International Journal of Population Data Science最新文献

Introduction: Up to 30% of newborns with in-utero selective serotonin reuptake inhibitor (SSRI) exposure experience withdrawal symptoms. The impact of newborn feeding method on alleviating withdrawal has not been investigated. We examined the effect of newborn feeding method (breastfeeding versus formula) among a cohort of Neonates With In-utero SSRI Exposure (NeoWISE).

Methods: This population-based retrospective cohort study included newborns born in Ontario hospitals between April 1, 2012, and March 31, 2020 to Ontario Drug Benefit Program beneficiaries who filled at least one SSRI prenatal prescription. Linked administrative health and registry data were used. Method of newborn feeding was available from birth to hospital discharge. The primary outcome was newborn withdrawal. The secondary outcome was transfer to the Neonatal Intensive Care Unit (NICU). Adjusted risk ratios (adjRR) in breast- versus formula-fed newborns and our outcomes were estimated using generalized linear models. Propensity scores based on antepartum and intrapartum characteristics and inverse probability of treatment weighting were used to balance differences in maternal-newborn characteristics by treatment.

Results: Overall, 5,079 newborns were included in the NeoWISE Cohort, with 3,321 (65.4%) exclusively breastfeeding from birth to hospital discharge. Among the breastfed newborns, 50 (1.5%) had neonatal withdrawal versus 41 (2.3%) in the formula-fed newborns. There was no difference in risk of withdrawal in breast versus formula-fed newborns (adjRR 0.86, 95% CI 0.56, 1.34). Breastfed newborns had a reduced risk of transfer to the NICU compared to formula-fed newborns (adjRR 0.80, 95% CI 0.66, 0.97); however, this finding did not persist in sensitivity analysis.

Conclusion: The rate of newborn withdrawal was low in this cohort of SSRI-exposed neonates and was not associated with feeding method in the hospital. The results of this study inform shared decision-making around newborn feeding for perinatal women who take SSRI medications.

The use of routinely collected administrative health data for research can provide unique insights to inform decision-making and, ultimately, support better public health outcomes. Yet, since these data are primarily collected to administer healthcare service delivery, challenges exist when using such data for secondary purposes, namely epidemiologic research. Many of these challenges stem from the researcher's lack of control over the quality and consistency of data collection, and - furthermore - a lessened understanding of the data being analyzed. That said, we assert that these challenges can be partly mitigated through careful, systematic use of these data in epidemiologic research. This article presents considerations derived from experiences analyzing administrative health data (e.g., healthcare practitioner billings, hospitalizations, and prescription medication data) in the Canadian province of British Columbia (population of over 5 million in 2024), though we believe the underlying principles generalize beyond this region. Key considerations were organized around four themes: 1) Know the data and their primary use (understand their scope and limitations); 2) Understand classification and coding systems (appreciate the nuances regarding classification systems, versions, how they are employed in the primary uses of the data, and querying the values); 3) Transform data into meaningful forms (process data and apply identification algorithms, when necessary); 4) Recognize the importance of validity when defining analytic variables (make meaningful inferences based on data/algorithms). Although this article is not an exhaustive list of all considerations, we believe that it will provide pragmatic insights for those interested in leveraging administrative health data for epidemiologic research.

Background: The Danish National Patient Registry (DNPR) is a valuable resource for population-based research, but the validity of routine registration of advanced heart failure (HF) treatments within the registry is unknown. We, therefore, investigated the validity of HF, advanced HF treatments, and HF readmissions in the DNPR.

Methods: We randomly sampled patients registered at a Danish University Hospital during 2017-2021 from the DNPR. We identified 200 patients with first-time HF, 390 patients with one of eight advanced HF treatments, and 133 patients with HF admission after implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy (CRT). Compared with medical record reviews, we calculated positive predictive values (PPVs) with 95% confidence intervals (CIs).

Results: The PPV for first-time HF was 81% (95% CI: 74-86%). For advanced HF treatments, the PPV was 97% (95% CI: 91-99%) for ICD, 96% (95% CI: 86-100%) for CRT-pacemaker, 88% (95% CI: 76-95%) for CRT-defibrillator, 100% (95% CI: 83-100%) for left ventricular assist device, 43% (95% CI: 18-71%) for intra-aortic balloon pump, 38% (95% CI: 25-35%) for impella, 100% (95% CI: 93-100%) for cardiopulmonary support, and 100% (95% CI: 94-100%) for heart transplantation. The PPV for HF admission after ICD was 25% (95% CI: 16-37%) and 18% (95% CI: 9.2-30%) after CRT.

Conclusions: The PPV of routine registrations in the DNPR was moderate for first-time HF, high for most advanced HF treatments, and low for HF admissions after ICD or CRT. Thus, the DNPR is a valuable data source for population-based research on first-time HF and many advanced HF treatments.

Introduction: Research on substance use harm in Canada has been hampered by an absence of linked data to analyse and report on the social drivers of substance use harm.

Objectives: This study aims to address this gap by providing a fully annotated Stata do-file that links sociodemographic data to 11 years of hospitalisation and death outcomes. This do-file will greatly facilitate the creation of provincial and national substance use cohorts using line-level data available through Statistics Canada's Research Data Centres (RDC) program.

Methods: We used Canadian Census Health and Environment Cohorts (CanCHEC) 2006 to create a cohort of Saskatchewanians followed from 2006 to 2016. We linked sociodemographic information of the 2006 Census (long-form) respondents to their hospitalisation data captured in the Discharge Abstract Database (DAD) (2006 to 2016) and their mortality records in the Canadian Vital Statistics Death Database (CVSD) (2006 to 2016). We developed an algorithm to identify Saskatchewanians who experienced a substance use harm event. We validated the cohort by comparing our descriptive findings with those from other Canadian studies on substance use.

Results: We used CanCHEC, a national data resource, whereas most previous studies have used provincial data resources. Despite this difference in constructing the cohorts, our results showed trends consistent with previous studies, including an overrepresentation of individuals with lower socioeconomic status among the people who experienced substance use harm (PESUH). Similar to other Canadian studies, our results indicate an increasing rate of substance use harm from 2006 to 2016.

Conclusion: This study provides a Stata do-file that compiles a validated substance use cohort using CanCHEC, enabling comprehensive substance use research by linking sociodemographic data with health outcomes. The do-file is likely to save researchers hundreds of hours and accelerate research on the drivers of substance use harms in Canada.

Background: Sources of public and private data and ways to link them continue to evolve. This offers new opportunities for research, and new reasons for data-holding organisations to form partnerships. While research using these data can be beneficial, there is also a potential for negative consequences for some individuals or groups, including unintended or unanticipated effects. It is important to consult the public on how we might achieve both opportunities to link different types of data for research purposes, and protections against the misuse of data and the possibility of negative consequences.

Methods: Combining data sources for research was the topic of four days of deliberation held in British Columbia, Canada in late 2019. Public deliberation events bring diverse groups of people together to give direct input to policy makers, through carefully structured in-depth discussion on issues that are controversial and/or a source of public concern. Participants discussed whether data from electronic medical records should be used for research purposes, whether it is acceptable to combine data from public and private sources, who should authorise its use in research, and how a public advisory group on data use might be structured.

Results: Over four days, 29 residents of BC developed 17 deliberative conclusions that can be grouped into four broad topic areas: balancing benefit and potential harms when linking data; the protections that are expected to govern use of data; the type of authorisation required; and how the public should be involved in an ongoing way. Overall, the public is very supportive of research as long as oversight and controls are in place, including ongoing input from members of the public.

Conclusion: Deliberative conclusions from this event provide essential public input on the use of linked data for research, in particular when those data come from multiple sources. This is important information as policy-makers continue to develop legislation and practices around the use and linkage of both public and private sources of data.

The trade-off between the costs of childcare provision and the benefits of having an increased proportion of women, particularly women with dependent children, in employment is one of the most taxing social issues for Western governments. In countries like Northern Ireland, the limited subsidised childcare provision for preschool and primary school children has been partially offset by a rise in informal childcare though this has been considerably hard to assess both in terms of magnitude and effect. Using the entire 2011 Census cohort of mothers with children aged 1 to 16 years of age, we argue that co-resident grandparents have a substantial positive impact on maternal labour force participation in Northern Ireland. The presence of a co-resident grandparent was associated with an increase of 3.7 percentage points in employment for single-parent mothers and 2 percentage points for mothers in two-parent households. Mothers with co-resident grandparents report an increase of 2.7 percentage points for a single mother and of 3.7 percentage points for a mother in a two-parent household being in full-time employment than mothers without. Overall, the presence of a co-resident grandparent was associated with at least a 3.2 percentage point increase in labour force participation among mothers with primary-school-age children.

Introduction: The Canadian Institute of Health Information's (CIHI) Discharge Abstract Database (DAD) contains standardised administrative data on all hospitalisations in Canada, excluding Quebec.

Objectives: We aimed to validate preterm birth related perinatal and neonatal data in DAD by assessing its accuracy against the reference standard of the Canadian Neonatal Network (CNN) database.

Methods: We linked birth hospitalization data between the DAD and CNN databases for all neonates born <33 weeks gestational age (GA) admitted to the Neonatal Intensive Care Units in Winnipeg, Canada, between 2010 and 2022. A comprehensive list of maternal and neonatal variables relevant to preterm birth was chosen a priori for validation. For categorical variables, we measured correlation using Cohen's weighted kappa (k) and for continuous variables, we measured agreement using Lin's concordance correlation coefficient (LCCC).

Results: 2084 neonates were included (mean GA 29.4 ± 2.4 weeks; birth weight 1430 ± 461g). Baseline continuous maternal and neonatal variables showed excellent accuracy in DAD [Maternal age: LCCC = 0.99 (0.99, 0.99); GA: LCCC = 0.95 (0.95, 0.96); birth weight: LCCC = 0.97 (0.96, 0.97); sex: k = 0.99 (0.98-0.99)]. In contrast, the accuracy of the maternal baseline categorical variables and neonatal outcomes and interventions ranged from very good to poor [e.g., Caesarean section: k = 0.91 (0.89-0.93), pre-gestational diabetes: k = 0.04 (0.03-0.05), neonatal sepsis: k = 0.37 (0.31-0.42), bronchopulmonary dysplasia: k = 0.26 (0.19-0.33), neonatal laparotomy: k = 0.55 (0.43-067)].

Conclusion: Neonatal variables such as gestational age and birth weight had high accuracy in DAD, while the accuracy of maternal and neonatal morbidities and interventions were variable, with some being poor. Reasons for the inaccuracy of these variables should be identified and measures taken to improve them.

Introduction: Fetal Alcohol Spectrum Disorder (FASD) is one of the leading non-genetic causes of developmental disability worldwide and is thought to be particularly common in the UK. Despite this, there is a lack of data on FASD in the UK.

Objective: To conduct public and professional involvement work to establish stakeholder views on the feasibility, acceptability, key purposes, and design of a national linked longitudinal research database for FASD in the UK.

Methods: We consulted with stakeholders using online workshops (one for adults with FASD [and their supporters] N = 5; one for caregivers of people with FASD (N=7), 1:1/small-team video calls/email communication with clinicians, policymakers, data-governance experts, third-sector representatives, and researchers [N=35]), and one hybrid clinical workshop (N = 17). Discussions covered data availability, benefits, challenges, and design preferences for a national pseudonymised linked database for FASD. We derived key themes from the notes and recordings collected across all involvement activities.

Results: Our tailored, multi-method approach generated high levels of stakeholder engagement. Stakeholders expressed support for a pseudonymised national linked database for FASD. Key anticipated benefits were the potential for: increased awareness and understanding of FASD leading to better support; new insights into clinical profiles leading to greater diagnostic efficiency; facilitating international collaboration; and increased knowledge of the long-term impacts of FASD on health, social care, education, economic and criminal justice outcomes. Given the rich data infrastructure established in the UK, stakeholders expressed that a national linked FASD database could be world-leading. Common stakeholder concerns were around privacy and data-sharing and the importance of retaining space for clinical judgement alongside insights gained from quantitative analyses.

Conclusions: Multi-method and multidisciplinary public and professional involvement activities demonstrated support for a national linked database for FASD in the UK. Flexible, diverse, embedded stakeholder collaboration will be essential as we establish this database.

Background: Child poverty remains a major global concern and a child's experience of deprivation is heavily shaped by where they live and the stability of their local neighbourhood. This study examines frequencies and patterns of residential mobility in children and young people (CYP) at a population level using novel geospatial techniques to assess how often their physical environment changes and to identify geographical variations in social mobility.

Methods: We used routinely collected administrative records held in the Secure Anonymised Information Linkage (SAIL) Databank for CYP aged under 18 years living in Wales between 2012 and 2022. We calculated the Moran's I statistic to assess the magnitude of Lower layer Super Output Area (LSOA)-level geographic variation in residential mobility and used the Local Indicator of Spatial Association (LISA) to identify clusters of LSOAs where there are higher rates of residential mobility.

Results: This study included 923,531 CYP, with 58% having moved at least once during the study period. A total number of 1,209,102 house moves were recorded, 59% of which occurred between the ages of 0 and 5 years. Almost 10% of the cohort resided in five or more dwellings before the age of 18 years. In terms of area-level (LSOA) deprivation, 75% of house moves were to areas with the same or higher levels of deprivation, leaving only 25% of house moves that achieved upward social mobility. Clustering of residential mobility was identified predominantly in areas of high deprivation.

Conclusion: The findings of this study show that residential mobility is linked with socio-economic circumstances and is experienced by over half of CYP in Wales. Understanding where CYP live, their mobility patterns and which areas have high levels of influx and efflux is crucial for policymakers to generate well-informed, targeted and effective child-focused interventions.

Introduction: Obesity and asthma are two of the most common childhood conditions and their prevalence have increased over the last decades. Several cross-sectional studies provide strong evidence for a positive association between these two conditions. However, few longitudinal studies have examined the temporal relationship between them.

Objective: To examine the relationship between body mass index (BMI) at school starting age and the risk of developing bronchial asthma later in childhood.

Methods: We used anthropometric measurements of children aged 4 to 5 years, obtained as part of a national surveillance programme in Wales, linked to multiple population-level longitudinal administrative and clinical datasets within a trusted research environment provided by the Secure Anonymised Information Linkage (SAIL) databank to examine whether obesity at age 4 to 5 years was associated with increased risk of having a recorded diagnosis of asthma during a nine year follow-up period.

Results: Out of 22,790 children included in the study, 7% had a recorded diagnosis of asthma during the nine years following anthropometric measurement. Children who were classified as obese (Body Mass Index [BMI] Z-score ≥98^th Centile) had a 41% increased risk of having a recorded diagnosis of asthma (adjusted odds ratio [aOR]: 1.41; 95% confidence interval [CI]: 1.17-1.7). Females were 26% less likely to have a recorded diagnosis of asthma after adjusting for weight status and deprivation index (aOR: 0.74; 95% CI: 0.67-0.82).

Conclusion: Obesity in children aged 4 to 5 years carries an increased risk of developing asthma. Anthropometric measurements obtained through standardised population-level surveillance programmes enable important research which would not be possible otherwise and expanding these programmes to older age groups is recommended. Lifestyle interventions aimed at weight loss may have a role in decreasing the risk of developing asthma.