Population-based Linkage Study Research Articles

Parental cardiorespiratory conditions and offspring fracture: A population-based familial linkage study.

The role of parental cardiorespiratory conditions on fracture risk is unclear. We examined the associations between parental cardiorespiratory conditions and offspring fracture risk. In this population-based retrospective cohort study, we identified 279,085 offspring aged≥40years between April 1, 1997 and December 31, 2015 with successful linkage to 273,852 mothers and 254,622 fathers. Parental cardiorespiratory conditions, including cerebral vascular disease, congestive heart failure, hypertension, ischemic heart disease, myocardial infarction, chronic obstructive pulmonary disease (COPD) and peripheral vascular disease, were ascertained using physician and hospital records dating back to 1979. The outcome was offspring incident major osteoporotic fracture (MOF). During an average of 11.8years of offspring follow-up, we identified 8762 (3.1%) incident MOF. Either parent congestive heart failure (adjusted hazard ratio [HR]: 1.13; 95% confidence interval [CI] 1.07-1.19) and COPD (adjusted HR: 1.12; 95% CI 1.07-1.17) were independently associated with increased offspring MOF risk; all their false discovery rates were <0.001. Similar risk estimates were observed when analyses were performed for fathers only, mothers only or both parents, in multivariable models with and without adjustment for offspring cardiorespiratory conditions, and stratified by offspring sex and offspring incident fracture site. Parental cerebrovascular disease, hypertension, ischemic heart disease and myocardial infarction were not associated with offspring MOF. Parental congestive heart failure and parental COPD are independent risk factors for offspring MOF.

Area deprivation, urbanicity, severe mental illness and social drift — A population-based linkage study using routinely collected primary and secondary care data

We investigated whether associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs, including schizophrenia and bipolar disorder) is accounted for by social drift or social causation.We extracted primary and secondary care electronic health records from 2004 to 2015 from a population of 3.9 million. We identified prevalent and incident individuals with SMIs and their level of deprivation and urbanicity using the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator. The presence of social drift was determined by whether odds ratios (ORs) from logistic regression is greater than the incidence rate ratios (IRRs) from Poisson regression. Additionally, we performed longitudinal analysis to measure the proportion of change in deprivation level and rural/urban residence 10 years after an incident diagnosis of SMI and compared it to the general population using standardised rate ratios (SRRs).Prevalence and incidence of SMIs were significantly associated with deprivation and urbanicity (all ORs and IRRs significantly >1). ORs and IRRs were similar across all conditions and cohorts (ranging from 1.1 to 1.4). Results from the longitudinal analysis showed individuals with SMIs are more likely to move compared to the general population. However, they did not preferentially move to more deprived or urban areas.There was little evidence of downward social drift over a 10-year period. These findings have implications for the allocation of resources, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.

Pregnancy-associated cancers: frequency and temporal trends in Italy

ObjectiveLimited data are available on the frequency and time trends of pregnancy-associated cancers, particularly from Southern European countries. The aim of this study was to analyze the frequency and time...

Area Deprivation, Urbanicity and Severe Mental Illness – A Population-Based Linkage Study Using Routinely Collected Primary and Secondary Care Data

Background There is a long-standing debate regarding the associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs).&#x0D; Main Aim We investigated the associations between area deprivation, urbanicity and risk of SMIs in a population cohorts in Wales.&#x0D; Methods/Approach We extracted primary and secondary care electronic health records from 2004 to 2015 from Wales’s population. We identified prevalent and incident individuals with SMIs (schizophrenia related disorders and bipolar disorder) and their level of deprivation and urbanicity. We used the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator to measure the level of area deprivation and urbanicity respectively for all lower layer super output areas, the geographic units used in the reporting of small area statistics comprised of approximately 1,500 individuals.&#x0D; Results Prevalence and incidence of SMIs is not evenly distributed in Wales. Increased prevalence and incidence of SMIs occur in more deprived and urban areas. Such associations occur for both schizophrenia related disorders and bipolar disorder and in both the primary and secondary care cohorts.&#x0D; Conclusion These findings have implications for resource allocation, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.

Associations of Birth Factors and Socio-Economic Status with Indicators of Early Emotional Development and Mental Health in Childhood: A Population-Based Linkage Study.

Using a linked population-based database established on healthcare, socio-economic, and survey datasets in British Columbia, Canada, we examined how biological, socio-demographic, and socio-economic status (SES) factors at birth related to children's emotional development and mental health. One analysis examined teacher-rated anxiety, hyperactivity, and aggression for kindergarten children (Mage = 5.7; n = 134,094). Another analysis examined administrative healthcare records comprising of physician-assigned diagnostic codes for mental health conditions (conduct disorder, attention deficit hyperactivity disorder, anxiety disorder and depression) from ages 5 through 15 (n = 89,404). Various factors at birth, including gestational age, birthweight, and maternal demographics, were related to emotional development and mental health in childhood. Across outcomes, low SES indicated detrimental associations with various aspects of children's emotional development and mental health (e.g., adjusted odds of mental health conditions were 25-39% higher for children of low income families versus others). Findings reinforce evidence that poverty (reduction) is a primary public health issue.

Socioeconomic determinants of leprosy new case detection in the 100 Million Brazilian Cohort: a population-based linkage study

SummaryBackgroundAlthough leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil.MethodsSocioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0–15 years), by leprosy subtype and region of residence.FindingsIn an analysis of 23 899 942 individuals including 18 518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32–1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62–2·72, for lowest vs highest level of education).InterpretationWithin the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control.FundingMedical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.

Association Between Birth Defects and Cancer Risk Among Children and Adolescents in a Population-Based Assessment of 10 Million Live Births

Birth defects affect approximately 1 in 33 children. Some birth defects are known to be strongly associated with childhood cancer (eg, trisomy 21 and acute leukemia). However, comprehensive evaluations of childhood cancer risk in those with birth defects have been limited in previous studies by insufficient sample sizes. To identify specific birth defect-childhood cancer (BD-CC) associations and characterize cancer risk in children by increasing number of nonchromosomal birth defects. This multistate, population-based registry linkage study pooled statewide data on births, birth defects, and cancer from Texas, Arkansas, Michigan, and North Carolina on 10 181 074 children born from January 1, 1992, to December 31, 2013. Children were followed up to 18 years of age for a diagnosis of cancer. Data were retrieved between September 26, 2016, and September 21, 2017, and data analysis was performed from September 2, 2017, to March 21, 2019. Birth defects diagnoses (chromosomal anomalies and nonchromosomal birth defects) recorded by statewide, population-based birth defects registries. Cancer diagnosis before age 18 years, as recorded in state cancer registries. Cox regression models were used to generate hazard ratios (HRs) and 95% CIs to evaluate BD-CC associations and the association between number of nonchromosomal defects and cancer risk. Compared with children without any birth defects, children with chromosomal anomalies were 11.6 (95% CI, 10.4-12.9) times more likely to be diagnosed with cancer, whereas children with nonchromosomal birth defects were 2.5 (95% CI, 2.4-2.6) times more likely to be diagnosed with cancer before 18 years of age. An increasing number of nonchromosomal birth defects was associated with a corresponding increase in the risk of cancer. Children with 4 or more major birth defects were 5.9 (95% CI, 5.3-6.4) times more likely to be diagnosed with cancer compared with those without a birth defect. In the analysis of 72 specific BD-CC patterns, 40 HRs were statistically significant (adjusted P < .05) after accounting for multiple comparisons. Cancers most frequently associated with nonchromosomal defects were hepatoblastoma and neuroblastoma. Several significant and novel associations were observed between specific birth defects and cancers. Among children with nonchromosomal birth defects, the number of major birth defects diagnosed was significantly and directly associated with cancer risk. These findings could inform clinical treatment for children with birth defects and may elucidate mechanisms that lead to these complex outcomes.

Australian population-based study of single- versus multi-fraction palliative radiotherapy for bone metastases.

6568 Background: Single fraction palliative radiotherapy (SFRT) has been shown to be equivalent to multi-fraction radiotherapy (MFRT) for bone metastases symptom management. Remuneration for radiotherapy (RT) in Australia are largely determined by fractions delivered. We aim to determine the use of SFRT for bone metastases in Australia. Methods: We did a population-based linkage study of multiple administrative healthcare databases in Victoria, Australia: the Victorian Radiotherapy Minimum Data Set (VRMDS), the Victorian Cancer Registry (VCR), and the Birth, Death and Marriage registry (BDM). All patients with solid tumour (excluding primary bone cancer) who received palliative radiotherapy for bone metastases between 2012 and 2017 were included. The primary outcome was use of SFRT. The Cochrane-Armitage test for trend was used to evaluate SFRT use over time. Multivariable logistic regression was used to identify factors associated with SFRT use. Results: A total of 15,668 courses of RT for bone metastases were delivered to 10,351 patients. The overall proportion of SFRT was 18% (2,746/ 15,668). There was no significant change in SFRT use over time, from 18% in 2012 to 20% in 2017 (P = 0.06). Older patients were more likely to have SFRT (mean age 69.4 vs. 68.2, P &lt; 0.001). Patients who had lung cancer (21%) and prostate cancer (19%) were more likely to have SFRT compared to other tumour types (P &lt; 0.001). Spine RT was associated with lower use of SFRT compared to other treatment sites (14% vs. 22%, P &lt; 0.001). Patients from remote area were more likely to have SFRT compared to patients from major cities (22% vs. 17%, P &lt; 0.001). Patients treated in private institutions were less likely to have SFRT compared to those treated in public institutions (10% vs. 22%, P &lt; 0.001). In multivariate analyses, patients’ age, tumour type, area of residence, and treatment institutions were independently associated with SFRT use. Conclusions: This is the largest Australian population-based cohort treated with RT for bone metastases, with low utilisation of SFRT over time. There is large variation in SFRT use depending on patient-, tumour-, geographical and institutional factors. Further work is needed to increase uptake, and reduce unwarranted variation, in SFRT use.

Pregnancy related cancer in Apulia. A population based linkage study.

ObjectiveDespite a quite large number of papers in literature, the current incidence of pregnancy associated cancer still remains uncertain. Moreover, different inclusion criteria and time intervals considered after delivery make these data poorly comparable. The aim of this study was to investigate the incidence of PACs in Apulia, an Italian region, while stressing differences or similarities with other populations.Study designWe collected 682,173 pregnancies from national discharge forms, regarding hospitals in Apulia from January 2003 to December 2015. Our aim was not only to obtain the raw incidence of PACs but also to estimate the odds ratio (OR) for some potential risk predictors such as calendar year, age, nationality and pregnancy outcome using a logistic model. Women were sorted into different groups by age (<30, 30–34, 35–39, >=40) and by nationality (Italian or foreign nationals). Each pregnancy had two possible outcomes: delivery or abortion.ResultsWe achieved a final cohort of 867 PACs: therefore, the raw incidence is 127.1 per 100,000 pregnancies. Breast cancer was the most common cancer (37.7 cases per 100,000 pregnancies) and as a typical feature in our population thyroid cancers followed it by incidence (22.3 per 100,000 pregnancies). Cervical cancer is, as expected, the first gynaecological cancer by incidence(3.8 per 100,000). Younger women have the lowest risk for PACs (64.5 per 100,000, OR = 1) while the highest risk for PACs was for women aged >=40 years (OR = 4.29, p < 0.05). Considering calendar years, we observed an increased OR from 2006 to 2009 (OR = 1.39 and OR = 1.41 respectively) without spotting a trend throughout the whole decade.ConclusionsThe ranking of each tumour by incidence more or less reflects its demographics in reproductive age females in western countries and the incidence for any cancer is expected to grow as the rate of first deliveries in older women continues to rise. We reported noticeable differences regarding the incidence of some cancers (such as thyroid cancer) with previous literature, reflecting an epidemiologic feature of our cohort. Women older than 40 years have a more than fourfold risk for oncologic diagnosis during pregnancy, and this finding is of pivotal clinical and social importance because of the tendency of women living in developed countries to postpone childbearing.

Cancer in children and adolescents with AIDS in the city of São Paulo: A population-based linkage study

Introduction Previous studies revealed an elevated risk of cancer in children and adolescents with AIDS. However, there is limited population-based data from developing countries. The objective of the present study was to describe the cancer spectrum in children and adolescents with AIDS in the City of Sao Paulo from 1997 to 2012. Methods It is a population-based registry linkage study using the databases of the Population-based Cancer Registry of Sao Paulo (1997–2012) and of the Sistema de Informacao de Agravos de Notificacao (SINAN)/Information System on Disease Notification (1984–2013). Children and adolescents with AIDS and cancer have been identified by means of a probabilistic record linkage process between the aforementioned databases. We calculated crude and age-standardized incidence rates (world standard population, 0–19 years) per million. To assess trends, we calculated the annual percent change (APC) and its 95% confidence intervals (95% CI) using Joinpoint software. To compare risk of cancer in children with AIDS to that of the general pediatric population of Sao Paulo, we estimated the standardized incidence ratio (SIR) and respective 95% CIs. Analysis were stratified by AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs). Results We identified 24 cases of cancer in patients with AIDS aged Conclusion To our knowledge, this is the first population-based study to describe cancer spectrum in children and adolescents with AIDS in Brazil. ADCs still account for an important share of cancer cases in this pediatric population. Between 1997 and 2012, there has been a reduction in the incidence of all cancers, driven by the decrease in the incidence of ADCs because of wide use of antiretroviral therapy. The finding of the present study is in line with previous research conducted in the United States, Spain and Italy. However, children and adolescents with AIDS remain at increased risk for developing ADCs as well as HL in comparison to the general population.

Risk for cancer among people living with AIDS, 1997-2012: the São Paulo AIDS-cancer linkage study.

Previous studies have reported an increased risk for certain types of cancer in the HIV-infected population. The aim of this study was to assess the risk for cancer in people with AIDS (PWA) in comparison with the general population in São Paulo (Brazil), between 1997 and 2012. A population-based registry linkage study was carried out to assess the risk for cancer, using a standardized incidence ratio (SIR) approach. A total of 480 102 person-years, of which 337 941 (70.4%) person-years were men, were included in the analysis. Around 2074 cancer cases were diagnosed among PWA, of which 51.0% were non-AIDS-defining cancers (NADC). The risk for AIDS-defining cancers and NADC in the male population with AIDS was significantly higher than that in the general population (SIR=27.74 and 1.87, respectively), as it was in the female population with AIDS compared with the general population (SIR=8.71 and 1.44, respectively). Most virus-related NADC occurred at elevated rates among PWA: anal cancer (SIR=33.02 in men and 11.21 in women), liver (SIR=4.35 in men and 4.84 in women), vulva and vagina (SIR=6.78 in women) and Hodgkin lymphoma (SIR=5.84 in men and 2.71 in women). Lung (SIR=2.24 in men and 2.60 in women) and central nervous system (SIR=1.92 in men and 3.48 in women) cancers also occurred at increased rates. Cancer burden among PWA in São Paulo was similar to that described in high-income countries such as the USA and Italy following the introduction of the highly active antiretroviral therapy. As coinfection with oncogenic viruses disproportionally affects this population, virus-related cancers accounted for a great share of excessive cases.

Mortality trends among people with hepatitis B and C: a population-based linkage study, 1993-2012

BackgroundThis study evaluated cause-specific mortality trends including liver-related mortality among people with a hepatitis B virus (HBV) and hepatitis C virus (HCV) notification in New South Wales, Australia.MethodsNotifications 1993-2012 were linked to cause-specific mortality records 1993-2013.ResultsAmong 57,929 and 92,474 people with a HBV and HCV notification, 4.8% and 10.0% died since 1997. In early 2010s, 28% and 33% of HBV and HCV deaths were liver-related, 28% and 17% were cancer-related (excluding liver cancer), and 5% and 15% were drug-related, respectively. During 2002-2012, annual HBV-related liver death numbers were relatively stable (53 to 68), while HCV-related liver death numbers increased considerably (111 to 284). Age-standardised HBV-related liver mortality rates declined from 0.2 to 0.1 per 100 person-years (PY) (P < 0.001); however, HCV-related rates remained stable (0.2 to 0.3 per 100 PY, P = 0.619). In adjusted analyses, older age was the strongest predictor of liver-related mortality [birth earlier than 1945, HBV adjusted hazard ratio (aHR) 28.1, 95% CI 21.0, 37.5 and; HCV aHR 31.9, 95% CI 26.8, 37.9], followed by history of alcohol-use disorder (HBV aHR 7.0, 95% CI 5.5, 8.8 and; HCV aHR 8.3, 95% CI 7.6, 9.1).ConclusionsDeclining HBV-related liver mortality rates and stable burden suggest an impact of improved antiviral therapy efficacy and uptake. In contrast, the impact of interferon-containing HCV treatment programs on liver-related mortality individual-level risk and population-level burden has been limited. These findings also highlight the importance of HBV/HCV public health interventions that incorporate increased antiviral therapy uptake, and action on health risk behaviors.

O23 Characterisation of populations with hepatitis C to improve access to antiviral therapy programs: a population-based linkage study

O23 Characterisation of populations with hepatitis C to improve access to antiviral therapy programs: a population-based linkage study

Frequency of Pregnancy Related Cancer: A Population Based Linkage Study in Lombardy, Italy.

The aims of this study were to estimate the occurrence of pregnancy-associated cancer overall and by site, to evaluate if the risk increases over time, and to investigate some major determinants. This is a population-based linkage study using the regional hospital discharge forms [Scheda di Dimissione Ospedaliera (SDO)] database of Lombardy, Italy, a region with 10 million inhabitants. All resident women with a SDO reporting a birth or abortion between 2001 and 2012 were identified. Pregnancy-associated cancers were defined as a cancer occurring during pregnancy or within 12 months after pregnancy and were identified by selecting all SDOs reporting a first diagnosis of cancer. Risk of developing a pregnancy-related cancer was calculated as the ratio of the number of pregnancy-related cancers to the total number of pregnancies. The effect of potential predictors on the risk was estimated using a logistic regression model, and odds ratios (OR) were estimated. During the period 2001-2012, the risk of pregnancy-related cancer was 122.9 per 100,000 pregnancies. The most common cancers were breast cancer (479 cases, 39.9/100,000 pregnancies), thyroid cancer (186 cases, 15.5/100,000), and lymphomas (157 cases, 13.1/100,000). Skin cancer accounted for 177 cases (14.8/100,000), half of which were melanomas. The risk of developing a pregnancy-related cancer increased significantly with age, from 60 of 100,000 for women less than 30 years old to 265 of 100,000 for women aged more than 40 years. Italian women had a higher risk than foreign ones (OR, 1.6), and the pregnancy outcome was more frequently an abortion (OR, 1.2), whereas no trend in risk was observed with calendar year (P = 0.249). This study confirms previously reported incidence estimates but does not show increases over time.

Antidepressant drug use among adolescents during 2004-2013: a population-based register linkage study.

ObjectiveTo study trends in use of antidepressants (ADs) by adolescents, and psychiatric morbidity and use of other psychotropic drugs as a measure of psychiatric comorbidity.MethodsOne‐year prevalence of AD drug use was analyzed for 13‐ to 17‐year‐old Norwegians during 2004–2013. Use of other psychotropic drugs and specialist healthcare services was analyzed for incident AD users in 2012, using linked data from the Norwegian Prescription Database and the Norwegian Patient Register.ResultsThe 1‐year prevalence of AD drug use increased from 6.4/1000 to 9.1/1000 during 2004–2013, with the steepest increase from 2010, particularly among girls. The highest prevalence was found in 17‐year‐old girls (17.8/1000 in 2010, 27.5/1000 in 2013). Of incident AD drug users in 2012, 84.4% had been in contact with specialist health care. As the first drug, 78.4% were prescribed a selective serotonin reuptake inhibitor. The most common types of other psychotropic drugs were melatonin (24.6%), antipsychotic drugs (13.2%), stimulants (8.8%), and anxiolytics (6.0%).ConclusionsUse of ADs among adolescents has increased over the last 3–4 years, particularly among 16‐ to 17‐year‐old girls. A total of 85% of incident users had been in contact with specialist health care, which may indicate that drug‐therapy is used by adolescents with more severe symptoms.

Increasing Prevalence and Decreasing In-Hospital Mortality of Acute Pulmonary Embolism in NSW - A Population Based Linkage Study

Increasing Prevalence and Decreasing In-Hospital Mortality of Acute Pulmonary Embolism in NSW - A Population Based Linkage Study

Determinants of non-adherence to adjuvant endocrine treatment in early stage breast cancer patients: A Swedish population-based registry linkage study.

535Background: Non-adherence to adjuvant endocrine treatment (ET) among breast cancer patients has been associated with worse prognosis. We sought to identify factors affecting non-adherence to ET, taking into account determinants at baseline and follow-up. Methods: From linkage between Swedish national registers, we identified all women diagnosed with stage I-III, ER-positive breast cancer in Stockholm-Gotland, Uppsala-Orebro and Northern Sweden between 2006 and 2009. A total of 4,413 women who had at least one dispensation of tamoxifen or aromatase inhibitors (AIs) and 5 years of follow-up were included in the analysis. A medical possession ratio (MPR) of < 80% was used to define non-adherents. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of non-adherence to ET. Results: During follow-up, 1,131 (25.6%) women became non-adherents. The following determinants of non-adherence were identified: age, marital status, region of diagnosis, private hospital, tumour...

Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome.

Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1,018,421 live born infants without an NAS diagnosis. Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poisoning (3.6, 2.6-4.8), and mental/behavioral (2.6, 2.1-3.2) and visual (2.9, 2.5-3.5) disorders. Mothers of infants with NAS were more likely to be Indigenous (6.4, 6.0-7.0), have no antenatal care (6.6, 5.9-7.4), and be socioeconomically deprived (1.6, 1.5-1.7). Regression analyses demonstrated that NAS was the most important predictor of admissions for maltreatment (odds ratio 4.5, 95% confidence interval: 3.4-6.1) and mental and behavioral disorders (2.3, 1.9-2.9), even after accounting for prematurity, maternal age, and Indigenous status. Children with NAS are more likely to be rehospitalized during childhood for maltreatment, trauma, and mental and behavioral disorders even after accounting for prematurity. This continues to adolescence and emphasizes the critical need for continued support of this vulnerable group after resolution of NAS.

Acute hospital service utilization by inpatients in psychiatric hospitals.

Standardized mortality ratios are twice the population average in the year following a mental health admission, yet there is a relative paucity of research on uptake of general medical care in psychiatric inpatients. A retrospective database analysis was performed to ascertain the frequency of acute medical care usage by psychiatric inpatients. Data were gathered through a static linkage between anonymized clinical records in a large UK mental health provider and the national hospital activity database (Hospital Episode Statistics) over 1year from 2010 to 2011. Over the year, 10.4% of the 8023 psychiatric admission episodes included at least one night in a general hospital during that psychiatric inpatient stay, while 12.0% of psychiatry admission episodes entailed an emergency department (ED) visit. Over the course of the full year, of the 4674 people admitted to the mental health provider at least once, 16.0% were admitted to a general hospital while registered as a mental health inpatient and 18.0% were seen in the ED. Patients were simultaneously registered as occupying beds in both general and psychiatric hospitals for a total of 5163 bed days at a cost of £2.4 million over the year. This large population-based linkage study indicates a high rate of general hospital utilization by psychiatric inpatients in an independent mental health provider. The need for combined, flexible and practical approaches to the medical care of psychiatric inpatients is highlighted to reduce unplanned care and provide treatment in the site best suited to the patient's needs.

The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study.

BackgroundWith rising obstetric anal sphincter injury (OASI) rates, the number of women at risk of OASI recurrence is in turn increasing. Decisions regarding mode of subsequent birth following an OASI are complex, and depend on a variety of factors. We sought to identify the risk factors for OASI recurrence from first and subsequent births, and to investigate the effect of OASI birth factors on planned caesarean for the second birth.MethodsUsing two linked population datasets from New South Wales, Australia, we selected women giving birth between 2001 and 2011 with a first birth OASI and a subsequent birth. Multivariable logistic regression was used to identify the association of first and second birth factors with OASI recurrence, and to determine which factors were associated with a planned pre-labour caesarean at the second birth.ResultsOf 6,380 women with a first birth OASI who proceeded to a subsequent birth, 75.4% had a vaginal second birth, 19.4% a pre-labour caesarean, and 5.2% an intrapartum caesarean. Although the OASI recurrence rate of 5.7% was significantly higher than the first birth OASI rate of 4.5% (p < 0.01), this may not reflect a clinically significant increase. Following adjustment for first and second birth factors, first birth diabetes and second birthweight ≥3.5 kg were associated with increased likelihood of OASI recurrence, while first birthweight ≥4.0 kg and second gestation at 37–38 weeks were associated with decreased likelihood. A fourth degree tear at the first birth was the strongest factor associated with planned caesarean at the second birth, with other factors including epidural, spinal or general anaesthetic, birthweight, gestation, country of birth and maternal age.ConclusionsCompared with previous reports, the low OASI recurrence rate (approximately one in twenty) may reflect appropriate decision-making about subsequent mode of delivery following first birth OASI. This assertion is supported by evidence of different risk profiles for women who have planned caesareans compared with planned vaginal births.