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Hua X, Petrou S, Coathup V, Carson C, Kurinczuk JJ, Quigley MA, Boyle E, Johnson S, Macfarlane A, Rivero-Arias O. Gestational age and hospital admission costs from birth to childhood: a population-based record linkage study in England. Arch Dis Child Fetal Neonatal Ed 2023; 108:485-491. [PMID: 36759168 PMCID: PMC10447377 DOI: 10.1136/archdischild-2022-324763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To examine the association between gestational age at birth and hospital admission costs from birth to 8 years of age. DESIGN Population-based, record linkage, cohort study in England. SETTING National Health Service (NHS) hospitals in England, UK. PARTICIPANTS 1 018 136 live, singleton births in NHS hospitals in England between 1 January 2005 and 31 December 2006. MAIN OUTCOME MEASURES Hospital admission costs from birth to age 8 years, estimated by gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks). RESULTS Both birth admission and subsequent admission hospital costs decreased with increasing gestational age at birth. Differences in hospital admission costs between gestational age groups diminished with increasing age, particularly after the first 2 years following birth. Children born extremely preterm (<28 weeks) and very preterm (28-31 weeks) still had higher average hospital admission costs (£699 (95% CI £419 to £919) for <28 weeks; £434 (95% CI £305 to £563) for 28-31 weeks) during the eighth year of life compared with children born at 40 weeks (£109, 95% CI £104 to £114). Children born extremely preterm had the highest 8-year cumulative hospital admission costs per child (£80 559 (95% CI £79 238 to £82 019)), a large proportion of which was incurred during the first year after birth (£71 997 (95% CI £70 866 to £73 097)). CONCLUSIONS The association between gestational age at birth and hospital admission costs persists into mid-childhood. The study results provide a useful costing resource for future economic evaluations focusing on preventive and treatment strategies for babies born preterm.
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Affiliation(s)
- Xinyang Hua
- Centre for Health Policy, Melbourne School for Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health, University of Oxford, Oxford, UK
| | - Victoria Coathup
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Reader M. The infant health effects of starting universal child benefits in pregnancy: Evidence from England and Wales. JOURNAL OF HEALTH ECONOMICS 2023; 89:102751. [PMID: 36948047 DOI: 10.1016/j.jhealeco.2023.102751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/27/2023] [Accepted: 03/11/2023] [Indexed: 06/18/2023]
Abstract
Child benefits are typically paid from birth. This paper asks whether starting universal child benefits in pregnancy leads to improvements in infant health. Leveraging administrative birth registry and hospital microdata from England and Wales, I study the effects of the Health in Pregnancy Grant, a universal conditional cash transfer equivalent to three months of child benefit (190 GBP) as a lump sum to pregnant mothers from 2009 to 2011. I exploit quasi-experimental variation in eligibility with a regression discontinuity design in the date of birth of the baby. I find that the policy increased birth weight by 8-12 grams on average, reduced low birth weight (<2500 g) by 3-6 percent and decreased prematurity by 9-11 percent. Younger mothers, particularly those living in deprived areas, benefit the most. I present evidence that the mechanisms are unlikely to be antenatal care, nutrition or smoking, with reductions in stress remaining a possible explanation.
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Affiliation(s)
- Mary Reader
- STICERD, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom.
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Garcia KKS, de Miranda CB, de Sousa FNEF. Procedures for health data linkage: applications in health surveillance. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e20211272. [PMID: 36287481 PMCID: PMC9887966 DOI: 10.1590/s2237-96222022000300004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/08/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To present a standardized methodology for linking different public health databases. METHODS This was a methodological review article specifically describing data processing procedures for deterministic linkage between structured databases. It instructs on how to: treat data, select linkage keys, and link databases using two databases simulated in R software. RESULTS The commands used for the deterministic linkage of the inner_join type were presented. The linkage process resulted in a database with 40,108 pairs using only the "Name" key. Adding the second key, "Name of mother", the resulted dropped to 112 pairs. By adding the third key, "Date of birth", only two pairs were identified. CONCLUSION Database linkage and its analysis are valid and valuable tools for health services in supporting health surveillance actions.
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Coathup V, Carson C, Kurinczuk JJ, Macfarlane AJ, Boyle E, Johnson S, Petrou S, Quigley MA. Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study. PLoS One 2021; 16:e0257341. [PMID: 34555039 PMCID: PMC8459942 DOI: 10.1371/journal.pone.0257341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Children born preterm (<37 completed weeks' gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship. METHODS AND FINDINGS Using a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1-2, 3-4, 5-6, and 7-10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7-10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91-7.22) during infancy, declining to 3.16 (2.50-3.99) at ages 7-10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21-1.27) and 1·18 (1.13-1.23), during infancy and aged 7-10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55-11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56-7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20-13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95-11.32)) were the most common causes. CONCLUSIONS Gestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7-10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.
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Affiliation(s)
- Victoria Coathup
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Claire Carson
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | | | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
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Favarato G, Clemens T, Cunningham S, Dibben C, Macfarlane A, Milojevic A, Taylor J, Wijlaars LPMM, Wood R, Hardelid P. Air Pollution, housing and respirfatory tract Infections in Children: NatIonal birth Cohort study (PICNIC): study protocol. BMJ Open 2021; 11:e048038. [PMID: 33941636 PMCID: PMC8098990 DOI: 10.1136/bmjopen-2020-048038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Respiratory tract infections (RTIs) are the most common reason for hospital admission among children <5 years in the UK. The relative contribution of ambient air pollution exposure and adverse housing conditions to RTI admissions in young children is unclear and has not been assessed in a UK context. METHODS AND ANALYSIS The aim of the PICNIC study (Air Pollution, housing and respiratory tract Infections in Children: NatIonal birth Cohort Study) is to quantify the extent to which in-utero, infant and childhood exposures to ambient air pollution and adverse housing conditions are associated with risk of RTI admissions in children <5 years old. We will use national administrative data birth cohorts, including data from all children born in England in 2005-2014 and in Scotland in 1997-2020, created via linkage between civil registration, maternity and hospital admission data sets. We will further enhance these cohorts via linkage to census data on housing conditions and socioeconomic position and small area-level data on ambient air pollution and building characteristics. We will use time-to-event analyses to examine the association between air pollution, housing characteristics and the risk of RTI admissions in children, calculate population attributable fractions for ambient air pollution and housing characteristics, and use causal mediation analyses to explore the mechanisms through which housing and air pollution influence the risk of infant RTI admission. ETHICS, EXPECTED IMPACT AND DISSEMINATION To date, we have obtained approval from six ethics and information governance committees in England and two in Scotland. Our results will inform parents, national and local governments, the National Health Service and voluntary sector organisations of the relative contribution of adverse housing conditions and air pollution to RTI admissions in young children. We will publish our results in open-access journals and present our results to the public via parent groups and social media and on the PICNIC website. Code and metadata will be published on GitHub.
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Affiliation(s)
- Graziella Favarato
- Population, Policy and Practice Research and Teaching Department, University College London Institute of Child Health, London, UK
| | - Tom Clemens
- School of Geosciences, The University of Edinburgh, Edinburgh, UK
| | - Steven Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Chris Dibben
- School of Geosciences, The University of Edinburgh, Edinburgh, UK
| | | | - Ai Milojevic
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathon Taylor
- Faculty of Built Environment, Tampere University, Tampere, Finland
| | | | - Rachael Wood
- Clinical and Public Health Intelligence Team, Public Health Scotland, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Pia Hardelid
- Population, Policy and Practice Research and Teaching Department, University College London Institute of Child Health, London, UK
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Coathup V, Boyle E, Carson C, Johnson S, Kurinzcuk JJ, Macfarlane A, Petrou S, Rivero-Arias O, Quigley MA. Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study). BMJ 2020; 371:m4075. [PMID: 33239272 PMCID: PMC7687266 DOI: 10.1136/bmj.m4075] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood. DESIGN Population based, record linkage, cohort study in England. SETTING NHS hospitals in England, United Kingdom. PARTICIPANTS 1 018 136 live, singleton births in NHS hospitals in England between January 2005 and December 2006. MAIN OUTCOME MEASURES Primary outcome was all inpatient hospital admissions from birth to age 10, death, or study end (March 2015); secondary outcome was the main cause of admission, which was defined as the World Health Organization's first international classification of diseases, version 10 (ICD-10) code within each hospital admission record. RESULTS 1 315 338 admissions occurred between 1 January 2005 and 31 March 2015, and 831 729 (63%) were emergency admissions. 525 039 (52%) of 1 018 136 children were admitted to hospital at least once during the study period. Hospital admissions during childhood were strongly associated with gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, and 42 weeks). In comparison with children born at full term (40 weeks' gestation), those born extremely preterm (<28 weeks) had the highest rate of hospital admission throughout childhood (adjusted rate ratio 4.92, 95% confidence interval 4.58 to 5.30). Even children born at 38 weeks had a higher rate of hospital admission throughout childhood (1.19, 1.16 to 1.22). The association between gestational age and hospital admission decreased with increasing age (interaction P<0.001). Children born earlier than 28 weeks had an adjusted rate ratio of 6.34 (95% confidence interval 5.80 to 6.85) at age less than 1 year, declining to 3.28 (2.82 to 3.82) at ages 7-10, in comparison with those born full term; whereas in children born at 38 weeks, the adjusted rate ratios were 1.29 (1.27 to 1.31) and 1.16 (1.13 to 1.19), during infancy and ages 7-10, respectively. Infection was the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life. CONCLUSIONS The association between gestational age and hospital admission rates decreased with age, but an excess risk remained throughout childhood, even among children born at 38 and 39 weeks of gestation. Strategies aimed at the prevention and management of childhood infections should target children born preterm and those born a few weeks early.
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Affiliation(s)
- Victoria Coathup
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7FL, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7FL, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jennifer J Kurinzcuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7FL, UK
| | | | - Stavros Petrou
- Nuffield Department of Primary Care Health, University of Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7FL, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7FL, UK
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