Hospital Episode Research Articles

Parental migration, socioeconomic deprivation and hospital admissions in preschool children in England: national birth cohort study, 2008 to 2014

BackgroundA third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group.MethodsBirth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group.ResultsOverall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4–171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1–156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4–188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42–1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia.ConclusionsOverall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health.

Behavioral, Cognitive, and Functional Risk Factors for Repeat Hospital Episodes Among Medicare-Medicaid Dually Eligible Adults Receiving Long-Term Services and Supports.

Repeat hospitalizations adversely impact the well-being of adults dually eligible for Medicare and Medicaid in the United States. This study aimed to identify behavioral, cognitive, and functional characteristics associated with the risk of a repeat hospital episode (HE) among the statewide population of dually eligible adults in Maryland receiving long-term services and supports prior to an HE between July 2018 and May 2020. The odds of experiencing a repeat HE within 30 days after an initial HE were positively associated with reporting difficulty with hearing (adjusted odds ratio, AOR: 1.10 [95% confidence interval: 1.02-1.19]), being easily distractible (AOR: 1.09 [1.00-1.18]), being self-injurious (AOR: 1.33 [1.09-1.63]), and exhibiting verbal abuse (AOR: 1.15 [1.02-1.30]). Conversely, displaying inappropriate public behavior (AOR: 0.62 [0.42-0.92]) and being dependent for eating (AOR: 0.91 [0.83-0.99]) or bathing (AOR: 0.79 [0.67-0.92]) were associated with reduced odds of a repeat HE. We also observed differences in the magnitude and direction of these associations among adults 65 years of age or older relative to younger counterparts.

Identifying markers of health-seeking behaviour and healthcare access in UK electronic health records

ObjectiveTo assess the feasibility of identifying markers of health-seeking behaviour and healthcare access in UK electronic health records (EHR), for identifying populations at risk of poor health outcomes and adjusting...

Estimated Carbon Savings from Changing Surgical Trends in Primary Elective Total Hip Arthroplasty in England: A Retrospective Observational Study.

The National Health Service (NHS) in England has set a target to be net zero for carbon emissions by 2045. The aim of this study was to investigate how changes in key aspects of clinical practice over the last 8 years have contributed towards reducing the per-patient carbon footprint of elective total hip arthroplasty (THA). This was a retrospective analysis of administrative data. Data were extracted from the Hospital Episode Statistics database for all adult (≥ 17 years), primary, elective THA procedures conducted in England from 1 April, 2014 to 31 March, 2022. The estimated carbon footprint for key elements of the surgical pathway were calculated based on data from Greener NHS and the Sustainable Healthcare Coalition. Data were available for 537,441 THA procedures conducted during the study period. The per-patient carbon footprint associated with the primary THA (index) procedure fell by around 25% from 2014/15 to 2021/22. Length of stay was by far the largest contributor to this decline, falling from 169.1 kgCO2e to 117.6 kgCO2e per patient from 2014/15 to 2021/22. Absolute declines in the carbon footprint associated with emergency readmissions, revisions and outpatient attendances were more modest. If all patients in all years had the 2021/22 average carbon footprint, then carbon equivalent to powering 19,976 UK homes for 1year would have been saved. Improving per-patient efficiency of surgery is likely to contribute towards meeting the NHS's net-zero target whilst also helping to improve patient outcomes, reduce costs and cut waiting lists.

Ab Initio Molecular Dynamics Simulations of Phosphocholine Interactions with a Calcium Oxalate Dihydrate (110) Surface.

We use ab initio modeling (CASTEP) to help elucidate the crystallization phenomena and chemistry behind kidney stone composition and formation. To explore the stone formation process, we have constructed a surface model of calcium oxalate dihydrate-the mineral most commonly found in patients with hypercalciuria and modeled stone growth, by simulating further calcium oxalate adsorption onto the surface (-7.446 eV, -0.065 eV/atom). Furthermore, urine analysis of kidney stone patients has previously revealed that their urine contains higher concentrations of phospholipids compared to healthy individuals. Therefore, to investigate the interactions between urinary macromolecules and the growing crystal surfaces at an atomic level, we have performed ab initio molecular dynamics simulations of phosphocholine adsorption on calcium oxalate surfaces. We have shown that the phosphocholine headgroups become entrapped within the growing crystal and the lowest energy structures (-18.008 eV, -0.0396 eV/atom) are those where the calcium oxalate dihydrate surfaces have become disrupted, with reorganization of their crystallographic structure. Urinary calculi (kidney stones) are a common ailment affecting around 10% of the world's population and resulting in nearly 90,000 finished consultant episodes (FCE) each year in the United Kingdom [Hospital Episode Statistics, Admitted Patient Care-England, 2011-12 NHS Digital, 2021-2022. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/hospital-episode-statistics-admitted-patient-care-england-2011-12].

Venous thromboembolism risk in amyotrophic lateral sclerosis: a hospital record-linkage study

BackgroundVenous thromboembolism (VTE) can occur in amyotrophic lateral sclerosis (ALS) and pulmonary embolism causes death in a minority of cases. The benefits of preventing VTE must be weighed against the...

A multicentre observational study of paediatric head and neck abscesses

IntroductionIn winter of 2022/3 paediatric ENT surgeons across the UK observed that the incidence of severe abscesses in the head and neck and associated complications was higher than seen in previous years. We aimed to collate and evaluate data from across the UK to establish if this was a true rise in cases, and to describe the factors associated. MethodsA multicentre retrospective data collection was undertaken from 13 units across the UK. Patients admitted between September 2022–February 2023 with a head and neck abscess including sinogenic, otogenic, deep and superficial neck abscesses were included. Demographic, disease specific, management and outcome data were collected. Hospital episode statistic data were also requested and analysed to allow for comparison with previous 10 years of head and neck abscesses. Results262 patients with abscesses of the head and neck were admitted during the study period, 100 between September and November and 163 between December and February. Mastoid abscesses were the most common abscess across both groups. The rate of group A streptococcus + culture results rose significantly from 12 % in autumn group to 30 % in winter (p = 0.02). The rate of intracranial complications rose from 10 % to 18 % (p = 0.11) and the rate of venous thrombosis rose over the same timeframe from 3 % to 14 % (p = 0.01). DiscussionThis study demonstrated a statistically significant rise in the rate of group A streptococcus associated abscesses when comparing Autumn and Winter 2022/2023. Over the same timeframe a statistically significant rise in the proportion of patients with venous thromboses associated with H&N abscesses was noted. Interestingly, despite perceived national consensus regarding a spike in abscess incidence, the number of abscesses seen in winter 2022/2023 was in keeping with expected rates of paediatric H&N abscesses, based on pre covid year-on-year rise in incidence.

Effectiveness and risk of ARB and ACEi among different ethnic groups in England: A reference trial (ONTARGET) emulation analysis using UK Clinical Practice Research Datalink Aurum-linked data.

Guidelines by the National Institute for Health and Care Excellence recommend an angiotensin receptor blocker (ARB) rather than an angiotensin-converting enzyme inhibitor (ACEi) for the treatment of hypertension for people of African and Caribbean descent, due to an increased risk of angioedema associated with ACEi use observed in US trials. However, the effectiveness and risk of these drugs in Black populations in UK routine care is unknown. We applied a reference trial emulation approach to UK Clinical Practice Research Datalink Aurum data (linked with data from Hospital Episode Statistics and Office for National Statistics) to study the comparative effectiveness of ARB and ACEi in ethnic minority groups in England, after benchmarking results against the ONTARGET trial. Approximately 17,593 Black, 30,805 South Asian, and 524,623 White patients receiving a prescription for ARB/ACEi between 1 January 2001 and 31 July 2019 were included with a median follow-up of 5.2 years. The primary composite outcome was cardiovascular-related death, myocardial infarction, stroke, or hospitalisation for heart failure with individual components studied as secondary outcomes. Angioedema was a safety endpoint. We assessed outcomes using an inverse-probability-weighted Cox proportional hazards model for ARB versus ACEi with heterogeneity by ethnicity assessed on the relative and absolute scale. For the primary outcome, 27,327 (18.0%) events were recorded in the ARB group (event rate: 25% per 5.5 person-years) and 80,624 (19.1%) events (event rate: 26% per 5.5 person-years) in the ACEi group. We benchmarked results against ONTARGET and observed hazard ratio (HR) 0.96 (95% CI: 0.95, 0.98) for the primary outcome, with an absolute incidence rate difference (IRD)% of -1.01 (95% CI: -1.42, -0.60) per 5.5 person-years. We found no evidence of treatment effect heterogeneity by ethnicity for the primary outcome on the multiplicative (Pint = 0.422) or additive scale (Pint = 0.287). Results were consistent for most secondary outcomes. However, for cardiovascular-related death, which occurred in 37,554 (6.6%) people, there was strong evidence of heterogeneity on the multiplicative (Pint = 0.002) and additive scale (Pint < 0.001). Compared to ACEi, ARB were associated with more events in Black individuals (HR 1.20 (95% CI: 1.02, 1.40); IRD% 1.07 (95% CI: 0.10, 2.04); number-needed-to-harm (NNH): 93) and associated with fewer events in White individuals (HR 0.91 (95% CI: 0.88, 0.93); IRD% -0.87 (95% CI: -1.10, -0.63); number-needed-to-treat (NNT): 115), and no differences in South Asian individuals (HR 0.97 (95% CI: 0.86, 1.09); IRD% -0.17 (95% CI: -0.87, 0.53)). For angioedema, HR 0.56 (95% CI: 0.46, 0.67) with no heterogeneity for ARB versus ACEi on the multiplicative scale (Pint = 0.306). However, there was heterogeneity on the additive scale (Pint = 0.023). Absolute risks were higher in Black individuals (IRD% -0.49 (95% CI: -0.79, -0.18); NNT: 204) compared with White individuals (IRD% -0.06 (95% CI: -0.09, -0.03); NNT: 1667) and no difference among South Asian individuals (IRD% -0.05 (95% CI: -0.15, 0.05) for ARB versus ACEi. These results demonstrate variation in drug effects of ACEi and ARB for some outcomes by ethnicity and suggest the potential for adverse consequences from current UK guideline recommendations for ARB in preference to ACEi for Black individuals.

How does health visiting in the first year of life vary by family characteristics? A longitudinal analysis of administrative data.

The health visiting service in UK promotes the health and wellbeing of families with young children and comprises a universal offer (three mandated contacts between birth and 12months) and additional contacts based on need. We aimed to understand how the level of health visiting support received varies by family characteristics. Using the Community Services Data Set linked to Hospital Episode Statistics, we identified 52 555 children in 10 local authorities with complete health visiting data for 12months between April 2016 and March 2020. We analysed variation in health visiting contacts by deprivation, child ethnicity, maternal age, adversity and previous live births. 41 340/52 555 children (79%) received the universal service; 63% received ≥1 additional contact and 25% received ≥3 additional contacts. The likelihood of receiving ≥3 additional contacts was greatest for children whose mothers had a history of hospital admissions relating to mental health, violence, self-harm or substance misuse (adjusted relative risk=1.55, 95% confidence interval 1.26-1.92). Most families received health visiting support in addition to the universal service. Policymakers and commissioners should consider how health visiting services can be expanded or targeted more effectively to ensure all families receive the support they need.

Prognostic determinants in cancer survival: a multidimensional evaluation of clinical and genetic factors across 10 cancer types in the participants of Genomics England’s 100,000 Genomes Project

BackgroundCancer is a complex disease, caused and impacted by a combination of genetic, demographic, clinical, environmental and lifestyle factors. Analysis of cancer characteristics, risk factors, treatment options and the heterogeneity across cancer types has been the focus of medical research for years. The aim of this study is to describe and summarise genetic, clinicopathological, behavioural and demographic characteristics and their differences across ten common cancer types and evaluate their impact on overall survival outcomes.MethodsThis study included data from 9977 patients with bladder, breast, colorectal, endometrial, glioma, leukaemia, lung, ovarian, prostate, and renal cancers. Genetic data collected through the 100,000 Genomes Project was linked with clinical and demographic data provided by the National Cancer Registration and Analysis Service (NCRAS), Hospital Episode Statistics (HES) and Office for National Statistics (ONS). Descriptive and Kaplan Meier survival analyses were performed to visualise similarities and differences across cancer types. Cox proportional hazards regression models were applied to identify statistically significant prognostic factor associations with overall survival.Results161 clinical and 124 genetic factors were evaluated for prognostic association with overall survival. Of these, 116 unique factors were found to have significant prognostic effect for overall survival across ten cancer types when adjusted for age, sex and stage. The findings confirmed prognostic associations with overall survival identified in previous studies in factors such as multimorbidity, tumour mutational burden, and mutations in genes BRAF, CDH1, NF1, NRAS, PIK3CA, PTEN, TP53. The results also identified new prognostic associations with overall survival in factors such as mental health conditions, female health-related conditions, previous hospital encounters and mutations in genes FANCE, FBXW7, GATA3, MSH6, PTPN11, RB1, RNF43.ConclusionThis study provides a comprehensive view of clinicopathological and genetic prognostic factors across different cancer types and draws attention to less commonly known factors which might help produce more precise prognosis and survival estimates. The results from this study contribute to the understanding of cancer disease and could be used by researchers to develop complex prognostic models, which in turn could help predict cancer prognosis more accurately and improve patient outcomes.

Impact of vaccination and circulating strains on clinical and economic burden among immunocompromised patients hospitalised for COVID-19 in England: a retrospective observational study using Hospital Episode Statistics (HES)

Impact of vaccination and circulating strains on clinical and economic burden among immunocompromised patients hospitalised for COVID-19 in England: a retrospective observational study using Hospital Episode Statistics (HES)

Has multimorbidity and frailty in adult hospital admissions changed over the last 15 years? A retrospective study of 107 million admissions in England

BackgroundFew studies have quantified multimorbidity and frailty trends within hospital settings, with even fewer reporting how much is attributable to the ageing population and individual patient factors. Studies to date have tended to focus on people over 65, rarely capturing older people or stratifying findings by planned and unplanned activity. As the UK’s national health service (NHS) backlog worsens, and debates about productivity dominate, it is essential to understand these hospital trends so health services can meet them.MethodsHospital Episode Statistics inpatient admission records were extracted for adults between 2006 and 2021. Multimorbidity and frailty was measured using Elixhauser Comorbidity Index and Soong Frailty Scores. Yearly proportions of people with Elixhauser conditions (0, 1, 2, 3 +) or frailty syndromes (0, 1, 2 +) were reported, and the prevalence between 2006 and 2021 compared. Logistic regression models measured how much patient factors impacted the likelihood of having three or more Elixhauser conditions or two or more frailty syndromes. Results were stratified by age groups (18–44, 45–64 and 65 +) and admission type (emergency or elective).ResultsThe study included 107 million adult inpatient hospital episodes. Overall, the proportion of admissions with one or more Elixhauser conditions rose for acute and elective admissions, with the trend becoming more prominent as age increased. This was most striking among acute admissions for people aged 65 and over, who saw a 35.2% absolute increase in the proportion of admissions who had three or more Elixhauser conditions. This means there were 915,221 extra hospital episodes in the last 12 months of the study, by people who had at least three Elixhauser conditions compared with 15 years ago. The findings were similar for people who had one or more frailty syndromes. Overall, year, age and socioeconomic deprivation were found to be strongly and positively associated with having three or more Elixhauser conditions or two or more frailty syndromes, with socioeconomic deprivation showing a strong dose–response relationship.ConclusionsOverall, the proportion of hospital admissions with multiple conditions or frailty syndromes has risen over the last 15 years. This matches smaller-scale and anecdotal reports from hospitals and can inform how hospitals are reimbursed.

Differences in health visiting contacts for children of mothers with and without a history of adversity-related hospital admissions in England (2018/19 to 2019/20): an analysis of novel linked community health and hospital data.

ObjectiveExplore differences in children’s contact with health visiting (HV) services by pre-birth exposure to maternal adversity. ApproachFor the first time, we linked the Community Services Dataset (CSDS), which records HV contacts for children in England from 1 April 2018 to 31 March 2020, to Hospital Episode Statistics (HES) which contains births and mothers’ hospital admissions in the preceding 3 years. We used admissions that included ICD-10 codes related to mental health, substance use and violence to identify children born to mothers with a history of adversity. We compared characteristics of children’s HV contacts (i.e. number, mode, location, duration) stratified by maternal adversity. ResultsOverall, 85.2% of 626,478 children in CSDS linked to a birth record in HES. Among children receiving HV contacts, 11.7% were exposed to maternal adversity: 11.1% mental health, 1.3% substance use, 0.4% violence. Children with maternal adversity had more HV contacts than other children (mean = 3.8 vs 2.7, p&lt;0.001). There were no differences in contact mode (i.e. face-to-face or phone) for children with maternal adversity compared to others, but their contacts were longer (44.5% lasting &gt;30 minutes vs 35.1%, p&lt;0.001) and more likely to be at home (56.3% vs 47.8%, p&lt;0.001). ConclusionsHV services respond in different ways to children with and without pre-birth exposure to serious maternal adversity, reflecting the “proportionate universalism” that underpins HV services in England. ImplicationsThe differential service response for vulnerable children may require additional resources (e.g. staff, training) which should be considered when designing and funding HV services.

Identifying disease phenotypes from linked health data: Comparison of self-report, hospital inpatient and primary care in UK Biobank.

ObjectivesAdministrative health data is commonly used for epidemiological research, however it is not well understood how disease phenotypes replicate across different data sources. ApproachUK Biobank is a prospective cohort study of 500,000 adults, with ascertainment of health outcomes using administrative health data. Prevalence at recruitment for 33 diseases were calculated in each health data source: self-report, primary-care, and hospital episode statistics (HES). Consistency of disease identification between sources, and median days between first diagnosis across data sources was determined. Linear regression was used to investigate determinant of differences in the average time between first diagnosis in primary-care and HES data. ResultsHypertension was the most commonly identified disease in both self-report and HES (26.5% and 12.1% respectively), and anxiety in primary-care (12.7%). Diseases could be grouped into: 1) those identified largely by self-report alone (e.g. migraine, constipation), with inconsistency in the date first diagnosed; 2) those identified largely by primary care alone (e.g. anxiety, depression), also with inconsistency in the date first diagnosed; and 3) those that appeared mostly in all three sources, with highly consistent date of first report (many were emergency hospital admissions [e.g. stroke]). A number of variables were associated with time between primary-care and HES diagnosis. For example, heavier smokers had a significantly shorter period between first primary-care and first HES record for asthma, diabetes and hypertension. Conclusions and ImplicationsThese results indicate that there are inherent biases in diseases ascertained from linked health data that must be taken into account for epidemiological studies.

Identifying hospitalization episodes of care among people with and without HIV in British Columbia, Canada

BackgroundHospitalizations are a resource-intensive form of healthcare use, particularly for persons with chronic conditions such as those with HIV. Interhospital transfers typically appear as separate records in Canadian databases; misclassifying transfers as independent hospitalizations can bias key metrics such as readmission rates. We examined approaches of combining sequential, related records into hospitalization episodes of care (HEoCs) among persons with and without HIV (PWH; PWoH) in British Columbia (BC), Canada. MethodsBC hospitalization records (1992 to 2020) were sourced from the Comparative Outcomes and Service Utilization Trends (COAST) study, a data linkage that includes samples of PWH and PWoH. We constructed 8 HEoC definitions that varied by the: a) time gap between records, and b) transfer indication. Comparisons were informed by the proportion of multi-record HEoCs (mHEoCs; episodes with multiple hospitalization records) generated, and feasibility given data quality. ResultsWe analyzed 98,553 hospitalization records from 13,498 PWH, and 1,874,507 hospitalization records from 385,011 PWoH. Across the definitions, the proportion of mHEoCs varied from 2.46% to 5.27% for PWH and 2.73% to 4.18% for PWoH. Definitions requiring no transfer indication yielded the highest proportion of mHEoCs, whereas those requiring two-way agreement of hospital identifiers yielded the lowest proportion of mHEoCs. Patterns were comparable among PWH and PWoH. A pragmatic approach to defining HEoCs can be a reasonable option for general purposes – requiring at least one populated hospital identifier field, and ≤ 1 day gap between hospitalizations. ConclusionsVarious approaches can be employed to combine sequential, related hospitalization records into HEoCs to help provide less biased estimates of hospitalization-related metrics.

Mental health of children with epilepsy compared to their peers: population-based cohort from linked primary and secondary healthcare record in England

BackgroundChildren with epilepsy have higher rates of internalising mental health (MH) conditions compared to their peers, although available evidence is limited by small and selective samples. We used linked primary care and hospital admission records covering approximately 4.42% of English population to describe incidence of mental health problems in children with epilepsy compared to their peers. MethodsWe developed a cohort of young people aged 7-17 years old between 2010-2019, with minimum 1 year of follow-up until death, 18th birthday or 2020 using linked data from the Clinical Practice Research Datalink and Hospital Episodes Statistics. Epilepsy (exposure), depression and anxiety (outcomes) were identified using a combination of diagnostic codes, and primary care prescribing records. We estimated incident rate ratios (IRR) for anxiety/depression/any MH condition for children with epilepsy compared to their peers using negative binomial regression adjusted for sex, age, and area-level deprivation. ResultsStudy cohort included 510,177 children and young people, of whom 3,011 (0.59%) had epilepsy. Children with epilepsy had higher incidence of any MH condition (IRR: 1.39, 95% CI: 1.11–1.73) and anxiety (IRR: 1.38, 95% CI: 1.06–1.77), with differences in depression being non-significant (IRR: 1.25, 95% CI: 0.92–1.66). DiscussionChildren with epilepsy have higher rates of MH problems than their peers. Further work will examine if this can be partially explained by increased opportunity for MH diagnosis due to more healthcare contacts. Our findings emphasise the importance of integrated care models that address both neurological and psychological aspects of epilepsy management.

Cumulative incidence of chronic health conditions recorded in hospital admissions from birth to age 16 in England: a cohort study using linked hospital and education administrative data

ObjectiveMonitoring the incidence of chronic health conditions (CHCs) in childhood in England using administrative data to derive numerators and denominators is challenged by unmeasured migration. We used a birth cohort design and different criteria for contact with health or education services to estimate the cumulative incidence of CHCs to age 16 years. ApproachWe identified all births in Hospital Episode Statistics (HES) from 2002/3 to 2011/12, with follow-up to 2018/19 (maximum age 8 to 16 years), censoring on death, first non-England residence record or 16th birthday. Children must have linked to later HES records and/or the National Pupil Database (NPD), which provides information on all state-school enrolments. The cumulative incidence of CHCs was estimated to age 16 using diagnostic codes in hospital admission records. We also explored temporal variation. Sensitivity analyses varied denominator criteria. ResultsBetween 423,456 children (79.4%, of all HES-recorded births in 2002/3) and 618,054 (97.5% in 2011/12) linked to later HES or NPD records. The cumulative incidence of ever having a recorded CHC before age 16 among children born in 2002/3 or 2003/4 was 24.6%, ranging from 21% to 32% in sensitivity analyses. There was little temporal variation. At least 28% of children with any CHC had more than one body system affected by age 16. Multimorbidity rates rose with later cohorts. ConclusionsApproximately one quarter of children are affected by CHCs, but varies depending on how the denominator is defined. More accurate estimation of the incidence of CHCs requires a dynamic population estimate.

Screening for psychological distress in childhood and mental health-related hospital attendance among young adults

ObjectivesThe prevalence of mental disorders is high and increasing among children and young people. Investigating the relationship between self-reported poor mental health and mental health service utilisation can provide evidence on the benefits of universal screening, but longitudinal data is rare. ApproachData from a nationally representative English cohort (Next Steps) were linked to NHS Hospital Episode Statistics. GHQ-12 assessed psychological distress in Next Steps at age 15; participants were followed until their first mental health-related hospital presentations or were censored at the end of the study (age 27). Cox proportionate hazard models with survey weights estimated associations. ResultsOut of 4058 young people included in the analyses, 19% reported high levels of distress at age 15. During the 12-year follow-up, 5.3%, 2.9% and 2.7% of the participants had at least one mental disorder, drug/alcohol misuse and self-harm presentation, respectively, and 4.2% had a mental health treatment. Higher GHQ-12 scores were associated with mental disorder presentations (HR=1.10, 95% CI:1.04-1.16), and mental health treatments (HR=1.14, 95% CI:1.08-1.20). Associations were weaker for young people living in deprived areas, or if their main parent had lower education. ConclusionsAdolescent psychological distress predicts subsequent hospital attendance in young adulthood, but there are treatment gaps in service utilisation among more disadvantaged individuals. Detecting youth with mental health difficulties through universal screening, may facilitate early intervention, improve life-course outcomes, and reduce secondary healthcare use. ImplicationsLinked cohort and administrative data can improve our understanding on long-term healthcare utilisation and treatment needs.

ThP1.11 - Harnessing digital consent analytics to highlight multicentre operative and consent trends in breast surgery

Abstract Introduction Paper-based consent is difficult to audit at scale, therefore hospital episode statistics data is used to provide insights into national breast surgical practice. However, as digital consent is becoming routine, analysis of amalgamated data is possible to provide a better understanding of consent practice. Methods Between 22/04/2020-29/11/23, patient anonymised digital consent data was analysed retrospectively using Concentric Health analytics (Audit ID:1123ABS). Inclusion criteria required the responsible clinician to be a breast surgeon, with non-breast surgical procedures excluded. Results n=6860 digital consent episodes were performed across 10 NHS Trusts and 4 private institutions (n=890 unique operations. n=82 unique responsible clinicians, n=191 consenting clinicians). 45.6% (n=3125/6860) of the cases were consented by consultants. 18.7% (n=1286/6860) underwent a mastectomy; 78.5% simple &amp; 21.5% reconstruction (of which 82.6% implant and 17.4% autologous reconstruction). 40.1% (n=2750/6860) underwent breast conserving surgery (79.2% WLE, 18.9% therapeutic mammoplasty, 1.9% Intercostal perforator). Re-excision of margins accounted for 16% of BCS cases (n=441/2750). SLNB was performed in 40.6% and ANC in 11.5% of all breast surgery cases. Regarding localisation; 44.5% Seed, 30.6% Wire, 21.7% palpable/other, 3.2% USS skin mark. Conclusion As well as providing benefits in terms of information sharing and improved patient satisfaction, digital consent also provides an opportunity to provide high-level data, regarding which operations are being consented to, when and by whom.

Association between surgical admissions, cognition, and neurodegeneration in older people: a population-based study from the UK Biobank

Previous studies have shown that major surgical and medical hospital admissions are associated with cognitive decline in older people (aged 40-69years at recruitment), which is concerning for patients and caregivers. We aimed to validate these findings in a large cohort and investigate associations with neurodegeneration using MRI. For this population-based study, we analysed data from the UK Biobank collected from March 13, 2006, to July 16, 2023, linked to the National Health Service Hospital Episode Statistics database, excluding participants with dementia diagnoses. We constructed fully adjusted models that included age, time, sex, Lancet Commission dementia risk factors, stroke, and hospital admissions with a participant random effect. Primary outcomes were hippocampal volume and white matter hyperintensities, both of which are established markers of neurodegeneration, and exploratory analyses investigated the cortical thickness of Desikan-Killiany-Tourville atlas regions. The main cognitive outcomes were reaction time, fluid intelligence, and prospective and numeric memory. Surgeries were calculated cumulatively starting from 8years before the baseline evaluation. Of 502 412participants in the UK Biobank study, 492 802participants were eligible for inclusion in this study, of whom 46 706underwent MRI. Small adverse associations with cognition were found per surgery: reaction time increased by 0·273ms, fluid intelligence score decreased by 0·057correct responses, prospective memory (scored as correct at first attempt) decreased (odds ratio 0·96 [95% CI 0·95to 0·97]), and numeric memory maximum correct matches decreased by 0·025in fully adjusted models. Surgeries were associated with smaller hippocampal volume (β=-5·76mm³ [-7·89to-3·64]) and greater white matter hyperintensities volume (β=100·02 mm³ [66·17to 133·87]) in fully adjusted models. Surgeries were also associated with neurodegeneration of the insula and superior temporal cortex. This population-based study corroborates that surgeries are generally safe but cumulatively are associated with cognitive decline and neurodegeneration. Perioperative brain health should be prioritised for older and vulnerable patients, particularly those who have multiple surgical procedures. The Australian and New Zealand College of Anaesthetists (ANZCA) Foundation and the University of Sydney.