Air Pollution, housing and respirfatory tract Infections in Children: NatIonal birth Cohort study (PICNIC): study protocol.

INTRODUCTION: Respiratory tract infections (RTIs) are the most common reason for hospital admission among children <5 years in the UK. The relative contribution of ambient air pollution exposure and adverse housing conditions to RTI admissions in young children is unclear and has not been assessed in a UK context. METHODS AND ANALYSIS: The aim of the PICNIC study (Air Pollution, housing and respiratory tract Infections in Children: NatIonal birth Cohort Study) is to quantify the extent to which in-utero, infant and childhood exposures to ambient air pollution and adverse housing conditions are associated with risk of RTI admissions in children <5 years old. We will use national administrative data birth cohorts, including data from all children born in England in 2005-2014 and in Scotland in 1997-2020, created via linkage between civil registration, maternity and hospital admission data sets. We will further enhance these cohorts via linkage to census data on housing conditions and socioeconomic position and small area-level data on ambient air pollution and building characteristics. We will use time-to-event analyses to examine the association between air pollution, housing characteristics and the risk of RTI admissions in children, calculate population attributable fractions for ambient air pollution and housing characteristics, and use causal mediation analyses to explore the mechanisms through which housing and air pollution influence the risk of infant RTI admission. ETHICS, EXPECTED IMPACT AND DISSEMINATION: To date, we have obtained approval from six ethics and information governance committees in England and two in Scotland. Our results will inform parents, national and local governments, the National Health Service and voluntary sector organisations of the relative contribution of adverse housing conditions and air pollution to RTI admissions in young children. We will publish our results in open-access journals and present our results to the public via parent groups and social media and on the PICNIC website. Code and metadata will be published on GitHub.

Association between health indicators of maternal adversity and the rate of infant entry to local authority care in England: a longitudinal ecological study.

OBJECTIVE: Infants enter care at varying rates across local authorities (LAs) in England, but evidence is lacking on what is driving these differences. With this ecological study, we aimed to explore the extent to which adversity indicated within women's hospitalisation histories, predelivery, explained the rate of infant entry into care. METHODS: We used two longitudinal person-level data sets on hospitalisations and entries to care to create annual measures for 131 English LAs, between 2006/2007 and 2013/2014 (April-March). We combined these measures by LA and financial year, along with other publicly available data on LA characteristics. We used linear mixed-effects models to analyse the relationship between the outcome-LA-specific rate of infant entry into care (per 10 000 infants in the LA population) - and LA-specific percentage of live births with maternal history of adversity-related hospital admissions (ie, substance misuse, mental health problems or violence-related admissions in the 3 years before delivery), adjusted for other predictors of entry into care. RESULTS: Rate of infant entry into care (mean: 85.16 per 10 000, SD: 41.07) and percentage of live births with maternal history of adversity-related hospital admissions (4.62%, 2.44%) varied greatly by LA. The prevalence of maternal adversity accounted for 24% of the variation in rate of entry (95% CI 14% to 35%). After adjustment, a percentage point increase in prevalence of maternal adversity-both within and between LAs-was associated with an estimated 2.56 (per 10 000) more infants entering care (1.31-3.82). CONCLUSIONS: The prevalence of maternal adversity before birth helped to explain the variation in LA rates of infant entry into care. Preventive interventions are needed to improve maternal well-being before and during pregnancy, and potentially reduce risk of child maltreatment and therefore entries to care. Evidence on who to target and data to evaluate change require linkage between parent-child healthcare data and administrative data from children's social care.

Emergency admissions and long-term conditions during transition from paediatric to adult care: a cross-sectional study using Hospital Episode Statistics data.

OBJECTIVE: To determine whether changes in emergency admission rates during transition from paediatric to adult hospital services differed in children and young people (CYP) with and without underlying long-term conditions (LTCs). DESIGN: Cross-sectional study. SETTING: Emergency admissions between 2009 and 2011 recorded in the Hospital Episode Statistics Admitted Patient Care data in England. PARTICIPANTS: 763 199 CYP aged 10-24 years with and without underlying LTCs (LTCs were defined using the International Classification of Diseases, 10th Revision codes recorded in the past 5 years). PRIMARY AND SECONDARY OUTCOME MEASURES: We calculated emergency admission rates before (10-15 years) and after transition (19-24 years), stratified by gender, LTC and primary diagnosis. We used negative binomial regression to estimate adjusted incidence rate ratios (IRRs). RESULTS: We included 1 109 978 emergency admissions, of which 63.2% were in children with LTCs. The emergency admission rate increased across the age of transition for all CYP, more so for those with LTCs (IRRLTC: 1.55, 99% CI 1.47 to 1.63), compared with those without (IRRnoLTC: 1.21, 99% CI 1.18 to 1.23). The rates increased most rapidly for CYP with mental health problems, MEDReG (metabolic, endocrine, digestive, renal, genitourinary) disorders, and multiple LTCs (both genders) and respiratory disorders (female only). Small or no increased rates were found for CYP without LTCs and for those with cancer or cardiovascular disease. Increases in length of stay were driven by long admissions (10+ days) for a minority (1%) of CYP with mental health problems and potentially psychosomatic symptoms. Non-specific symptoms related to abdominal pain (girls only), gastrointestinal and respiratory problems were the most frequent primary diagnoses. CONCLUSIONS: The increased rates and duration of emergency admissions and predominance of non-specific admission diagnoses during transition in CYP with underlying LTCs may reflect unmet physical or mental health needs.