Record Linkage Study Research Articles

Long-term observations on the mortality of mentally ill patients admitted to a short-stay psychiatric hospital: 23 years retrospective Egyptian study

BackgroundInformation about mortality patterns in different psychiatric populations is scanty, yet it is vital for designing successful preventive mental health strategies. In this study, we aimed to assess mortality rates and patterns for the patients admitted to Ain Shams University Institute of Psychiatry (ASUIP) with different psychiatric diagnoses from1990 to 2013. All medical records and related registration files were reviewed and investigated for death cases and their possible causes in a retrospective record linkage study. Data were recorded, tabulated, and coded to be used in the Statistical Package for Social Sciences (SPSS) Version 17.ResultsThe study identified 57 death cases in 23-years duration with a mortality rate of 3/1000. Mortality rates were more in younger patients and females. Medical comorbidity was reported in 34.8% of them. The most common known causes for death in the current sample were cardiac causes 15.2%, followed by cerebrovascular causes that were 10.9%. However, sudden or unknown causes were the most frequent diagnosis in the sample.ConclusionsThe institute mortality rates were lower than those of the general population during this period. The most common known death causes were cardiovascular problems, which mandates close monitoring of high-risk psychiatric patients with co-morbid cardiac problems. Unknown morality causes represented an unresolved challenge for the current registration system and the quality of care given to patients with serious mental illness.

The receipt of information by family physicians about their patient\u2019s emergency department visits: a record linkage study of electronic medical records to health administrative data

BackgroundCanadians are known to be frequent users of emergency department (ED) care. However, the exchange of information from ED visits to family physicians (FPs) is not well known. Our objectives were to determine whether Canadian FPs received information about their patient’s ED visit and the patient characteristics related to the receipt of ED information.MethodsThis study was a descriptive record linkage study of FP Electronic Medical Record (EMR) data linked to health administrative data. Our study cohort included patients who had at least one ED visit in 2010 or 2015 in Ontario, Canada. An ED visit could include a transfer to or from another ED. The receipt of information from an ED note was examined in relation to patient age, sex, neighbourhood income quintiles, rurality and comorbidity.ResultsThere were 26,609 patients in 2010 and 50,541 patients in 2015 with at least one ED visit. In 2010, 53.3% of FPs received an ED note for patients having a single ED visit compared to 41.0% in 2015. For patients with multiple ED visits, 58.2% of FPs received an ED note in 2010 compared to 45.7% in 2015. FPs were more likely to receive an ED note for patients not living in low income neighbourhoods, older patients, patients living in small urban areas and for patients having moderate comorbidity. FPs were less likely to receive a note for patients living in rural areas.ConclusionsCommunity-based FPs are more likely to get information after an ED visit for their older and sicker patients. However, FPs do not receive any information from EDs for over half their patients. Electronic health record technologies and their adoption by ED providers need to improve the seamless transfer of information about the care provided in EDs to FPs in the community.

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

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

Impact of fetal presentation on neurodevelopmental outcome in a trial of preterm vaginal delivery: a nationwide, population-based record linkage study

PurposeTo assess the risk of adverse neurodevelopmental outcomes at the age of four after an attempted vaginal delivery according to the fetal presentation in birth.MethodsThis retrospective record linkage study evaluated the risks of cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, and speech, visual, and auditory disabilities among preterm children born after an attempted vaginal breech delivery. The control group comprised children born in a cephalic presentation at the same gestational age. This study included 23 803 singleton deliveries at gestational weeks 24 + 0–36 + 6 between 2004 and 2014.ResultsFrom 1629 women that underwent a trial of vaginal breech delivery, 1122 (66.3%) were converted to emergency cesarean sections. At extremely preterm and very preterm gestations (weeks 24 + 0—31 + 6), no association between a trial of vaginal breech delivery and neurodevelopmental delay occurred. At gestational weeks 32 + 0—36 + 6, the risks of visual disability (aOR 1.67, CI 1.07—2.60) and autism spectrum disorders (aOR 2.28, CI 1.14—4.56) were increased after an attempted vaginal breech delivery as compared to vaginal cephalic delivery.ConclusionA trial of vaginal breech delivery at extremely preterm and very preterm gestations appears not to increase the risk of adverse neurodevelopmental outcomes at the age of four. In moderate to late preterm births, a trial of vaginal breech delivery was associated with an increased risk of visual impairment and autism spectrum disorders compared to children born in cephalic presentation. A trial of vaginal preterm breech delivery requires distinctive consideration and careful patient selection.

Factors associated with admission of children to an intensive care unit and readmission to hospital within 28 days of discharge: A population-based study.

Hospital readmissions within 28 days are an important performance measurement of quality and safety of health care. The aims of this study were to examine the rates, trends and characteristics of paediatric intensive care unit admissions, and factors associated with readmissions to hospital within 28 days of discharge. This retrospective, population-based record linkage study included all children ≥28 days and <16 years old admitted to an intensive care unit (ICU) in a New South Wales (NSW) public hospital from 2004 to 2013. Data were sourced from the NSW Admitted Patients Data Collection and the NSW Registry of Births, Deaths and Marriages, Death Registration. We identified 21 200 ICU admissions involving 17 130 children. Admissions increased by 24% over the study period with the greatest increase attributed to respiratory and musculoskeletal conditions. A higher proportion of children were <5 years, male, lived in major cities, were publicly insured and had chronic conditions. The median length of ICU stay was 42 h and overall hospital stay was 7 days. There were 905 deaths, two-thirds during the index admission with the leading causes being injuries, cancer and infections. Twenty-three per cent of ICU admissions were readmitted to hospital within 28 days of discharge. Associated independent factors were younger age, longer index hospital stay and emergency index admission. Children with chronic conditions of cancer and genitourinary disorders were more likely to be readmitted. Identification of complex chronic conditions, consideration of long-term health planning and interventions intended to reduce readmission is warranted in order to reduce the burden to families and the health-care system.

DTap vaccination uptake during pregnancy: Pregnant women-focused and health professionals-focused predictors in the Veneto Region (Italy)

BackgroundDespite recommendations, the uptake of dTap maternal vaccination is still low in many countries. The reasons for this must be investigated both on the patient’s and the healthcare professionals’ sides. MethodsA record linkage study was performed linking Birth Assitance Certificates and dTap mothers’ vaccination records (5183 deliveries) to describe the influence of socioeconomical and obstetrical-gynecological factors after the recommendations concerning dTap vaccination in pregnancy issued by the Italian Ministry of Health (August 2018). An interview was also administered to a subgroup of 656 new mothers on the occasion of the first vaccination of their newborns, in order to assess the dTap vaccination advice received from maternal care providers during pregnancy. A generalized linear model (binomial family, log link) was implemented to give a correct estimate of the mother’s relative risk of being vaccinated. ResultsSeveral pregnant women-focused factors are evident, but the most important ones are related to maternal care providers’ practices: after mutual adjustment, the explicit advice towards dTap maternal vaccination given by the Obstetrician-Gynecologist or the Midwife is associated with a 12-fold increase in the dTap coverage. ConclusionsMultiprofessional training is essential to make Obstetricians-Gynecologists and Midwives more confident in recommending dTaP maternal immunization.

Early childhood predictors of elementary school suspension: An Australian record linkage study

Out-of-school suspension is associated with adverse educational, justice, health, and welfare outcomes. Little research has focussed on suspensions from primary (elementary) school, despite early exclusions representing high-risk events for poor outcomes. This study aimed to identify early life predictors of primary school suspensions in a sample of 34,855 Australian children using linked education, health, child protection, and justice records for children and their parents. Associations between 26 sociodemographic, pregnancy/birth, child, and parent factors (measured prior to 3rd grade) and subsequent suspensions, issued during the 3rd through 6th grades (ages ~8–11 years), were examined in bivariate and multivariable logistic regressions. In the fully adjusted model, 18 factors were associated with suspension, with the largest effects for male gender, child protection services contacts, and aggressive behaviour. Identification of students at risk of early suspension using multi-sector information available at school entry may assist educators and policymakers to deliver preventative interventions.

Social Isolation and All-Cause and Heart Disease Mortality Among Working-Age Adults in the United States: The 1998-2014 NHIS-NDI Record Linkage Study.

Purpose: Living alone, an indicator of social isolation, has been increasing in the United States; 28% of households in 2019 were one-person households, compared with 13% in 1960. The working-age population is particularly vulnerable to adverse social conditions such as low social support. Although previous research has shown that social isolation and loneliness lead to poorer health and decreased longevity, few studies have focused on the working-age population and heart disease mortality in the United States using longitudinal data.Methods: This study examines social isolation as a risk factor for all-cause and heart disease mortality among U.S. adults aged 18–64 years using the pooled 1998–2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (n=388,973). Cox proportional hazards regression was used to model survival time as a function of social isolation, measured by “living alone,” and sociodemographic, behavioral, and health characteristics.Results: In Cox regression models with 17 years of mortality follow-up, the age-adjusted all-cause mortality risk was 45% higher (hazard ratio [HR]=1.45; 95% confidence interval [CI]=1.40–1.50) and the heart disease mortality risk was 83% higher (HR=1.83; 95% CI=1.67–2.00) among adults aged 18–64 years living alone at the baseline, compared with adults living with others. In the full model, the relative risk associated with social isolation was 16% higher (HR=1.16; 95% CI=1.11–1.20) for all-cause mortality and 33% higher (HR=1.33; 95% CI=1.21–1.47) for heart disease mortality after controlling for sociodemographic, behavioral-risk, and health status characteristics.Conclusion: In this national study, adults experiencing social isolation had statistically significantly higher relative risks of all-cause and heart disease mortality in the United States than adults living with others.

Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.

BackgroundChildren born preterm (<37 completed weeks’ gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship.Methods and findingsUsing a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28–29, 30–31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1–2, 3–4, 5–6, and 7–10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7–10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91–7.22) during infancy, declining to 3.16 (2.50–3.99) at ages 7–10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21–1.27) and 1·18 (1.13–1.23), during infancy and aged 7–10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55–11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56–7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20–13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95–11.32)) were the most common causes.ConclusionsGestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7–10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.

Evolution of disability pension after renal transplantation: methods and results of a database linkage study of the Swiss Transplant Cohort Study and Swiss Disability Insurance.

In Switzerland, certain patients with disabilities and reduced working ability are entitled to a disability pension granted by the Swiss Federal Social Insurance Office (FSIO). The aim was to assess the evolution of disability pension and work capacity after kidney transplantation and thereby pilot the procedures linking FSIO data with Swiss Transplant Cohort Study (STCS) data. The current study pilot tested the record linkage of FSIO data with data from the STCS in a single-centre, observational setting. Patients were requested to consent to the use of their Swiss social security number (SSSN) for the purpose of record linkage. A privacy preserving trust centre approach was implemented with blinded statistical analysis. Between May 2008 and December 2015, 282 working-age renal transplant recipients of the University Hospital of Basel transplant centre were eligible for inclusion and 136 (48%, median age 48 years) consented to the use of their social security number and record linkage. The FSIO datasets of all patients were successfully retrieved and linked to STCS data in the trust centre and were numerically analysable. Yearly FSIO allowance data were available for the entire study duration. Fifty-five patients (40%) were registered as disability insurance recipients (DIR). In the entire population, the proportion of working patients slightly decreased from 76% to 72% between the pre-transplant and the post-transplant period. This was due to the lower proportion of patients working after transplantation in DIR compared with non-recipients (non-DIR) (DIR: 60% before vs 44% after; non-DIR: 83% before vs 88% after). In the DIR group, the proportion of patients not working increased from 36% to 49%, whereas in non-DIR the proportion changed only marginally (14% to 12%). The average disability insurance allowance was CHF 1172 per month. It changed from CHF 1135 before transplantation to CHF 1209 after transplantation (p = 0.59). In the Swiss healthcare and social insurance system, record linkage studies combining clinical datasets with data from FSIO are feasible but associated with great efforts and resource needs. The lack of changes in disability allowances after kidney transplantation should be further investigated in the nationwide setting.

US Cancer survival disparities by socioeconomic, behavioral, and health characteristics: The 1997-2014 NHIS-NDI record linkage study

US Cancer survival disparities by socioeconomic, behavioral, and health characteristics: The 1997-2014 NHIS-NDI record linkage study

1034All-cause mortality in Australia: impact of social isolation and living alone

Abstract Background The prevalence of social isolation (SI), living alone (LA) and loneliness among older people in Australia is 17%, 25% and 19% respectively. In a meta-analysis of 70 prospective studies undertaken by Holt-Lunstad et al (2015)1 they found, after controlling for covariates, a 29% increased all-cause mortality for SI, 32% for LA, and 26% for loneliness. But how accurate is this evidence for Australia considering that the meta-analysis only included three Australian studies; all only reporting on LA, and only one reported a significant effect of LA on total mortality. Methods We conducted a record linkage study in NSW using the Social Economic and Environmental Factors sub-study questionnaire data (n = 60,399) from the 45 and Up Study (n = 267,153) and death registrations (Centre for Health Record Linkage). Overall, 20% were SI and 18% were LA. Univariate and multivariable generalised linear models were used to estimate crude and adjusted 7-year all-cause mortality rate ratios (MRR). Results Crude MRR were 28% higher for SI and 98% higher for LA. When adjusted by age and sex they were still significantly higher (28% and 23% respectively). However, when controlled for covariates, SI was 9% higher [AdjRR(95%CI):1.09(1.01-1.18)] and LA had no effect on mortality [AdjRR(95%CI):1.05(0.94-1.18)]. Conclusions As was the case for the Australian studies used in the meta-analysis we found no association between LA and all-cause mortality. We did however find a small significant effect for SI. Key messages Applying the overall meta-analysis results to Australia overestimates the effect of SI and LA on increased all-cause mortality.

505Maternal autoimmune disease and increased attention deficit/hyperactivity disorder among offspring: A cohort study and meta-analysis

Abstract Background Maternal autoimmune disease (AD) has been associated with increased neurodevelopmental disorders in the offspring, but few studies have assessed Attention Deficit/Hyperactivity Disorder (ADHD). Methods Population-based record linkage study of 831,718 singleton term births in New South Wales, Australia, 2000-2010. Any maternal AD and specific autoimmune conditions were identified from hospital admission data, and ADHD in children was ascertained from stimulant prescription data (up to 2014). The association between maternal AD and ADHD was examined using Cox regression analysis after propensity score matching (1:4) to control for maternal confounders. A systematic review and meta-analyses were conducted, and pooled hazard ratios (HR) were calculated using random-effects meta-analysis with inverse variance weights. Results Of 831,718 births, 12,767 (1.5%) women had AD. In a propensity score-matched cohort (n = 63,050) maternal AD was associated with ADHD in offspring: “any AD” (HR 1.30, 95%CI 1.15-1.46), type-1 diabetes (T1D) (HR 2.23, 95%CI 1.66-3.00), psoriasis (HR 1.66, 95%CI 1.02-2.70) and rheumatic fever/carditis (HR 1.75, 95%CI 1.06-2.89). Five studies including ours were identified and included in the meta-analysis. Any AD (2 studies: HR 1.20, 95%CI 1.03-1.38), T1D (4 studies: HR 1.53, 95%CI 1.27-1.85), hyperthyroidism (3 studies: HR 1.15, 95%CI 1.06-1.26), and psoriasis (2 studies: HR 1.31, 95%CI 1.10-1.56) were associated with ADHD. Conclusions Maternal ADs were associated with increased ADHD among offspring, suggesting shared underlying genetic vulnerability or a role for maternal immune activation in fetal neurodevelopment. Future studies are required to understand causal mechanisms and identify interventions. Key messages Maternal ADs are associated with increased ADHD among offspring.

618Is mode of first birth a risk factor for subsequent preterm birth?

Abstract Background Previous preterm birth is a strong predictor of subsequent preterm birth but less is known about the causes of preterm birth following a full-term pregnancy. Recent research highlighted previous caesarean as a potential risk factor and we aimed to further explore this risk. Methods This population-based record linkage study included all women in NSW, Australia who had a live singleton first birth at ≥ 37 weeks gestation, followed by a singleton second birth between 2005–2017. Relative risk (RR) and 95%CI of having a subsequent preterm birth, spontaneous preterm birth or preterm pre-labour caesarean was calculated using individual modified Poisson regression models, with mode of first birth as the exposure. Results Women who had an intrapartum (RR:1.26, 95%CI 1.19–1.32) or prelabour caesarean (RR:1.26,95%CI 1.18–1.35) first birth had a higher risk of subsequent preterm birth, than those who birthed vaginally. Those who had a pre-labour caesarean (RR:0.74, 95%CI 0.67–0.82) had a lower risk of subsequent spontaneous preterm birth. However, prior pre-labour caesarean also greatly increased the risk of subsequent preterm prelabour caesarean (RR:5.25, 95%CI 4.65–5.93). Conclusions Pre-labour and intrapartum caesareans have differing effects on the risk of subsequent spontaneous preterm birth and preterm pre-labour caesarean. Key messages The risk of subsequent preterm birth following a first birth caesarean depends on whether the caesarean occurred before or after the onset of labour and whether the subsequent preterm birth is spontaneous or a pre-labour caesarean.

Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care

The median age for total hip arthroplasty (THA) is over 70 years with the corollary that many individuals have multiple multimorbidities. Despite the predicted improvement in quality of life, THA...

1018Long-term risk of distant metastasis and post-metastasis survival for breast cancer: health record linkage study

Abstract Background After early breast cancer (BC) treatment, women need information about long-term prognosis. In this population-based health record linkage study, we assessed the cumulative incidence of distant metastasis (DM) conditional on the DM-free interval; and BC-specific survival post-metastasis. Methods We included all women diagnosed with non-metastatic BC in the NSW Cancer Registry, 2001-2002. We used linked records from hospitals, dispensed medicines, radiotherapy services and death registrations and applied stringent criteria to determine time to first DM and BC death. Results 6338 women were included (BC: localised 3885, regional 2453). The 5-year cumulative incidence of DM was 7.4% (95% confidence interval 6.6-8.3) for localised BC; 22.8% (21.2-24.5) for regional BC. For women DM-free at 5 years, it was 5.7% (5.0-6.6); and 11.4% (10.0-13.0) to year 10, respectively. The annual hazard for BC death following localised BC remained lower than that for non-BC causes; for regional BC, it was similar to that for non-BC causes at 8 years. Following DM (N = 1492), BC-specific survival varied widely (median 25 months, interquartile range 6-127). The probability of surviving BC for ≥5 years was 32.0% (29.4-34.7) overall; and 47.1% (42.6-51.5) for those with a DM-free interval &amp;gt;5 years. Conclusions Women’s risk of DM improves over time since diagnosis; and post-metastasis survival is longer for women with later DM. Key messages Health record linkage methods can be used for conditional risk estimates to inform women who remain DM-free after early BC about their risk of DM in subsequent years; and post-metastasis survival.

518Trajectories of offending in people with psychotic illness and other mental disorders: a population study

Abstract Background Trajectory analysis has been used to study long-term patterns of offending and identify offending groups. Only few studies have explored patterns in people with psychotic illness and these were restricted to adult offenders. This study examines offending trajectories, and identifies risk factors, for people aged 10-26 with psychotic illness (PI) and other mental disorders (OMD) compared to those with no mental disorders (NMD). Methods This is a whole-population record-linkage study of 184,147 people born in Western Australia (WA) 1983-1991 using data from WA psychiatric case register, WA corrective services and other state-wide registers. Group-based trajectory modelling was used to identify offending trajectories. Results Four offender groups were identified for each mental health status (MHS) group: MHS groups had similar offending patterns, however PI had a lower proportion of individuals in the G1 group and later offending onset in the G3 group. Gender, indigenous status, substance use, childhood victimisation and parental offending were risk factors associated with group membership; for PI, childhood victimisation and parental offending were only significant in the G4 group. Conclusions Overall offending patterns and risk factors were similar for all MHS groups, however, some differences were observed for PI. Key messages To reduce offending in this population, interventions need to occur at an early age.

Esophageal achalasia diagnosed in people previously diagnosed with an eating disorder: Epidemiological study using record-linkage.

Occasionally, patients with eating disorders have been subsequently diagnosed with esophageal achalasia. We sought to establish whether eating disorders and achalasia coexisted more often than expected by chance alone. National record-linkage study of hospital inpatients in England, between 2001 and 2017. Use of Cox proportional hazards to compare the occurrence of achalasia in cohorts of people with or without anorexia nervosa (AN), and with or without bulimia nervosa (BN), with adjustment of the comparisons for such confounders as age, sex, and year of admission. There were 18,500 people in the AN cohort, 11,300 in the BN cohort, and 8.7 million in the comparison cohort. The Cox regression hazard ratio, comparing the AN cohort with the reference cohort, was 3.4 (95% confidence interval 1.8-6.3) and that in the BN cohort was 4.2 (2.2-8.2). AN and achalasia, and BN and achalasia, were diagnosed in the same individuals, more often than expected by chance. Clinicians should be aware of the possible associations with achalasia because the treatment of eating disorders and achalasia is different.

Inequalities in life expectancy in Australia according to education level: a whole-of-population record linkage study

BackgroundLife expectancy in Australia is amongst the highest globally, but national estimates mask within-country inequalities. To monitor socioeconomic inequalities in health, many high-income countries routinely report life expectancy by education level. However in Australia, education-related gaps in life expectancy are not routinely reported because, until recently, the data required to produce these estimates have not been available. Using newly linked, whole-of-population data, we estimated education-related inequalities in adult life expectancy in Australia.MethodsUsing data from 2016 Australian Census linked to 2016-17 Death Registrations, we estimated age-sex-education-specific mortality rates and used standard life table methodology to calculate life expectancy. For men and women separately, we estimated absolute (in years) and relative (ratios) differences in life expectancy at ages 25, 45, 65 and 85 years according to education level (measured in five categories, from university qualification [highest] to no formal qualifications [lowest]).ResultsData came from 14,565,910 Australian residents aged 25 years and older. At each age, those with lower levels of education had lower life expectancies. For men, the gap (highest vs. lowest level of education) was 9.1 (95 %CI: 8.8, 9.4) years at age 25, 7.3 (7.1, 7.5) years at age 45, 4.9 (4.7, 5.1) years at age 65 and 1.9 (1.8, 2.1) years at age 85. For women, the gap was 5.5 (5.1, 5.9) years at age 25, 4.7 (4.4, 5.0) years at age 45, 3.3 (3.1, 3.5) years at 65 and 1.6 (1.4, 1.8) years at age 85. Relative differences (comparing highest education level with each of the other levels) were larger for men than women and increased with age, but overall, revealed a 10–25 % reduction in life expectancy for those with the lowest compared to the highest education level.ConclusionsEducation-related inequalities in life expectancy from age 25 years in Australia are substantial, particularly for men. Those with the lowest education level have a life expectancy equivalent to the national average 15–20 years ago. These vast gaps indicate large potential for further gains in life expectancy at the national level and continuing opportunities to improve health equity.

Maternal body mass index in pregnancy and mental disorders in adult offspring: a record linkage study in Aberdeen, Scotland

Maternal obesity in pregnancy predicts offspring psychopathology risk in childhood but it remains unclear whether maternal obesity or underweight associate with adult offspring mental disorders. We examined longitudinally whether maternal body mass index (BMI) in pregnancy predicted mental disorders in her offspring and whether the associations differed by offspring birth year among 68,571 mother–child dyads of Aberdeen Maternity and Neonatal Databank, Scotland. The offspring were born 1950–1999. Maternal BMI was measured at a mean 15.7 gestational weeks and classified into underweight, normal weight, overweight, moderate obesity and severe obesity. Mental disorders were identified from nationwide registers carrying diagnoses of all hospitalizations and deaths in Scotland in 1996–2017. We found that maternal BMI in pregnancy was associated with offspring mental disorders in a time-dependent manner: In offspring born 1950–1974, maternal underweight predicted an increased hazard of mental disorders [Hazard Ratio (HR) = 1.74; 95% Confidence Interval (CI) = 1.01–3.00)]. In offspring born 1975–1999, maternal severe obesity predicted increased hazards of any mental (HR 1.60; 95% CI 1.08–2.38) substance use (HR 1.91; 95% CI 1.03–3.57) and schizophrenia spectrum (HR 2.80; 95% CI 1.40–5.63) disorders. Our findings of time-specific associations between maternal prenatal BMI and adult offspring mental disorders may carry important public health implications by underlining possible lifelong effects of maternal BMI on offspring psychopathology.