bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between antibiotic prescribing and deprivation in Wales: A multilevel analysis
Authors: Adekanmbi Victor , Smith Ann , Farewell Daniel , Jones Hywel , Paranjothy Shantini , Routledge Phil , Francis Nicholas 
Published: September 2018

IntroductionThe most recent Welsh Antimicrobial Resistance Programme (WARP) report on antibiotic use in primary care found significant variations between Health Boards and hospitals in gross antibiotic use in 2014. The aim of this study was to evaluate the association between socioeconomic deprivation and antibiotic prescribing volumes.
Objectives and ApproachWelsh General Practitioner (GP) antibiotic prescribing data for years 2013 to 2016 for patients’ resident in Wales were extracted from the Secure Anonymised Information Linkage GP tables. Deprivation was assessed by linking prescribing events to the Welsh Index of Multiple Deprivation (WIMD) score for the patient’s neighbourhood area. The association between deprivation area and antibiotic prescribed (items per 1000 persons per day) was stratified according to the patient’s age, sex, prescription year and antibiotic class. A three-level multilevel Poisson regression model of 1.58 million patients nested within 349 GP practices, nested with 67 GP clusters, was specified to assess the associations
ResultsJust over 7.97 million antibiotic items were prescribed between 2013 and 2016. Patients in the most deprived WIMD quintile had an overall prescription rate that was 25.2% higher than those in the least deprived WIMD quintile. The final model revealed that residing in the most deprived WIMD quintile (incidence rate ratio [IRR] = 1.1769, 95% confidence interval [CI] 1.1768 to 1.1770, being female (IRR = 1,2699, 95% CI 1.2698 to 1.2700), being aged $\geq$90 (IRR = 2.0687, 95% CI 2.0683 to 2.0690), and prescription year being 2013 were associated with significantly higher rate of antibiotics prescription. There were significant primary cares clustering of antibiotics prescription in Wales.
Conclusion/ImplicationsThis study provides evidence that patients in areas of higher socioeconomic deprivation are more likely to be prescribed antibiotics in primary care in Wales. Population health prevention strategies aimed at reducing high antibiotic prescription rates should consider targeting areas of high deprivation.
Using Residential Anonymous Linking Fields to Identify Vulnerable Populations in Administrative Data
Authors: Hollinghurst Joe , Fry Richard , Akbari Ashley , Rodgers Sarah 
Published: September 2018

IntroductionDemographic profiling is an important aspect of anonymised healthcare research to identify the population of interest. Typically, administrative data is used in conjunction with patient registers to create cohorts, but it can be a time consuming process. We describe a method using routinely collected health data to identify vulnerable populations.
Objectives and ApproachUsing existing longitudinal data and the Residential Anonymised Linking Field (RALF) we aim to identify institutions linked to vulnerable populations. We search for specific characteristics of these institutions including the age of occupants, number of current residents, and rate of change of occupants. We also aim to compare our method to a pseudonymised national registry for care homes to ensure it is accurate. This can effectively reduce the need for repeat pseudonymisation of institutions, which is both expensive and time consuming.
ResultsTo implement our method we found the most recent address for living individuals aged 65-95. This produced 202,640 residences from 1,330,335. Of the 202,640 residences, 1347 had four or more cohabitants aged 65-95, and 172 had exactly three residents with ten or more distinct individuals registered over a 10-year period. Our final synthetic dataset therefore had 1519 unique potential care homes to compare to the national registry, which contains 1525 registered care homes.
We can now link the synthetic dataset to individuals to flag their residential status, which may be a defining factor in their level of care. Furthermore, we can answer specific research questions relating to their residency, such as the time it takes to move to a care home following a hospital admission.
Conclusion/ImplicationsBy using quantifiable characteristics of care homes we were able to create a synthetic care home register by searching existing data. This is a reproducible process that would be of particular benefit for projects where a registry is not available, or where time or cost would limit the availability.
Maternal mortality of women with opioid-use during pregnancy in England: investigating bias in a cohort of linked mother-baby hospital records
Authors: Blackburn Ruth , Wijlaars Linda , Harron Katie , Guttmann Astrid , Gilbert Ruth 
Published: September 2018

IntroductionOpioid-addiction is a major public health threat, with rates of drug misuse related deaths increasing in North America and England. Linkage within and between administrative data datasets is important for capturing determinants and outcomes but this vulnerable population is highly susceptible to linkage error, which can result in inaccurate estimates.
Objectives and ApproachWe investigated neonatal abstinence syndrome (NAS) as a marker of opioid-use in pregnancy, using linked mother-baby records to identify maternal opioid-use based on NAS in the baby’s record. Maternal all-cause mortality was compared for mothers with and without a NAS-pregnancy. Bias was assessed through comparison of linked and unlinked NAS baby characteristics. De-identified national hospital inpatient data – including postcode-district and GP surgery-code – were used for deterministic and probabilistic linkage of mothers and babies born in England 2002-2013. Linked national mortality data captured maternal deaths
ResultsLinkage between maternal and baby records was possible for 96% of all live births in England, but for only 88% of study/cohort babies with NAS (n=18,087). NAS babies with unlinked records represented a more vulnerable population with longer hospital stay (median 12 versus 7 days, p<0.001), low birthweight (44% <2500g versus 27%, p<0.001) and discharge to social services (13% versus 8%, p<0.001) than NAS babies who could be linked to maternal records. Non-linkage may plausibly be driven by mismatching or missing identifiers reflecting adoption and out-of-home care arrangements for the baby, potentially also indicating greater maternal adversity. Within the linked cohort (comparing 13,581 women with a NAS baby and 4,205,941 women without a NAS baby), the crude hazard ratio for all-cause mortality was 12.1 (11.1-13.2).
Conclusion/ImplicationsReview of unlinked records suggests evidence of linkage bias, with the implication that our results may underestimate the risk of death among women with opioid-use. Complementary linkages, drawing on other data - such as birth records where the mother is named - could help address non-linkage driven by out-of-home care.
Evaluating the impacts on health outcomes of Welsh Government funded schemes designed to improve the energy efficiency of the homes of low income households: A comparison of individual level and area based schemes.
Authors: Morrison-Rees Sian , Lowe Sarah 
Published: September 2018

IntroductionLiving in a cold and/or damp house can damage health. To reduce fuel poverty in Wales, the Welsh Government developed domestic energy efficiency schemes - an individual-level scheme, Warm Homes Nest and an area-based scheme, Warm Homes Arbed. Both schemes provide improvements to those most likely affected by fuel poverty.
Objectives and ApproachOverall aim: to evaluate the health impacts of Welsh Government funded schemes designed to reduce fuel poverty. Presented objective: to investigate the relative impact of the individual-level and area-based schemes on the health of recipients.
A longitudinal dataset was created using the anonymised residence that received improvements linked to residents’ health measures (hospital admissions, GP prescriptions and clinical diagnoses) using routine health records held in the SAIL Databank at Swansea University.
We used difference-in-difference (DID) estimations to compare any changes in recipient health before and after intervention with any concurrent change in health in those yet to receive the intervention.
ResultsAn analysis of the Warm Homes Nest Scheme, published in 2017 and presented at the IPDLN 2017 conference found a positive impact of the scheme on the health of recipients.
This presentation will describe the further analysis (concluding shortly) comparing the area-based Arbed scheme with both the recipients of the individual-level Nest scheme and groups in comparable need that had not yet received the intervention. We will present results focussing on the relative impacts of the two schemes on cardiovascular, respiratory and general health.
Conclusion/ImplicationsProviding home energy efficiency interventions has the potential to benefit population health; however, there is a scarcity of evidence comparing different methods of implementing schemes. Our findings will inform more effectively-focussed home energy efficiency schemes and potentially thus improve the health of people living in Wales.
Is educational attainment associated with acute exposure to air pollution and pollen, and is it worse for pupils with asthma and seasonal allergic rhinitis?
Authors: Mizen Amy , Lyons Jane , Akbari Ashley , Berridge Damon , Carruthers David , Davies Gwyneth , Dearden Lorraine , Doherty Ruth , Mavrogianni Anna , Lake Iain , Rodgers Sarah 
Published: September 2018

IntroductionThere is a lack of evidence of the adverse effects of air pollution and pollen on cognition for people with air quality related health conditions. This study explored the effects of air quality and respiratory health conditions on educational attainment for 18,241 pupils across the city of Cardiff, United Kingdom.
Objectives and ApproachAnonymised, routinely collected health and education data were linked at the household and school level with modelled high spatial resolution pollution data, and daily pollen measurements using the Secure Anonymised Information Linkage (SAIL) databank. This created 7 repeated cross-sectional cohorts (2009-2015). Multilevel linear regression analysis examined whether exam performance was associated with health status and/or air quality levels averaged at school and home locations during revision and examination periods. We also investigated the combined effects of air quality and associations with educational attainment for pupils who were treated for asthma and/or Severe Allergic Rhinitis (SAR), and those who were not.
ResultsThe cohort contained 9337 males and 8904 female pupils. There were 871 treated for asthma, 2091 for SAR, and 634 treated for both. Asthma was not associated with exam performance (p=0.700). However, SAR was positively associated with exam performance (p 2) was negatively associated with educational attainment (p = 0.002). Other indicators of air quality (pollutants: Ozone, Particulate Matter - PM2.5, and pollen) were not associated with educational attainment (p> 0.05). Exposure to NO2 was negatively associated with educational attainment irrespective of treatment for asthma or SAR. There was no combined effect of air quality on the variation in educational attainment between those who are treated for asthma and/or SAR and those who were not.
Conclusion/ImplicationsIrrespective of health status, exposure to NO2 was negatively associated with educational attainment. Treatment seeking behaviour may be a possible explanation for the positive association between SAR and educational attainment. For a more accurate reflection of health status, health outcomes not subject to treatment seeking behaviour should be investigated.
Access to palliative care in Canada
Authors: Johnson Tracy , Cheng Clare , Lawand Christina , Kelly Maureen 
Published: September 2018

IntroductionMany Canadians prefer to remain in the community at end-of-life, and to die at home. To do so, early and integrated palliative care (PC) is needed to provide individuals with care and support services across care settings. Measuring access to PC can help to evaluate progress over time.
Objectives and ApproachThis presentation will show findings from our study on whether Canadian decedents had access to PC in the last year of life. Data from physician billings, drug claims, home care, long-term care and acute care were linked to identify decedents and PC service use. These data were also used to examine how PC may affect, or be affected by other interactions with the health system, including inpatient alternate level care days, admissions from long-term care, emergency department visits and stays in intensive care units. Gaps in data availability and quality will also be highlighted.
ResultsAbout 70% of decedents were identified using administrative health data, although there were variations across jurisdictions due to differences in data availability and quality (9%-81%). For decedents identified across care settings, few received PC in the community in their last year of life, ranging from 4% in long-term care to 12% in home care. More decedents were identified as palliative in acute care (44%) but only one-third received PC in another setting despite multiple interactions with the health system in the last year of life. Those who had integrated, community-based PC were less likely to have a stay in an intensive care unit, and more likely to die in the community. However, few Canadian decedents had access to this type of care.
Conclusion/ImplicationsData linkage identified opportunities for earlier integration of PC and improved care transitions. However, lack of common definitions of PC across sectors and jurisdictions, limitations in data availability and issues in PC coding were identified. Improvements in PC data are required to evaluate progress for the future.
Priorities for future research: the community adding value to linked data research
Authors: McKenzie Anne , Holland Maria , Harrison Hayley , O'Donnell Melissa , Preen David B 
Published: September 2018

IntroductionWhilst there is limited published information on the benefits of engaging the public in linked data research, our presentation will add to international knowledge about the benefits of involving the community in a priority setting exercise for future research areas in a new linkage project.
Objectives and ApproachWe’ll co-present with a consumer about our experiences of the community having a role in linked data research over the past 20-years. Community members have provided input into: research projects; feedback to government agencies; submissions to federal/state governments; issues about access to data; and priorities for research.
In 2017 community members prioritised broad research areas for a new project involving cross-agency linkage, investigating pathways to wellbeing and social-outcomes across the life-course to improve outcomes and identify cost-efficiencies. Community members completed a survey to rank the broad themes and then attended a workshop to discuss the themes and identify gaps or new ideas.
ResultsFollowing the workshop all suggestions made on the day were themed into broad areas and then circulated to the attendees to rank in order of importance. These community activities identified the top ten priorities, as shown below, as being the most important areas for future research:

Aboriginal Health and Wellbeing
Children in Care
Disability
Education
Families
Health
Homelessness
Refugees
Alcohol and other drugs
Fetal Alcohol Spectrum Disorders

The community input has provided valuable insights about ‘what is important to them’ and informed the development of the proposal for this new cross-agency project. It also had a positive impact on the community member’s perception of, and support for, this potential new research.
Conclusion/ImplicationsThe 20 years’ experience gained by the WA Consumer and Community Health Research Network in Western Australia has led to the development of a range of methods for involving the community in linked data research. These methods enable us to clearly demonstrate benefits and value of consumer and community involvement.
Changes in Development Among Kindergarten Children in Ontario 2012-2015: Linking Developmental, Sociodemographic, and Policy Implementation Data
Authors: Webb Simon , Janus Magdalena , Duku Eric , Gaskin Ashley , Offord Amanda 
Published: September 2018

IntroductionIn Ontario kindergarten children, measures of early child development (ECD) indicate worsening outcomes over the last two provincial measurements (2012-2015), particularly among indicators of early physical, emotional and social development. This is despite significant investments in early childhood in the province through the roll-out of universal full day kindergarten.
Objectives and ApproachOur objective is to uncover correlates of change in the measures of ECD using the Early Development Instrument (EDI) between 2012 and 2015, particularly in relation to the average home/neighbourhood environments of students where school-level outcomes declined. This analysis links individual EDI data in Ontario, with 2016 DA-level Canadian Census data aggregated to the school level. The EDI is a kindergarten teacher-completed questionnaire measuring school readiness across five domains of child development. The schools are classified into groups based on whether they experienced statistically meaningful change in the domains of the EDI over the observed timeframe.
ResultsThe changes observed at the provincial level were consistent with those observed at the school level. Developmental vulnerability increased overall, in the Physical Health and Well-being, Social Competence and Emotional Maturity domains. Vulnerability decreased in the Language and Cognitive Development and Communication Skills and General Knowledge domains. While the analyses are still ongoing, preliminary findings suggest that schools with a higher proportion of children from high immigrant, and high income neighbourhoods tended to improve more than other schools. These along with some other socioeconomic neighbourhood characteristics identify sub-groups of schools that tended to see more positive or negative change on average across the five domains. We will supplement these findings using the time of introduction of the free full-day kindergarten program in each school.
Conclusion/ImplicationsThe presentation breaks down recent trends in kindergarten school readiness to identify schools that did better or worse than average based on socioeconomic and demographic characteristics. The analysis will also incorporate the timing of the introduction of full-day kindergarten into each school, providing insight into the effects of the program.
Comparing two asthma diagnoses using a prospective cohort of young children
Authors: Omand Jessica , Maguire Jonathon , O'Connor Deborah , Parkin Patricia , Birken Catherine , Thorpe Kevin , Zhu Jingqin , To Teresa 
Published: September 2018

IntroductionAsthma is the most common chronic illness of childhood and places a large burden on the health care system. Asthma prevalence is commonly measured in national surveys by questionnaire. In Ontario, the Ontario Asthma Surveillance Information System (OASIS) developed a validated health claims diagnosis algorithm using health administrative data.
Objectives and ApproachThe primary objective of this study was to measure the agreement between the health claims diagnosis algorithm (OASIS diagnosis algorithm) and questionnaire diagnosis (TARGet Kids! diagnosis) of asthma in children younger than 6 years of age. Secondary objectives were to identify concordant and discordant pairs, and to identify factors associated with disagreement.
A comparison study including 3368 children participating in the TARGet Kids! practice based research network between 2008 and 2013 in Toronto, Canada. OASIS diagnosis algorithm and TARGet Kids! diagnosis asthma cases were compared using kappa statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
ResultsPrevalence of asthma was estimated to be 15% by the OASIS diagnosis algorithm and 7% by TARGet Kids! diagnosis. The Kappa statistic was 0.47 (95% CI: 0.42 – 0.51), sensitivity 82\%, specificity 90%, PPV 38% and NPV 98% for OASIS diagnosis algorithm using TARGet Kids! diagnosis as the criterion standard. There were 3011 concordant pairs (2820 true negatives and 191 true positives) and 357 discordant pairs (315 false positives and 42 false negatives). Statistically significant factors associated with false positives included: male sex, higher zBMI and history of allergy. No statistically significant factors associated with false negatives were identified.
Conclusion/ImplicationsOASIS diagnosis algorithm had high sensitivity, specificity, and NPV but low PPV relative to TARGet Kids! diagnosis of asthma. Although, the OASIS diagnosis may identify more asthma cases in young children, its diagnostic properties are similar in older children and it may be a useful tool for longitudinal asthma surveillance.
25-hydroxyvitamin D and health service utilization for asthma in early childhood
Authors: Omand Jessica , To Teresa , O'Connor Deborah , Parkin Patricia , Birken Catherine , Thorpe Kevin , Maguire Jonathon 
Published: September 2018

IntroductionAsthma is the most common chronic illness of childhood and a common reason for hospital admission. Studies suggest that low vitamin D levels may be associated with health service utilization (HSU) for childhood asthma.
Objectives and ApproachThe primary objective was to determine if vitamin D serum levels in early childhood were associated with HSU for asthma including: a) total HSU, b) hospital admissions, c) emergency department visits and d) outpatient sick visits. Secondary objectives were to determine whether vitamin D supplementation in pregnancy or childhood were associated with HSU for asthma. Prospective cohort study of children participating in the TARGet Kids! practice based research network. HSU was determined by linking each child's provincial health insurance number to health administrative databases. Multivariable quasi Poisson and logistic regression were used to evaluate the associations.
Results2926 healthy children ages 0-6 years had 25-hydroxyvitamin D data available and were included in the primary analysis. Mean (IQR) 25-hydroxyvitmain D level was 84 nmol/L (65-98 nmol/L), 218 and 1267 children had 25-hydroxyvitamin D levels <50 nmol/L and <75 nmol/L, respectively. In the adjusted models, there were no associations between 25-hydroxyvitamin D (continuously or dichotomized at 50 and 75 nmol/L), vitamin D supplementation in pregnancy or childhood and HSU for asthma.
Conclusion/ImplicationsHigher vitamin D blood values do not appear to be associated with HSU for asthma in this population of healthy urban children.