notification data regarding mother's country of birth, gravidity and previous stillbirths as well as other potentially modifiable risk factors such as antenatal attendance and smoking during pregnancy.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study

et al. 2022

View full text Add to dashboard Cite

ObjectivesTo investigate inequalities in stillbirth rates by ethnicity to facilitate development of initiatives to target those at highest risk.DesignPopulation-based perinatal mortality surveillance linked to national birth and death registration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK).SettingUK.Participants4 391 569 singleton births at ≥24+0 weeks gestation between 2014 and 2019.Main outcome measuresStillbirth rate difference per 1000 total births by ethnicity.ResultsAdjusted absolute differences in stillbirth rates were higher for babies of black African (3.83, 95% CI 3.35 to 4.32), black Caribbean (3.60, 95% CI 2.65 to 4.55) and Pakistani (2.99, 95% CI 2.58 to 3.40) ethnicities compared with white ethnicities. Higher proportions of babies of Bangladeshi (42%), black African (39%), other black (39%) and black Caribbean (37%) ethnicities were from most deprived areas, which were associated with an additional risk of 1.50 stillbirths per 1000 births (95% CI 1.32 to 1.67). Exploring primary cause of death, higher stillbirth rates due to congenital anomalies were observed in babies of Pakistani, Bangladeshi and black African ethnicities (range 0.63–1.05 per 1000 births) and more placental causes in black ethnicities (range 1.97 to 2.24 per 1000 births). For the whole population, over 40% of stillbirths were of unknown cause; however, this was particularly high for babies of other Asian (60%), Bangladeshi (58%) and Indian (52%) ethnicities.ConclusionsStillbirth rates declined in the UK, but substantial excess risk of stillbirth persists among babies of black and Asian ethnicities. The combined disadvantage for black, Pakistani and Bangladeshi ethnicities who are more likely to live in most deprived areas is associated with considerably higher rates. Key causes of death were congenital anomalies and placental causes. Improved strategies for investigation of stillbirth causes are needed to reduce unexplained deaths so that interventions can be targeted to reduce stillbirths.

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 96%

Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Parity and previous cesarean section were determined using women’s previous HES hospital admission records. Ethnic background was coded using the Office for National Statistics (ONS) 2001 census categorisation for ethnicity, collapsed into 4 groups: White, South Asian, Black, and Other (combined Mixed and Other, including Chinese), as there is evidence of misclassification if more granular groups are used [ 19 , 20 ].…”

Section: Methodsmentioning

confidence: 99%

Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention and pregnancy outcome rates in England during the pandemic and corresponding pre-pandemic calendar periods, and to assess whether differences in these rates varied according to ethnic and socioeconomic background. Methods and findings We conducted a national study of singleton births in English National Health Service hospitals. We compared births during the COVID-19 pandemic period (23 March 2020 to 22 February 2021) with births during the corresponding calendar period 1 year earlier. The Hospital Episode Statistics database provided administrative hospital data about maternal characteristics, obstetric inventions (induction of labour, elective or emergency cesarean section, and instrumental birth), and outcomes (stillbirth, preterm birth, small for gestational age [SGA; birthweight < 10th centile], prolonged maternal length of stay (≥3 days), and maternal 42-day readmission). Multi-level logistic regression models were used to compare intervention and outcome rates between the corresponding pre-pandemic and pandemic calendar periods and to test for interactions between pandemic period and ethnic and socioeconomic background. All models were adjusted for maternal characteristics including age, obstetric history, comorbidities, and COVID-19 status at birth. The study included 948,020 singleton births (maternal characteristics: median age 30 years, 41.6% primiparous, 8.3% with gestational diabetes, 2.4% with preeclampsia, and 1.6% with pre-existing diabetes or hypertension); 451,727 births occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% pandemic versus 0.37% pre-pandemic, p = 0.16). Preterm birth and SGA birth rates were slightly lower during the pandemic (6.0% versus 6.1% for preterm births, adjusted odds ratio [aOR] 0.96, 95% CI 0.94–0.97; 5.6% versus 5.8% for SGA births, aOR 0.95, 95% CI 0.93–0.96; both p < 0.001). Slightly higher rates of obstetric intervention were observed during the pandemic (40.4% versus 39.1% for induction of labour, aOR 1.04, 95% CI 1.03–1.05; 13.9% versus 12.9% for elective cesarean section, aOR 1.13, 95% CI 1.11–1.14; 18.4% versus 17.0% for emergency cesarean section, aOR 1.07, 95% CI 1.06–1.08; all p < 0.001). Lower rates of prolonged maternal length of stay (16.7% versus 20.2%, aOR 0.77, 95% CI 0.76–0.78, p < 0.001) and maternal readmission (3.0% versus 3.3%, aOR 0.88, 95% CI 0.86–0.90, p < 0.001) were observed during the pandemic period. There was some evidence that differences in the rates of preterm birth, emergency cesarean section, and unassisted vaginal birth varied according to the mother’s ethnic background but not according to her socioeconomic background. A key limitation is that multiple comparisons were made, increasing the chance of false-positive results. Conclusions In this study, we found very small decreases in preterm birth and SGA birth rates and very small increases in induction of labour and elective and emergency cesarean section during the COVID-19 pandemic, with some evidence of a slightly different pattern of results in women from ethnic minority backgrounds. These changes in obstetric intervention rates and pregnancy outcomes may be linked to women’s behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels.

show abstract

“…Bangladeshi, Indian, and other Asian. Importantly, guidance for the collection of ethnicities has not been updated in the NHS since 2001 and is no longer in line with the census categories for 2011 and 2021 [ 38 , 40 ]. This presents challenges in comparing the health data across populations, and patients are not being presented with the same survey response options as those used in population estimates.…”

Section: Discussionmentioning

confidence: 99%

“…The outdated classification in the NHS may also confound the selection of ‘other’ or ‘any other’ as the narrowly defined categories do not represent their ethnicity. For example, Arab, Gypsy, or Irish Traveller were not defined in the NHS categorisation but are in the more recent ONS census [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020

Toal

Fowler

Pearse

et al. 2022

J. Racial and Ethnic Health Disparities

View full text Add to dashboard Cite

Background and Aim The COVID-19 pandemic highlighted adverse outcomes in Asian, Black, and ethnic minority groups. More research is required to explore underlying ethnic health inequalities. In this study, we aim to examine pre-COVID ethnic inequalities more generally through healthcare utilisation to contextualise underlying inequalities that were present before the pandemic. Design This was an ecological study exploring all admissions to NHS hospitals in England from 2017 to 2020. Methods The primary outcomes were admission rates within ethnic groups. Secondary outcomes included age-specific and age-standardised admission rates. Sub-analysis of admission rates across an index of multiple deprivation (IMD) deciles was also performed to contextualise the impact of socioeconomic differences amongst ethnic categories. Results were presented as a relative ratio (RR) with 95% confidence intervals. Results Age-standardised admission rates were higher in Asian (RR 1.40 [1.38–1.41] in 2019) and Black (RR 1.37 [1.37–1.38]) and lower in Mixed groups (RR 0.91 [0.90–0.91]) relative to White. There was significant missingness or misassignment of ethnicity in NHS admissions: with 11.7% of admissions having an unknown/not-stated ethnicity assignment and ‘other’ ethnicity being significantly over-represented. Admission rates did not mirror the degree of deprivation across all ethnic categories. Conclusions This study shows Black and Asian ethnic groups have higher admission rates compared to White across all age groups and when standardised for age. There is evidence of incomplete and misidentification of ethnicity assignment in NHS admission records, which may introduce bias to work on these datasets. Differences in admission rates across individual ethnic categories cannot solely be explained by socioeconomic status. Further work is needed to identify ethnicity-specific factors of these inequalities to allow targeted interventions at the local level.

show abstract

Validation of ethnicity in administrative hospital data in women giving birth in England: cohort study

Cited by 9 publications

References 20 publications

Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study

Understanding ethnic inequalities in stillbirth rates: a UK population-based cohort study

Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study

Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020

Contact Info

Product

Resources

About