Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683 716 children

BackgroundThe global prevalence of childhood asthma is increasing. The condition impacts physical and psychosocial morbidity; therefore, wide-ranging effects on health and education outcomes are plausible.MethodsLinkage of eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions and unemployment, provided data on 683 716 children attending Scottish schools between 2009 and 2013. We compared schoolchildren on medication for asthma with peers, adjusting for sociodemographic, maternity and comorbidity confounders, and explored effect modifiers and mediators.ResultsThe 45 900 (6.0%) children treated for asthma had an increased risk of hospitalisation, particularly within the first year of treatment (incidence rate ratio 1.98, 95% CI 1.93–2.04), and increased mortality (HR 1.77, 95% CI 1.30–2.40). They were more likely to have special educational need for mental (OR 1.76, 95% CI 1.49–2.08) and physical (OR 2.76, 95% CI 2.57–2.95) health reasons, and performed worse in school exams (OR 1.11, 95% CI 1.06–1.16). Higher absenteeism (incidence rate ratio 1.25, 95% CI 1.24–1.26) partially explained their poorer attainment.ConclusionsChildren with treated asthma have poorer education and health outcomes than their peers. Educational interventions that mitigate the adverse effects of absenteeism should be considered.

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Increased Risk for Nonmedullary Thyroid Cancer in the First Degree Relatives of Prevalent Cases of Nonmedullary Thyroid Cancer: A Hospital-Based Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.86.11.8010 ◽

2001 ◽

Vol 86 (11) ◽

pp. 5307-5312 ◽

Cited By ~ 67

Author(s):

Tuya Pal ◽

Florian D. Vogl ◽

Pierre O. Chappuis ◽

Richard Tsang ◽

James Brierley ◽

...

Keyword(s):

Thyroid Cancer ◽

Confidence Interval ◽

Incidence Rate ◽

Rate Ratio ◽

Genetic Basis ◽

Incidence Rate Ratio ◽

Cancer Susceptibility ◽

Degree Relative ◽

First Degree Relatives ◽

Increased Risk

The genetic basis for nonmedullary forms of thyroid cancer (NMTC) is less well established than that of medullary thyroid cancer. However, epidemiological and family studies suggest that a proportion of NMTC may be due to inherited predisposition. To estimate the familial risk of thyroid cancer, we conducted a hospital-based case-control study at the Princess Margaret Hospital in Toronto, Ontario, Canada, and at 2 university hospitals in Montréal, Québec, Canada. We obtained pedigrees from 339 unselected patients diagnosed with NMTC and from 319 unaffected ethnically matched controls. Family histories of cancer were obtained from the cases and controls for 3292 first degree relatives of cases and controls. Seventeen cases (5.0%) and 2 controls (0.6%) reported at least one first degree relative with thyroid cancer. In relatives of patients with thyroid cancer, the incidence of any type of cancer (including NMTC) was 38% higher than in relatives of controls (incidence rate ratio, 1.4; 95% confidence interval, 1.1–1.7). The relative risk for thyroid cancer was 10-fold higher in relatives of cancer patients than in controls (incidence rate ratio, 10.3; 95% confidence interval, 2.2–47.6). Our findings suggest that hereditary or other familial factors are important in a small proportion of NMTC. Molecular studies are needed to determine the genetic basis of cancer susceptibility in these families.

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Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study

PLoS Medicine ◽

10.1371/journal.pmed.1003832 ◽

2021 ◽

Vol 18 (11) ◽

pp. e1003832

Author(s):

Michael Fleming ◽

James S. McLay ◽

David Clark ◽

Albert King ◽

Daniel F. Mackay ◽

...

Keyword(s):

Health Outcomes ◽

Educational Outcomes ◽

Protective Factor ◽

Local Authority ◽

Hospital Admissions ◽

Linkage Study ◽

Looked After Children ◽

Adjusted Incidence Rate ◽

Self Harm ◽

Educational Need

Background Looked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders. Methods and findings Linkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care. Conclusions Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.

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Investigating the relationships between chronic ill health and educational outcomes in children

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.181 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Michael Fleming ◽

Daniel Mackay ◽

Jill Pell ◽

James McLay

Keyword(s):

Educational Outcomes ◽

Chronic Conditions ◽

Census Data ◽

Hospital Admissions ◽

Linkage Study ◽

Education Data ◽

Increased Risk ◽

Obstetric Factors ◽

Educational Need ◽

The Impact

ABSTRACT ObjectivesThis population wide record linkage study linked Scottish education data to a number of administrative health datasets to explore the impact of childhood chronic ill health on subsequent educational and health outcomes. Chronic conditions investigated in this study were diabetes, asthma, epilepsy, ADHD and depression. Specific educational outcomes of interest were academic attainment, school leaver destination, absence levels, exclusions and record of special educational need (SEN). Children were also followed up for hospital admissions and all-cause mortality. ApproachPupil census data and associated education records for all children attending primary and secondary schools in Scotland between 2009 and 2013 were linked to national prescribing data, hospital admissions (acute, psychiatric and cancer), death records and their mother’s maternity records to enable a range of different chronic conditions to be studied whilst controlling for various confounders. Specific drugs are prescribed for some particular chronic conditions therefore children identified from prescribing data as receiving these drugs at the time of the school census were assumed to have these conditions. Hospital admissions and death records provided information on subsequent admissions and mortality. Linking all children to their mother’s maternity records provided ability to control for a range of obstetric factors, birth outcomes and maternal antecedents. ResultsDiabetes, asthma, epilepsy, ADHD and depression were significantly associated with increased numbers of absences at school and increased risk of SEN. All of the conditions with the exception of diabetes were significantly associated with poorer subsequent educational grade attainment. ADHD and depression were significantly associated with increased numbers of exclusions at school whilst asthma was significantly associated with less exclusion. Epilepsy, ADHD and depression were significantly associated with poorer leaver destination 6 months after leaving school. ConclusionCompared to peers, children who had ADHD or depression were most adversely affected experiencing poorer educational outcomes in all five of the educational domains investigated. Children with epilepsy experienced poorer outcomes across four domains. Children with diabetes and asthma experienced more absence and increased SEN and asthmatic children experienced poorer attainment. Children who have these chronic illnesses at school appear to be at an educational disadvantage therefore further understanding of the intricate relationships between health and education is an on-going important area of public health.

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Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash

The Journal of Rheumatology ◽

10.3899/jrheum.141315 ◽

2015 ◽

Vol 42 (8) ◽

pp. 1502-1510 ◽

Cited By ~ 3

Author(s):

Donald A. Redelmeier ◽

Jeremy D. Zung ◽

Deva Thiruchelvam ◽

Robert J. Tibshirani

Keyword(s):

Incidence Rate ◽

Traffic Safety ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Motor Vehicle ◽

Cohort Analysis ◽

Motor Vehicle Crash ◽

Vehicle Crash ◽

Increased Risk ◽

Population Norm

Objective.Motor vehicle crashes are a widespread contributor to mortality and morbidity, sometimes related to medically unfit motorists. We tested whether patients diagnosed with fibromyalgia (FM) have an increased risk of a subsequent serious motor vehicle crash.Methods.We conducted a population-based self-matched longitudinal cohort analysis to estimate the incidence rate ratio of crashes among patients diagnosed with FM relative to the population norm in Ontario, Canada. We included adults diagnosed from April 1, 2006, to March 31, 2012, excluding individuals younger than 18 years, living outside Ontario, lacking valid identifiers, or having only a single visit for the diagnosis. The primary outcome was an emergency department visit as a driver involved in a motor vehicle crash.Results.The patients (n = 137,631) accounted for 738 crashes during the first year of followup after diagnosis, equal to an incidence rate ratio of 2.44 compared with the population norm (95% CI 2.27–2.63, p < 0.001). The crash rate was more than twice the population norm for those with a new or a persistent diagnosis. The increased risk included patients with diverse characteristics, approached the rate observed among other patients diagnosed with alcoholism, and was mitigated among those who received dedicated FM care or a physician warning for driving safety.Conclusion.A diagnosis of FM is associated with an increased risk of a subsequent motor vehicle crash that might justify medical interventions for traffic safety.

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Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa337 ◽

2021 ◽

Author(s):

Susanna Scharrer ◽

Christian Primas ◽

Sabine Eichinger ◽

Sebastian Tonko ◽

Maximilian Kutschera ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Venous Thromboembolism ◽

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Fatal Bleeding ◽

Adjusted Incidence Rate ◽

Inflammatory Bowel ◽

Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

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Secrets of the hospital underbelly: abundance of antimicrobial resistance genes in hospital wastewater reflects hospital antimicrobial use and inpatient length of stay

10.1101/19006858 ◽

2019 ◽

Author(s):

Meghan R. Perry ◽

Bram van Bunnik ◽

Luke McNally ◽

Bryan Wee ◽

Patrick Munk ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Length Of Stay ◽

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Clinical Activity ◽

Hospital Wastewater ◽

Antimicrobial Consumption ◽

Gene Abundance ◽

Class Level

ABSTRACTIntroductionHospital wastewater is a potential major source of antimicrobial resistance (AMR). This study uses metagenomics to ask how abundances of AMR genes in hospital wastewater are related to clinical activity.MethodsSewage was collected over a 24-hour period from multiple wastewater collection points representing different specialties within a tertiary hospital site and simultaneously from community sewage works. High throughput shotgun sequencing was performed using Illumina HiSeq4000. AMR gene abundances were correlated to hospital antimicrobial usage (AMU), data on clinical activity and resistance prevalence in clinical isolates.FindingsMicrobiota and AMR gene composition varied between each collection point and overall AMR gene abundance was higher in hospital wastewater than in community influent. The composition of AMR genes correlated with microbiota composition (Procrustes analysis, p=0.002). Increased antimicrobial consumption at a class level was associated with higher AMR gene abundance within that class in wastewater (incidence rate ratio 2.80, C.I. 1.2-6.5, p=0.016). Prolonged average patient length of stay was associated with higher total AMR gene abundance in wastewater (incidence rate ratio 2.05, C.I. 1.39-3.01, p=0.0003). AMR gene abundance at a class level within hospital wastewater did not reflect resistance patterns in the 181 clinical isolates grown from hospital inpatients over the time of wastewater sampling.ConclusionsHospital antimicrobial consumption and patient length of stay are important drivers of AMR gene outflow into the environment. Using metagenomics to identify the full range of AMR genes in hospital wastewater could represent a useful surveillance tool to monitor hospital AMR gene outflow and guide environmental policy on AMR.

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Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2021-0159 ◽

2021 ◽

pp. 1-11

Author(s):

Benjamin T. Schumacher ◽

John Bellettiere ◽

Michael J. LaMonte ◽

Kelly R. Evenson ◽

Chongzhi Di ◽

...

Keyword(s):

Physical Function ◽

Older Women ◽

Incidence Rate ◽

Fall Risk ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Steps Per Day ◽

Falls In Older Adults ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63–97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

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Incidence of chronic immune-mediated inflammatory diseases after diagnosis with Kawasaki disease: a population-based cohort study

Rheumatology ◽

10.1093/rheumatology/keab680 ◽

2021 ◽

Author(s):

Stephen G Fung ◽

Richard Webster ◽

M Ellen Kuenzig ◽

Braden D Knight ◽

Michelle Batthish ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Liver Disease ◽

Kawasaki Disease ◽

Sclerosing Cholangitis ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Population Based ◽

Immune Mediated ◽

Increased Risk

Abstract Objectives Kawasaki disease (KD) is an immune-mediated vasculitis of childhood with multi-organ inflammation. We determined the risk of subsequent immune-mediated inflammatory disease (IMID), including arthritis, type 1 diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis and multiple sclerosis. Methods We conducted a matched population-based cohort study using health administrative data from Ontario, Canada. Children aged <18 years born between 1991 and 2016 diagnosed with KD (n = 3753) were matched to 5 non-KD controls from the general population (n = 18 749). We determined the incidence of IMIDs after resolution of KD. Three- and 12-month washout periods were used to exclude KD-related symptoms. Results There was an elevated risk of arthritis in KD patients compared with non-KD controls, starting 3 months after index date [103.0 vs 12.7 per 100 000 person-years (PYs); incidence rate ratio 8.07 (95% CI 4.95, 13.2); hazard ratio 8.08 (95% CI 4.95, 13.2), resulting in the overall incidence of IMIDs being elevated in KD patients (175.1 vs 68.0 per 100 000 PYs; incidence rate ratio 2.58 (95% CI 1.93, 3.43); hazard ratio 2.58, 95% CI 1.94, 3.43]. However, there was no increased risk for diabetes, IBD, autoimmune liver disease, primary sclerosing cholangitis or multiple sclerosis in KD patients. Similar results were observed using a 12-month washout period. Conclusion Children diagnosed with KD were at increased risk of arthritis following the acute KD event, but not other IMIDs. Health-care providers should monitor for arthritis in children following a diagnosis of KD.

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Thirteen-Year Trends in Cardiovascular Risk in Men and Women with Chronic Coronary Syndrome

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcab015 ◽

2021 ◽

Author(s):

Kevin Kris Warnakula Olesen ◽

Esben Skov Jensen ◽

Christine Gyldenkerne ◽

Morten Würtz ◽

Martin Bødtker Mortensen ◽

...

Keyword(s):

Coronary Artery ◽

Incidence Rate ◽

Cardiac Death ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Men And Women ◽

Coronary Syndrome ◽

Adjusted Incidence Rate ◽

Artery Disease ◽

Adjusted Incidence

Abstract Aims To examine combined and sex-specific temporal changes in risks of adverse cardiovascular events and coronary revascularization in patients with chronic coronary syndrome undergoing coronary angiography. Methods We included all patients with stable angina pectoris and coronary artery disease examined by coronary angiography in Western Denmark from 2004 to 2016. Patients were stratified by examination year interval: 2004-2006, 2007-2009, 2010-2012, and 2013-2016. Outcomes were two-year risk of myocardial infarction, ischemic stroke, cardiac death, and all-cause death estimated by adjusted incidence rate ratios using patients examined in 2004-2006 as reference. Results A total of 29,471 patients were included, of whom 70% were men. The two-year risk of myocardial infarction (2.8% versus 1.9%, adjusted incidence rate ratio 0.65, 95% CI 0.53-0.81), ischemic stroke (1.8% versus 1.1%, adjusted incidence rate ratio 0.48, 95% CI 0.37-0.64), cardiac death (2.1% versus 0.9%, adjusted incidence rate ratio 0.38, 95% CI 0.29-0.51), and all-cause death (5.0% versus 3.6%, adjusted incidence rate ratio 0.65, 95% CI 0.55-0.76) decreased from the first examination interval (2004-2006) to the last examination interval (2013-2016). Coronary revascularizations also decreased (percutaneous coronary intervention: 51.6% versus 42.5%; coronary artery bypass grafting: 24.6% versus 17.5%). Risk reductions were observed in both men and women, however, women had a lower absolute risk. Conclusion The risk for adverse cardiovascular events decreased substantially in both men and women with chronic coronary syndrome from 2004 to 2016. These results most likely reflect the cumulative effect of improvements in the management of chronic coronary artery disease.

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Azithromycin distribution and childhood mortality in compliance-related subgroups in Niger: complier average causal effect and spillovers in a cluster-randomized, placebo-controlled trial

International Journal of Epidemiology ◽

10.1093/ije/dyab198 ◽

2021 ◽

Author(s):

Kieran S O’Brien ◽

Ahmed M Arzika ◽

Ramatou Maliki ◽

Abdou Amza ◽

Farouk Manzo ◽

...

Keyword(s):

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Causal Effect ◽

Controlled Trial ◽

Effect Analysis ◽

Intention To Treat ◽

Average Causal Effect ◽

Cluster Randomized ◽

Complier Average Causal Effect

Abstract Background Biannual azithromycin distribution to children 1–59 months old reduced all-cause mortality by 18% [incidence rate ratio (IRR) 0.82, 95% confidence interval (CI): 0.74, 0.90] in an intention-to-treat analysis of a randomized controlled trial in Niger. Estimation of the effect in compliance-related subgroups can support decision making around implementation of this intervention in programmatic settings. Methods The cluster-randomized, placebo-controlled design of the original trial enabled unbiased estimation of the effect of azithromycin on mortality rates in two subgroups: (i) treated children (complier average causal effect analysis); and (ii) untreated children (spillover effect analysis), using negative binomial regression. Results In Niger, 594 eligible communities were randomized to biannual azithromycin or placebo distribution and were followed from December 2014 to August 2017, with a mean treatment coverage of 90% [standard deviation (SD) 10%] in both arms. Subgroup analyses included 2581 deaths among treated children and 245 deaths among untreated children. Among treated children, the incidence rate ratio comparing mortality in azithromycin communities to placebo communities was 0.80 (95% CI: 0.72, 0.88), with mortality rates (deaths per 1000 person-years at risk) of 16.6 in azithromycin communities and 20.9 in placebo communities. Among untreated children, the incidence rate ratio was 0.91 (95% CI: 0.69, 1.21), with rates of 33.6 in azithromycin communities and 34.4 in placebo communities. Conclusions As expected, this analysis suggested similar efficacy among treated children compared with the intention-to-treat analysis. Though the results were consistent with a small spillover benefit to untreated children, this trial was underpowered to detect spillovers.

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