Women's preconception health in England: a report card based on cross-sectional analysis of national maternity services data from 2018/2019.

OBJECTIVE: To present the first national-level report card on the state of women's preconception health in England. DESIGN: Cross-sectional population-based study. SETTING: Maternity services, England. POPULATION: All pregnant women in England with a first antenatal (booking) appointment recorded in the national Maternity Services Dataset (MSDS) from April 2018 to March 2019 (n = 652 880). METHODS: We analysed the prevalence of 32 preconception indicator measures in the overall population and across socio-demographic subgroups. Ten of these indicators were prioritised for ongoing surveillance based on modifiability, prevalence, data quality and ranking by multidisciplinary UK experts. RESULTS: The three most prevalent indicators were the proportion of the 22.9% of women who smoked 1 year before pregnancy who did not quit smoking before pregnancy (85.0%), those who had not taken folic acid supplementation before pregnancy (72.7%) and previous pregnancy loss (38.9%). Inequalities were observed by age, ethnicity and area-based deprivation level. The ten indicators prioritised were not taking folic acid supplementation before pregnancy, obesity, complex social factors, living in the most deprived areas, smoking around the time of conception, overweight, pre-existing mental health condition, pre-existing physical health condition, previous pregnancy loss and previous obstetric complication. CONCLUSIONS: Our findings suggest important opportunities to improve the state of preconception health and reduce socio-demographic inequalities for women in England. In addition to MSDS data, other national data sources that record further and possibly better quality indicators could be explored and linked to build a comprehensive surveillance infrastructure.

Population variation in admission rates and duration of inpatient stay for bronchiolitis in England.

AIM: To explore the variation in hospital admission rates and duration of inpatient stay across England. METHODS: Hospital Episode Statistics were used to identify all children aged below 2 years who were discharged from hospital with a primary code of bronchiolitis in England, between 1 April 2007 and 31 March 2010; rates of admission and duration of stay were analysed by Primary Care Trust (PCT). RESULTS: There were a total of 75 318 admissions for bronchiolitis in England in children under 2 years old during the study period. There was a 15-fold variation across PCTs in England in the admission rate for bronchiolitis (351-5140 admissions per 100 000; coefficient of variation (CV)=0.43) and a sixfold variation in the mean duration of stay in days for children with bronchiolitis (0.7-4.1 days in hospital; CV=0.27). Duration of stay was not correlated with socioeconomic deprivation, while admission rates showed variation even among PCTs of similar socioeconomic profile. CONCLUSIONS: We postulate that healthcare provider factors manifested by variation in clinical decision-making (including thresholds for admission and discharge, and variation in therapies) are responsible at least in part for variation in rate of admission and length of stay for children with bronchiolitis in England.