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Background/rationaleWhen a baby is born in England and Wales, the event is recorded in several separate systems, each of which contains different data items. Data recorded at birth registration are mainly socio-demographic, while some different data items are recorded when the birth is notified to the NHS. The data recorded in hospital systems in England and in Wales about the majority of babies who are born in NHS maternity units are largely clinical.
Over a ten year period, a series of three collaborative projects have linked data about 7,013,804 births registered in 2005-14 to establish a birth cohort for use in research and national statistics and to quality assure the linkage. Data about outcomes of birth in terms of death and subsequent readmissions to hospital have also been linked in. The linked data are held in the Secure Research Service at the Office for National Statistics.
The data have been used for analyses of pattern of births by time of day, day of the week and season and in relation to obstetric intervention in labour and birth. They are now being used by other researchers.
strong>Challenges encounteredThere were major problems in accessing NHS data for England, compounded by intermittent availability of funding.
Lessons learnedDespite the many challenges, it proved feasible to construct a linked birth cohort which has increased the scope and range of national maternity data for England and Wales. NHS Digital's opt-outs are causing gaps in national data and could invalidate linkage.
RecommendationsThe cohort should be updated with data for more recent years. Linkage should be undertaken within ONS by teams who are not subject to NHS Digital's opt-out policy. Data access policies should reflect the higher public trust in research uses of NHS data compared to commercial uses.

BackgroundClinical policies have aimed at increase the proportion of births occurring during working hours on weekdays in the belief that this facilitates staffing and is safer for mothers and babies. Our recent analyses of hospital births have shown that that planned caesareans are concentrated into weekday mornings. In contrast, spontaneous births after spontaneous onset of labour are more likely in the hours after midnight, peaking from 4-6am. Births after induced labours are more likely in the hours around midnight.
Main AimTo compare the timing of births of births at home and elsewhere with timing in NHS hospitals.
MethodData from civil registration of births from 2005 to 2014 in England and Wales were linked to data recorded when newborn babies are notified to the NHS. Data about babies born in NHS maternity units were further linked to hospital data for England and for Wales. Data were analysed in the secure facilities of the Office for National Statistics' Secure Research Service. Analysis was by place of birth recorded at birth registration.
ResultsNumbers of singleton births in freestanding midwifery units and at home were highest from midnight to 7am, peaking from 4am-6am. Births on non-hospital sites followed a similar pattern with a flatter peak from 4am-8am, but peaks in non-maternity hospitals tended to occur during mornings. Births in military hospitals had a sharp peak at 8am and births in private hospitals had a peak in the morning and then again in early and late afternoon.
ConclusionConclusion The small numbers of births in hospitals without maternity units or 'elsewhere' are unlikely to have occurred there intentionally, but the latter, along with home and midwifery unit births were more common at night. This has implications for staffing. A newly funded project will explore relative safety.

Background with rationaleLinked administrative datasets are particularly useful within the field of perinatal epidemiology. By linking multiple datasets, researchers can create longitudinal datasets, which allow them to explore research questions relating to early exposures and outcomes later in life.
Main AimThe aims of this study were to describe the methods used to deal with duplicate hospital admission records, assess the quality of linkage between babies birth registration records and subsequent hospital admissions, and to evaluate the potential bias that may be introduced as a result of these methods.
MethodsThree routinely collected datasets were linked for use within this study and included data from birth registration, NHS Numbers for Babies (NN4B) and Hospital Episode Statistics (HES) for babies born in England between 1st January 2005 and 31st December 2006. A number of stages to cleaning were undertaken, including dealing with duplicate HES records and assessing the quality of the linkage using a deterministic algorithm. Internal and external validity was also assessed.
ResultsThere were a total of 1,170,970 live, singleton births, occurring in NHS hospitals, to mothers who normally reside in England in 2005 and 2006 combined. Of these, approximately 92% were successfully linked with a HES birth record. Data quality was somewhat poorer in HES birth records compared to birth registration and NN4B. The quality assurance algorithms identified 1,456 incorrect linkages (<1%) and examination of external validity identified children that were not linked were slightly more likely to be born to mothers who were older and of higher socio-economic status.
ConclusionIt is possible to create valuable longitudinal datasets allowing researchers to explore important questions about exposures and childhood outcomes using administrative datasets, however, missing data and coding errors and inconsistencies mean it is important that the quality of linkage is assessed prior to analysis.

IntroductionWe report on service user participation in 'Births and their Outcomes', a population-based, retrospective, birth cohort, data linkage study to analyse the daily, weekly and yearly cycles of births and their implications for the NHS. Although Public Involvement and Engagement (PI&E), also referred to here as Patient and Public Involvement (PPI), has a long history in maternity services, PI&E in maternity data linkage studies is new. We have reported using the GRIPP2 short form.
ObjectivesWe aimed to involve and engage a wide range of maternity service users and their representatives to ensure that our use of routinely collected maternity and birth records was acceptable and that our research analyses using linked data were relevant to their expressed safety and quality of care needs.
MethodsA three-tiered approach to PPI was used. Having both PPI co-investigators and PPI members of the Study Advisory Group ensured service user involvement was part of the strategic development of the project. A larger constituency of maternity service users was engaged through four workshops held throughout England.
ResultsTwo co-investigators with experience of PPI in maternity research were involved from design stage to dissemination. Four PPI study advisors contributed service user perspectives. Engagement workshops attracted around 100 attendees, recruited largely from Maternity Services Liaison Committees and a community engagement group. They supported use of the data, believing the study had potential to improve safety and quality of maternity services. They contributed their experiences and concerns which will assist with interpretation of the analyses.
ConclusionUse of PPI 'knowledge intermediaries' successfully bridged the gap between data intensive research and lived experience, but more inclusivity in involvement and engagement is required. The concerns and questions of service users provide social legitimacy and a relevance framework for researchers carrying out analyses.

ObjectivesPotential 'weekend effects' in healthcare prompt concerns that care could be of lower quality during non-working hours, but may reflect differences in case mix or other factors This research aimed to compare neonatal mortality in English hospitals from 2005 to 2014 by time of day and day of the week.
ApproachWe analysed data from a retrospective cohort of 6,054,536 singleton births in England 2005—2014, created by linking ONS birth and death registration and birth notification data with Hospital Episode Statistics.
Working hours were defined as 07:00—19:00 on weekdays, and non-working hours were all other times on weekdays and all weekends and public holidays.
The primary outcome was all-cause neonatal mortality unattributed to congenital anomaly. We also modelled cause-specific neonatal mortality attributed to asphyxia, anoxia or trauma (AAT). On advice through our public involvement and strategy, analysis was stratified by mode of onset of labour and method of delivery.
ResultsAfter adjustment for confounders, the odds of all-cause neonatal mortality outside of working hours were similar to those during working hours for spontaneous births, instrumental births and emergency caesareans. Planned caesareans occurring in non-working hours had a high crude risk compared to planned caesareans in working hours, but were considered to be unreliably recorded and likely to reflect emergency caesarean delivery of babies originally scheduled for planned caesarean birth.
Further stratification of emergency caesareans by onset of labour showed higher odds of cause-specific neonatal mortality (AAT) during non-working compared with working hours for emergency caesareans without labour recorded but not for emergency caesareans after spontaneous or induced onset of labour.
ConclusionIt may be that the apparent 'weekend effect' is caused by deaths among the relatively small number of babies who were born by caesarean section apparently without labour outside normal working hours. Obstetric staffing should be planned to allow for these relatively unusual emergencies.

ABSTRACT
ObjectivesThis project builds on previous work linking routinely collected data from birth registration, birth notification, death registration and hospital discharges, extending it to six million births in England and Wales from 2005 to 2014. This linkage is creating a new dataset to investigate previously unanswerable questions about variations in time of birth and its outcome which are highly contested in the health service in England and Wales:
1. How do numbers of births vary according to time of day, day of the week and time of year of birth and how does this relate to modes of onset of labour and delivery?2. How do patterns of birth vary between maternity services in relation to variations in medical and midwifery staffing, patterns of intervention and size of unit?3. How does the outcome of pregnancy, in terms of mortality and morbidity rates at birth and in the first year of life, vary according to time of birth in relation to gestational age, and intervention in the onset of labour and delivery?4. Have the patterns changed over the years 2005 to 2014?
ApproachRoutinely collected national datasets for 2005-14 have been linked using patient identifiable data items. They differ in the way data items are recorded. Methods of linkage, quality assurance and data cleaning have been improved, compared with those developed in the original project.
This unique approach links clinical data from hospital admissions with more reliable data on birthweight from birth registration and with gestational age and time of birth from birth notification. This enables investigation of the associations between day and time of birth with its outcome.
This is also the first study to link mothers' and babies' hospital discharge data for England and Wales and to draw on public and patient involvement to include outcome measures specifically designed to be women-centred. Overall, the linkage has created a fuller range of data.
ResultsResults will be available by the time of the conference. Initial results already clearly illustrate differences in timings of birth by time of day and day of the week by mothers' age, gestational age and birth setting and for singleton and multiple births.
ConclusionThe study has created a valuable linked dataset that will uniquely enable analyses of associations between timing of birth and its outcome. These results will potentially be able to inform and impact NHS service provision.

Introduction & BackgroundEvidence is mounting that children's physical environment (e.g. in and around the home, school, and neighbourhood) is critical for their long-term health and education. Early life exposure to factors such as indoor and outdoor air pollution, or a lack of access to greenspaces are associated with the development of long-term health conditions such as asthma or mental health problems. Local and central government in England are implementing numerous policies to improve air quality and housing, and mitigate climate change. Further, England has seen large scale changes to local service provision (including childcare and libraries) due to austerity policies and the COVID-19 pandemic. Currently, there is no national, linked data resource for England that allows research into how the local environment impacts children's health and education.
Objectives & ApproachThe Kids' Environment and Health Cohort will be a new, linked national data resource for England currently being developing by researchers from UCL, London School of Hygiene and Tropical Medicine, London School of Economics and Political Science, Brock University, and City, University of London in collaboration with the Office for National Statistics (ONS), and funded by Administrative Data Research-UK (ADR-UK). The Kids' Environment and Health Cohort will be a de-identified and annually updated national birth cohort of all children born in England from 2006 onwards – around 10.5 million children until 2023. The cohort will be constructed using linked administrative data from vital registration (live and stillbirth, and death registration), Census (housing and socio-economic indicators), health (hospital contacts, mental health referrals, and community dispensing data), and education (key stage results, special educational needs, absenteeism). Environmental exposure data can be securely linked to the Cohort via longitudinal residential unique property reference numbers (UPRNs) and postcodes from the Personal Demographic Service, and school location from education records.
Relevance to Digital FootprintsThe Kids' Environment and Health Cohort will, for the first time, link health, education, Census and environmental data at national level in England. It will allow researchers to integrate data on local environments, including physical characteristics (such as temperature, building energy efficiency, or greenspace access) or the social environment (including proximity to food outlets, or services like libraries) with individual level data on health and education outcomes in children. This will be done using the ONS's 5 safes framework, ensuring highest standards of data security and confidentiality.
ResultsThe Kids' Environment and Health Cohort will be constructed using administrative datasets, including national linked vital statistics, health, education and Census data from multiple data providers (ONS, NHS England and Department for Education), combined with small-area level environmental data for England. Together, these datasets allow detailed analyses of the impact of environmental exposures on health and education outcomes in children, with robust confounder adjustment. The Kids' Environment and Health Cohort will be made available in a de-identified format in the ONS Secure Research Service (SRS).
Conclusions & ImplicationsThe Kids' Environment and Health Cohort will provide researchers secure access to a national data resource integrating environmental and administrative health and education data, for child public health research.

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. ; publishedVersion ; Peer reviewed

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.

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 ...

This book documents the early lives of almost 19,000 children born in the UK at the start of the 21st century, and their families. It is the first time that analysis of data from the hugely important Millennium Cohort Study, a longitudinal study following the progress of the children and their families, has been drawn together in a single volume. The unrivalled data is examined here to address important policy and scientific issues. The book is also the first in a series of publications that will report on the children's lives at different stages of their development. The fascinating range of findings presented here is strengthened by comparison with data on earlier generations. This has enabled the authors to assess the impact of a wide range of policies on the life courses of a new generation, including policies on child health, parenting, childcare and social exclusion. Babies of the new millennium (title tbc) is the product of an exciting collaboration from experts across a wide range of health and social science fields. The result is a unique and authoritative analysis of family life and early childhood in the UK that cuts across old disciplinary boundaries. It is essential reading for academics, students and researchers in the health and social sciences. It will also be a useful resource for policy makers and practitioners who are interested in childhood, child development, child poverty, child health, childcare and family policy