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BackgroundTransition from adolescent to adult health and education services is a vulnerable period for young people with learning disability (LD) or autism spectrum disorders (ASD), yet there is a lack of information on their risk of death in that period.
MethodsWe developed an English national cohort of 11-year-olds enrolled in state schools between 2009/10-20014/15, followed-up until their 22nd birthday, death or 31st August 2020 using linked health, mortality and education data from the ECHILD database. LD and ASD were indicated using diagnoses from hospital admissions or if LD or ASD were a reason for special educational needs provision in education records before age 11. We estimated crude mortality rates and compared with unaffected peers using rate ratios (RR).
ResultsThe cohort comprised 3,080,516 young people (52% boys), of whom 4,589 (0.15%) died (crude mortality rate: 0.17/1000 person-years, 95% CI: 0.16-0.17/1000).
45,174 (1.5%) young people were autistic (85% boys; 15% with co-existing LD), of whom 113 died (mortality rate: 0.29/1000 person-years, 95%CI: 0.24-0.35/1000). Mortality was 1.7 times higher for autistic young people compared to their peers (RR: 1.7, 95% CI: 1.4-2.1). Among 40,264 (1.3% of all) young people with LD (63% boys; 17% with co-existing ASD) there were 812 deaths (mortality rate: 2.31/1000, 95%CI: 2.15-2.47/1000PY). They had 17 times higher risk of death (RR: 16.4, 95%CI: 15.2-17.7).
ConclusionsYoung people with LD/ASD are more likely to die than their peers. Findings on disparities within these groups according to co-existing comorbidities, sex and socioeconomic factors will be reported.

Objective and ApproachIn England, the National human papillomavirus (HPV) HPV Immunisation Programme was introduced for young girls in 2008. Whilst clinical trials have shown high vaccine effectiveness, real-world evidence is still accruing. Estimating vaccine effectiveness based on real-world data without randomised control trials is challenging, but critical for policy makers. Using Census 2011 data and a population level linked dataset, we exploit a regression discontinuity design (RDD) to assess the impact of the catch-up vaccination programme on cervical dysplasia and cancer diagnoses as recorded in hospital and mortality data in girls born between 1987 and 1992.
ResultsWe estimate that vaccination reduces the incidence of cervical dysplasia diagnoses by 27% and cervical cancer diagnoses by 75% respectively. Girls were followed for a 7-year period between ages 23 and 30 years in girls who were offered vaccination at ages 17 to 18 years as part of the catch-up cohort compared to those who were not eligible for HPV vaccination.
Conclusions and ImplicationsOur work demonstrates how pivotal the HPV vaccination programme has been for reducing adverse cervical outcomes in young women. Additionally, it shows that the estimates of the effectiveness of HPV vaccination obtained using a RDD are comparable to those based on more classic observational studies. This work shows real world vaccination effectiveness and demonstrates how pivotal the national HPV campaign has been in young girls.

BackgroundOver a third of children in England receive either special educational need (SEN) provision/children's social care (CSC) support at least once during school. We aimed to describe all-cause and adversity-related mortality for adolescents who received SEN or CSC provision in England.
ApproachWe used linked data from hospital admissions, death registrations, social care and education in the ECHILD database to follow all adolescents in state schools from age 13-years between 2009/10-2014/15 until death or 2020. Adolescents were grouped according to provision ever recorded before age 14: None, SEN only, CSC only or CSC and SEN. We estimated all-cause and adversity-related mortality in children with SEN/CSC/both compared to peers.
ResultsThe cohort comprised 3,381,502 children (51% boys), of whom 30.1% (n=1,017,670, 62% boys) received SEN only, 4.2% (n=143,430, 36% boys) received CSC only and 8.7% (n=293,310, 57% boys) received SEN and CSC. In ten-year follow up, 6,590 deaths occurred (66% in boys). Mortality rates were 5.4 times higher for adolescents receiving both SEN and CSC, 2.4 times higher for CSC only, and 1.7 times higher for SEN only compared to peers. Rates of adversity-related deaths were highest for boys receiving SEN and CSC compared to peers.
Conclusions & Implications8-in-1000 adolescents who received both SEN and CSC before age 13 died by age 23 years, far more often than their peers. Policies need to consider support for young people with additional educational and social care needs as they leave school and transition to adulthood.

ObjectivesDuring the COVID-19 pandemic, higher mortality among some ethnic minority groups was identified and has become the subject of significant public and government interest, highlighting an urgent requirement to quantify the reliability of ethnicity classification across health administrative data sets, which are utilised in health analysis and pandemic planning.
ApproachThe aim of our work was to assess how ethnicity data recorded in Census and health admin records varied across ethnicities and provide recommendations for how missingness can be accounted for by statisticians. Combining population level data from general practice (GP) records with hospital episode statistics (HES) for patients in England, we created a linked data set with Census 2011 data to reliably assess coverage and missingness between data sources. Most recent and modal ethnicity classifications were derived on a person-level from both HES and GP administrative data for comparison to gold-standard Census 2011 records.
ResultsAgreement rates were calculated to assess the reliability of ethnicity data recorded in health administrative datasets compared to Census data. We found that the agreement rates vary by ethnic group and other demographic characteristics. Furthermore, we highlighted groups of people who exist in one health-admin source, but not Census, and vice versa, illustrating the importance of accounting for the sample bias in health analysis when relying solely on primary or secondary care data sources. Implementation of techniques to account for bias and missingness were tested to propose methodology to improve reliability of ethnicity estimates from both HES and GP data, in order to ensure estimates of health disparities are as accurate as possible.
ConclusionWe have linked GP records to Census 2011 and HES data to provide population-based ethnicity estimates of coverage, missingness and bias between data sources, in order to improve our understanding of ethnicity data quality. This work aims to inform policies tackling ethnic health inequalities in England.

Child mortality is a common measure of the overall health of society. Maternal characteristics, such as ethnicity and socioeconomic status are known to contribute to inequalities in health and mortality in babies and children. Overall, in the UK babies born to non-white mothers have a higher risk of mortality, and there is also a strong association between deprivation and risk of death. However, population data is currently lacking for England and Wales disentangling the various socioeconomic risk factors which are known to contribute to increased risk. We utilise population level data to assess the association between socioeconomic status, ethnicity, and child mortality.
Our cohort consisted of all live singleton births in England and Wales between 2011 and 2016. We linked birth notifications to mothers' 2011 Census records using NHS number, which provides person-level sociodemographic information. Death registration data was linked to identify all-cause and cause-specific deaths in babies. Babies were followed from date-of-birth for up to 10-years, or date-of-death. We report cumulative incidence of all-cause mortality for a 10-year follow-up for neonatal, infant and child deaths based on maternal socioeconomic and ethnic groups. Cox proportional hazard models are used to estimate hazard ratios for neonatal, infant and child deaths, with both minimally adjusted (maternal age and baby sex) and fully-adjusted models (accounting for other maternal, household and birth characteristics).
This presentation will give an overview of our unique linked data sources, the statistical techniques employed, the latest available analytical results, and the emerging implications of the research.

ObjectivesWith suicide a major public health concern, it is vital research identifies predictors of suicide to support vulnerable groups who should be targeted for intervention. We use a novel linkage of 2011 Census and population level mortality data to assess which risk factors are important predictors of suicide.
MethodsExposures of interest were identified from Census 2011 and were sex, age, ethnicity, marital status, day-to-day impairments, religion, region, National Statistics Socio-economic Classification. Our study population consisted of 35,136,917 people aged 18-to-74; there were 35,928 suicides in our study period (28/03/2011-31/12/2021), with 73.9\% occurring in men. We fitted generalised linear models with a Poisson link function, with suicide being the outcome of interest. The natural logarithm of exposure time was included as an offset term. To estimate rates of suicide per 100,000 people for each level of our exposure, by sex for the average age, we calculated marginal means.
ResultsThe groups with the highest rates of suicide were those who reported an impairment affecting their day-to-day activities, those who were long term unemployed or never had worked, or those who were single or separated. Comparison of minimally adjusted models with models accounting for all other characteristics identified predictors which remain important risk factors after accounting for other characteristics; day-to-day impairments were still found to increase the incidence of suicide relative to those whose activities were not impaired after adjusting for employment status. Additionally, the estimated rates of suicide remained lowest in London compared to other regions in our fully adjusted estimates. Overall, rates of suicide were higher in men compared to females across all ages, with the highest rates in 40- to 50-year-olds.
ConclusionThe findings of this work provide novel population level insights into the risk of suicide by sociodemographic characteristics, this work should pave the way for further research exploring the interaction of factors which lead to suicide and drive policy change for targeted intervention.

This book explores what's happening to ways of seeing urban spaces in the contemporary moment, when so many of the technologies through which cities are visualised are digital. Cities have always been pictured, in many media and for many different purposes. This edited collection explores how that picturing is changing in an era of digital visual culture. Analogue visual technologies like film cameras were understood as creating some sort of a trace of the real city. Digital visual technologies, in contrast, harvest and process digital data to create images that are constantly refreshed, modified and circulated. Each of the chapters in this volume examines a different example of this processual visuality is reconfiguring the spatial and temporal organisation of urban life.