The Linked CENTURY Study: linking three decades of clinical and public health data to examine disparities in childhood obesity.

Summer Sherburne Hawkins,Ken P Kleinman,Megan Mariotti,Sheryl L Rifas-Shiman,Elsie M Taveras,Matthew W Gillman

doi:10.1186/s12887-016-0567-0

Abstract

BackgroundDespite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations. We report on the construction of the Linked CENTURY database, incorporating CENTURY (Collecting Electronic Nutrition Trajectory Data Using Records of Youth) Study data with birth certificates; and discuss the potential implications of combining clinical and public health data sources in examining the etiology of disparities in childhood obesity.MethodsWe linked the existing CENTURY Study, a database of 269,959 singleton children from birth to age 18 years with measured heights and weights, with each child’s Massachusetts birth certificate, which captures information on their mothers’ pregnancy history and detailed socio-demographic information of both mothers and fathers.ResultsOverall, 74.2 % were matched, resulting in 200,343 children in the Linked CENTURY Study with 1,580,597 well child visits. Among this cohort, 94.0 % (188,334) of children have some father information available on the birth certificate and 60.9 % (121,917) of children have at least one other sibling in the dataset.Using maternal race/ethnicity from the birth certificate as an indicator of children’s race/ethnicity, 75.7 % of children were white, 11.6 % black, 4.6 % Hispanic, and 5.7 % Asian. Based on socio-demographic information from the birth certificate, 20.0 % of mothers were non-US born, 5.9 % smoked during pregnancy, 76.3 % initiated breastfeeding, and 11.0 % of mothers had their delivery paid for by public health insurance. Using clinical data from the CENTURY Study, 22.7 % of children had a weight-for-length ≥ 95th percentile between 1 and 24 months and 12.0 % of children had a body mass index ≥ 95th percentile at ages 5 and 17 years.ConclusionsBy linking routinely-collected data sources, it is possible to address research questions that could not be answered with either source alone. Linkage between a clinical database and each child’s birth certificate has created a unique dataset with nearly complete racial/ethnic and socio-demographic information from both parents, which has the potential to examine the etiology of racial/ethnic and socioeconomic disparities in childhood obesity.

Highlights

Despite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations
The proportion of children who were linked to their birth certificate was higher in recent years from 47.8 % in 1969 to 92.4 % in 2008 (Fig. 2)
Based on socio-demographic information from the birth certificate, 20.0 % of mothers were non-US born, 15.6 % were not married at the time of birth, 5.9 % smoked during pregnancy and 76.3 % initiated breastfeeding

Summary

Introduction

Despite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations. In 2011–2012, 4 % of preschool-age white children were obese, compared to 11 % of black children, and 17 % of Hispanic children [1]. Obesity rates among older children have remained stable over the past decade at 18–21 % and ethnic minority children continue to be at higher risk [1]. In 2011–2012, 13 % of 6–11-year-old white children were obese, compared to 24 % of black children, and 26 % of Hispanic children [1]. Examining the causes of racial/ethnic and socioeconomic disparities in childhood obesity could help inform preventive interventions among those populations at highest risk

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