COVID-19-related school closures and patterns of hospital admissions with stress-related presentations in secondary school-aged adolescents: weekly time series

This study examines health service indicators of stress-related presentations (relating to pain, mental illness, psychosomatic symptoms and self-harm) in adolescents of secondary school age, using Hospital Episode Statistics data for England. We examined weekly time series data for three academic years spanning the time before (2018-2019) and during the COVID-19 pandemic (2019-2020 and 2020-2021), including the first lockdown when schools were closed to the majority of pupils. For all secondary school children, weekly stress presentations dropped following school closures. However, patterns of elevated stress during school terms re-established after reopening, with girls aged 11-15 showing an overall increase compared with pre-pandemic rates

Umbrella systematic review finds limited evidence that school absence explains the association between chronic health conditions and lower academic attainment

INTRODUCTION: Absence from school is more frequent for children with chronic health conditions (CHCs) than their peers and may be one reason why average academic attainment scores are lower among children with CHCs. METHODS: We determined whether school absence explains the association between CHCs and academic attainment through a systematic review of systematic reviews of comparative studies involving children with or without CHCs and academic attainment. We extracted results from any studies that tested whether school absence mediated the association between CHCs and academic attainment. RESULTS: We identified 27 systematic reviews which included 441 unique studies of 7, 549, 267 children from 47 jurisdictions. Reviews either covered CHCs generally or were condition-specific (e.g., chronic pain, depression, or asthma). Whereas reviews found an association between a range of CHCs (CHCs generally, cystic fibrosis, hemophilia A, end-stage renal disease (pre-transplant), end-stage kidney disease (pre-transplant), spina bifida, congenital heart disease, orofacial clefts, mental disorders, depression, and chronic pain) and academic attainment, and though it was widely hypothesized that absence was a mediator in these associations, only 7 of 441 studies tested this, and all findings show no evidence of absence mediation. CONCLUSION: CHCs are associated with lower academic attainment, but we found limited evidence of whether school absence mediates this association. Policies that focus solely on reducing school absence, without adequate additional support, are unlikely to benefit children with CHCs. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285031, identifier: CRD42021285031

Trends in survival of children with severe congenital heart defects by gestational age at birth: A population‐based study using administrative hospital data for England

BACKGROUND: Children with congenital heart defects (CHD) are twice as likely as their peers to be born preterm (<37 weeks' gestation), yet descriptions of recent trends in long-term survival by gestational age at birth (GA) are lacking. OBJECTIVES: To quantify changes in survival to age 5 years of children in England with severe CHD by GA. METHODS: We estimated changes in survival to age five of children with severe CHD and all other children born in England between April 2004 and March 2016, overall and by GA-group using linked hospital and mortality records. RESULTS: Of 5,953,598 livebirths, 5.7% (339,080 of 5,953,598) were born preterm, 0.35% (20,648 of 5,953,598) died before age five and 3.6 per 1000 (21,291 of 5,953,598) had severe CHD. Adjusting for GA, under-five mortality rates fell at a similar rate between 2004-2008 and 2012-2016 for children with severe CHD (adjusted hazard ratio [HR] 0.79, 95% CI 0.71, 0.88) and all other children (HR 0.78, 95% CI 0.76, 0.81). For children with severe CHD, overall survival to age five increased from 87.5% (95% CI 86.6, 88.4) in 2004-2008 to 89.6% (95% CI 88.9, 90.3) in 2012-2016. There was strong evidence for better survival in the ≥39-week group (90.2%, 95% CI 89.1, 91.2 to 93%, 95% CI 92.4, 93.9), weaker evidence at 24-31 and 37-38 weeks and no evidence at 32-36 weeks. We estimate that 51 deaths (95% CI 24, 77) per year in children with severe CHD were averted in 2012-2016 compared to what would have been the case had 2004-2008 mortality rates persisted. CONCLUSIONS: Nine out of 10 children with severe CHD in 2012-2016 survived to age five. The small improvement in survival over the study period was driven by increased survival in term children. Most children with severe CHD are reaching school age and may require additional support by schools and healthcare services

Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland

While acute respiratory tract infections can trigger cardiovascular events, the differential effect of specific organisms is unknown. This is important to guide vaccine policy.Using national infection surveillance data linked to the Scottish Morbidity Record, we identified adults with a first myocardial infarction or stroke from January 1, 2004 to December 31, 2014 and a record of laboratory-confirmed respiratory infection during this period. Using self-controlled case series analysis, we generated age- and season-adjusted incidence ratios (IRs) for myocardial infarction (n=1227) or stroke (n=762) after infections compared with baseline time.We found substantially increased myocardial infarction rates in the week after Streptococcus pneumoniae and influenza virus infection: adjusted IRs for days 1-3 were 5.98 (95% CI 2.47-14.4) and 9.80 (95% CI 2.37-40.5), respectively. Rates of stroke after infection were similarly high and remained elevated to 28 days: day 1-3 adjusted IRs 12.3 (95% CI 5.48-27.7) and 7.82 (95% CI 1.07-56.9) for S. pneumoniae and influenza virus, respectively. Although other respiratory viruses were associated with raised point estimates for both outcomes, only the day 4-7 estimate for stroke reached statistical significance.We showed a marked cardiovascular triggering effect of S. pneumoniae and influenza virus, which highlights the need for adequate pneumococcal and influenza vaccine uptake. Further research is needed into vascular effects of noninfluenza respiratory viruses

Maternal vulnerability and birth interval in England: a retrospective analysis of hospital episode statistics

Introduction Several studies have shown that a short birth interval is associated with increased risks of adverse perinatal outcomes (e.g.: preterm birth, stillbirth) and neonatal and maternal death. It is unclear whether this relationship is likely to be causal or to reflect confounding due to psychosocial vulnerability. Objectives and Approach To determine the association between birth interval for mothers with and without indicators of vulnerability. Using Hospital Episode Statistics for England, we included mothers with a live birth in 2011. Vulnerability indicators were codes for mental health problems, adversity related injury (ARI), material or social disadvantage (M/SD) recorded in admissions in the previous five years, or age Time (in days) to next delivery within five years was analysed using Cox proportional hazard regression models and adjusted for maternal age, parity, multiple and preterm birth. Results Of 636,876 women delivering in 2011, 93,266 (14.6\%) had indicators of vulnerability: 63,421 (10.0%) for mental health problems, 8,229 (1.2%) for an ARI, 21,616 (3.4%) for M/SD, and 32,622 (5.1%) were teenage mothers. Over a third of mothers (242,401; 38.1%) had another live birth within five years. Median time to next delivery was 957 days (5-95% centiles: 433-1694), and was longest for teenage mothers (979 days, 391-1726), and shortest for women with ARIs (904 days, 391-1697). Vulnerable mothers were more likely than women with no vulnerability indicators to have another live birth (HRadj: 1.13, 95%CI: 1.12-1.14): risks were independently increased for teenage mothers (HRadj: 1.53, 1.50-1.55), women with an ARI (HRadj: 1.15, 1.11-1.19) or mental health problems (HRadj: 1.05, 1.03-1.06). Conclusion/Implications Vulnerable mothers had a shorter subsequent birth interval and an increased risk of birth in the next five years. Maternity care may be an appropriate time to target interventions to vulnerable families to enable choice about timing of subsequent pregnancy

Maternal vulnerability and birth interval in England: a birth cohort study using hospital episode statistics from 2006 to 2016

Aim To determine the association between birth interval for mothers with and without indicators of vulnerability. Methods We included mothers who gave birth in 2011 recorded in Hospital Episode Statistics. Vulnerability indicators included diagnostic codes for mental health problems, adversity related injuries (ARI), material/social disadvantage (MSD) recorded in the previous five years, or age <20 years at index delivery. We analyses birth interval using Cox proportional hazard models and adjusted for maternal and birth characteristics. Results We included 636,876 women, of whom 93,266 (14.6%) had indicators of vulnerability: 63,421 (10.0%) for mental health problems, 8,229 (1.2%) for ARI, 21,616 (3.4%) for MSD, and 32,622 (5.1%) were aged <20y. Over a third of mothers (242,401; 38.1%) had another live birth. Median birth interval was 957 days (5-95%centiles:433- 1694), and was shortest for women with ARIs (904 days,391- 1697). Vulnerable mothers were more likely than women with no vulnerability indicators to have another live birth (HRadj:1.13, 95%CI:1.12-1.14), particularly teenage mothers (HRadj:1.53,1.50-1.55). Conclusions Vulnerable mothers had a shorter subsequent birth interval and were more likely to have another birth in the next five years. Maternity care may be an appropriate time to target interventions to vulnerable families to enable choice about timing of subsequent pregnancy

Gestational age at birth, chronic conditions and school outcomes: a population-based data linkage study of children born in England

INTRODUCTION: We aimed to generate evidence about child development measured through school attainment and provision of special educational needs (SEN) across the spectrum of gestational age, including for children born early term and >41 weeks of gestation, with and without chronic health conditions. METHODS: We used a national linked dataset of hospital and education records of children born in England between 1 September 2004 and 31 August 2005. We evaluated school attainment at Key Stage 1 (KS1; age 7) and Key Stage 2 (KS2; age 11) and any SEN by age 11. We stratified analyses by chronic health conditions up to age 2, and size-for-gestation, and calculated population attributable fractions (PAF). RESULTS: Of 306 717 children, 5.8% were born <37 weeks gestation and 7.0% had a chronic condition. The percentage of children not achieving the expected level at KS1 increased from 7.6% at 41 weeks, to 50.0% at 24 weeks of gestation. A similar pattern was seen at KS2. SEN ranged from 29.0% at 41 weeks to 82.6% at 24 weeks. Children born early term (37-38 weeks of gestation) had poorer outcomes than those born at 40 weeks; 3.2% of children with SEN were attributable to having a chronic condition compared with 2.0% attributable to preterm birth. CONCLUSIONS: Children born with early identified chronic conditions contribute more to the burden of poor school outcomes than preterm birth. Evaluation is needed of how early health characteristics can be used to improve preparation for education, before and at entry to school

Changes in adolescents' planned hospital care during the COVID-19 pandemic: analysis of linked administrative data

OBJECTIVE: To describe changes in planned hospital care during the pandemic for vulnerable adolescents receiving children's social care (CSC) services or special educational needs (SEN) support, relative to their peers. DESIGN: Observational cohort in the Education and Child Health Insights from Linked Data database (linked de-identified administrative health, education and social care records of all children in England). STUDY POPULATION: All secondary school pupils in years 7-11 in academic year 2019/2020 (N=3 030 235). MAIN EXPOSURE: Receiving SEN support or CSC services. MAIN OUTCOMES: Changes in outpatient attendances and planned hospital admissions during the first 9 months of the pandemic (23 March-31 December 2020), estimated by comparing predicted with observed numbers and rates per 1000 child-years. RESULTS: A fifth of pupils (20.5%) received some form of statutory support: 14.2% received SEN support only, 3.6% received CSC services only and 2.7% received both. Decreases in planned hospital care were greater for these vulnerable adolescents than their peers: -290 vs -225 per 1000 child-years for outpatient attendances and -36 vs -16 per 1000 child-years for planned admissions. Overall, 21% of adolescents who were vulnerable disproportionately bore 25% of the decrease in outpatient attendances and 37% of the decrease in planned hospital admissions. Vulnerable adolescents were less likely than their peers to have face-to-face outpatient care. CONCLUSION: These findings indicate that socially vulnerable groups of children have high health needs, which may need to be prioritised to ensure equitable provision, including for catch-up of planned care postpandemic

Generating synthetic identifiers to support development and evaluation of data linkage methods

IntroductionCareful development and evaluation of data linkage methods is limited by researcher access to personal identifiers. One solution is to generate synthetic identifiers, which do not pose equivalent privacy concerns, but can form a 'gold-standard' linkage algorithm training dataset. Such data could help inform choices about appropriate linkage strategies in different settings. ObjectivesWe aimed to develop and demonstrate a framework for generating synthetic identifier datasets to support development and evaluation of data linkage methods. We evaluated whether replicating associations between attributes and identifiers improved the utility of the synthetic data for assessing linkage error. MethodsWe determined the steps required to generate synthetic identifiers that replicate the properties of real-world data collection. We then generated synthetic versions of a large UK cohort study (the Avon Longitudinal Study of Parents and Children; ALSPAC), according to the quality and completeness of identifiers recorded over several waves of the cohort. We evaluated the utility of the synthetic identifier data in terms of assessing linkage quality (false matches and missed matches). ResultsComparing data from two collection points in ALSPAC, we found within-person disagreement in identifiers (differences in recording due to both natural change and non-valid entries) in 18% of surnames and 12% of forenames. Rates of disagreement varied by maternal age and ethnic group. Synthetic data provided accurate estimates of linkage quality metrics compared with the original data (within 0.13-0.55% for missed matches and 0.00-0.04% for false matches). Incorporating associations between identifier errors and maternal age/ethnicity improved synthetic data utility. ConclusionsWe show that replicating dependencies between attribute values (e.g. ethnicity), values of identifiers (e.g. name), identifier disagreements (e.g. missing values, errors or changes over time), and their patterns and distribution structure enables generation of realistic synthetic data that can be used for robust evaluation of linkage methods

Reductions in hospital care among clinically vulnerable children aged 0-4 years during the COVID-19 pandemic

OBJECTIVE: To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic. DESIGN: Birth cohort. SETTING: National Health Service hospitals in England. STUDY POPULATION: All children aged <5 years with a birth recorded in hospital administrative data (January 2010-March 2021). MAIN EXPOSURE: Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks' gestation) or low birth weight (<2500 g). MAIN OUTCOMES: Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020-2021). RESULTS: Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic. CONCLUSION: One in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic