Understanding participation in European cohort studies of preterm children: the views of parents, healthcare professionals and researchers

Recommendations for data collection in cohort studies of preterm born individuals - The RECAP Preterm Core Dataset

BACKGROUND

Preterm birth (before 37 completed weeks of gestation) is associated with an increased risk of adverse health and developmental outcomes relative to birth at term. Existing guidelines for data collection in cohort studies of individuals born preterm are either limited in scope, have not been developed using formal consensus methodology, or did not involve a range of stakeholders in their development. Recommendations meeting these criteria would facilitate data pooling and harmonisation across studies.

OBJECTIVES

To develop a Core Dataset for use in longitudinal cohort studies of individuals born preterm.

METHODS

This work was carried out as part of the RECAP Preterm project. A systematic review of variables included in existing core outcome sets was combined with a scoping exercise conducted with experts on preterm birth. The results were used to generate a draft core dataset. A modified Delphi process was implemented using two stages with three rounds each. Three stakeholder groups participated: RECAP Preterm project partners; external experts in the field; people with lived experience of preterm birth. The Delphi used a 9-point Likert scale. Higher values indicated greater importance for inclusion. Participants also suggested additional variables they considered important for inclusion which were voted on in later rounds.

RESULTS

An initial list of 140 data items was generated. Ninety-six participants across 22 countries participated in the Delphi, of which 29% were individuals with lived experience of preterm birth. Consensus was reached on 160 data items covering Antenatal and Birth Information, Neonatal Care, Mortality, Administrative Information, Organisational Level Information, Socio-economic and Demographic information, Physical Health, Education and Learning, Neurodevelopmental Outcomes, Social, Lifestyle and Leisure, Healthcare Utilisation and Quality of Life.

CONCLUSIONS

This core dataset includes 160 data items covering antenatal care through outcomes in adulthood. Its use will guide data collection in new studies and facilitate pooling and harmonisation of existing data internationally.

Survey of data collection methods and retention strategies in European birth cohorts of children and adults born very preterm

BACKGROUND

The long-term follow-up of very preterm and very low birthweight cohorts contributes to valuable evidence to understand life-course outcomes in these vulnerable populations. However, attrition is a major challenge in long-term outcome studies. Examining the techniques used by existing cohorts may help to reveal practices that enhance willingness to continue participation over time.

OBJECTIVES

To evaluate the effect of data collection methods and retention strategies on overall retention in European birth cohorts of individuals born very preterm and very low birthweight.

METHODS

A survey of European cohorts integrated in the RECAP-preterm Consortium provided data on study characteristics, retention at the most recent follow-up, data collection methods and retention strategies. Cohorts were classified according to participants' age at most recent follow-up as child (<18) or adult cohorts (≥18 years old).

RESULTS

Data were obtained for 17 (81%) cohorts (7 adult and 10 child) in 12 countries. Considering the baseline, at the most recent follow-up, overall retention ranged from 10% to 99%. Child cohorts presented higher median retention (68% versus 38% or 52% for adult cohorts with ≤5 or >5 follow-ups) and used relatively more retention strategies. For contact and invitation, cohorts mostly resorted to invitation letters, and to face-to-face interviews for assessments. Study duration was negatively correlated with retention and positively associated with the number of follow-up evaluation. We identified 109 retention strategies, with a median of 6 per cohort; bond-building (n = 41; 38%) was the most utilised, followed by barrier-reduction (n = 36; 33%) and reminders (n = 32; 29%). Retention was not influenced by category or number of strategies.

CONCLUSIONS

Regular contact with cohort participants favour retention whilst neither the number nor the categories of retention strategies used seemed to have an influence, suggesting that tailored strategies focussed on participants at higher risk of dropout might be a more effective approach.

Record linkage of population-based cohort data from minors with national register data: a scoping review and comparative legal analysis of four European countries

Background: The GDPR was implemented to build an overarching framework for personal data protection across the EU/EEA. Linkage of data directly collected from cohort participants, potentially serving as a prominent tool for health research, must respect data protection rules and privacy rights. Our objective was to investigate law possibilities of linking cohort data of minors with routinely collected education and health data comparing EU/EEA member states. Methods: A legal comparative analysis and scoping review was conducted of openly accessible published laws and regulations in EUR-Lex and national law databases on GDPR's implementation in Portugal, Finland, Norway, and the Netherlands and its connected national regulations purposing record linkage for health research that have been implemented up until April 30, 2021. Results: The GDPR does not ensure total uniformity in data protection legislation across member states offering flexibility for national legislation. Exceptions to process personal data, e.g., public interest and scientific research, must be laid down in EU/EEA or national law. Differences in national interpretation caused obstacles in cross-national research and record linkage: Portugal requires written consent and ethical approval; Finland allows linkage mostly without consent through the national Social and Health Data Permit Authority; Norway when based on regional ethics committee's approval and adequate information technology safeguarding confidentiality; the Netherlands mainly bases linkage on the opt-out system and Data Protection Impact Assessment. Conclusions: Though the GDPR is the most important legal framework, national legislation execution matters most when linking cohort data with routinely collected health and education data. As national interpretation varies, legal intervention balancing individual right to informational self-determination and public good is gravely needed for health research. More harmonization across EU/EEA could be helpful but should not be detrimental in those member states which already opened a leeway for registries and research for the public good without explicit consent.

Strategies for assessing the impact of loss to follow-up on estimates of neurodevelopmental impairment in a very preterm cohort at 2 years of age

BACKGROUND

Loss to follow-up is a major challenge for very preterm (VPT) cohorts; attrition is associated with social disadvantage and parents with impaired children may participate less in research. We investigated the impact of loss to follow-up on the estimated prevalence of neurodevelopmental impairment in a VPT cohort using different methodological approaches.

METHODS

This study includes births < 32 weeks of gestational age (GA) from 4 regions in the UK and Portugal participating in a European birth cohort (N = 1737 survivors). Data on maternal characteristics, pregnancy complications, neonatal outcomes and neighborhood deprivation were collected at baseline. Neurodevelopment was assessed at 2 years of corrected age (CA) using standardized parent-report measures. We applied (1) multiple imputation (MI) and (2) inverse probability weighting (IPW) to estimate the impact of non-response on the prevalence of moderate to severe neurodevelopmental impairment and assessed violations of the missing at random (MAR) assumption using the delta method.

RESULTS

54.2% of children were followed-up. Follow-up was less likely when mothers were younger, multiparous, foreign-born, did not breastfeed and came from deprived areas. The prevalence of neurodevelopmental impairment was 18.4% (95% confidence interval (CI):15.9-21.1) and increased to 20.4% (95%CI: 17.3-23.4) and 20.0% (95%CI:16.9-23.1) for MI and IPW models, respectively. Simulating strong violations of MAR (children with impairments being 50% less likely to be followed-up) raised estimates to 23.6 (95%CI:20.1-27.1) CONCLUSIONS: In a VPT cohort with high loss to follow-up, correcting for attrition yielded modest increased estimates of neurodevelopmental impairment at 2 years CA; estimates were relatively robust to violations of the MAR assumption.