Suchergebnisse

Data from Northeast Scotland for 11,803 cancer patients (diagnosed 2007-13) were linked to UK Censuses to explore relationships between hospital travel-time, timely-treatment and one-year-mortality, adjusting for both area and individual-level socioeconomic status (SES). Adjusting for area-based SES, those living >60 minutes from hospital received timely-treatment more often than those living <15 minutes. Substituting individual-level SES changed little. Adjusting for area-based SES those living >60 minutes from hospital died within one year more often than those living <15 minutes. Again, substituting individual-level SES changed little. In Northeast Scotland distance to services, rather than individual SES, likely explains poorer rural cancer survival.
Background and objectiveThe Northeast and Aberdeen Scottish Cancer and Residence (NASCAR) study found rural-dwellers are treated quicker but more likely to die within a year of a cancer diagnosis. A potential confounder of the relationship between geography and cancer mortality is socioeconomic status (SES). We linked the original NASCAR cohort to the UK Censuses of 2001 and 2011, at an individual level, to explore the relationship between travel time to key healthcare facilities, timely cancer treatment and one-year mortality adjusting for both area and individual-level markers of socioeconomic status.
MethodsA data linkage study of 11803 patients examined the association between travel times, timely treatment and one-year mortality with adjustment for area, and for individual-level, markers of socioeconomic status.
ResultsFollowing adjustment for area-based SES measures those living more than 60 minutes from the cancer treatment centre were significantly more likely to be treated within 62 days of GP referral than those living within 15 minutes (Odds Ratio [OR]) 1.41; 95% (Confidence Interval [CI]) 1.23 , 1.60]. Replacing area-based with individual-level SES measures from UK Censuses made little impact on the results [OR 1.39; 95% CI 1.22, 1.57].
Following adjustment for area-based SES measures of socioeconomic status those living more than 60 minutes from the cancer treatment centre were significantly more likely to die within one year than those living closer by [OR 1.22; 95% CI 1.08, 1.38]. Again, replacing area-based with individual-level SES measures from UK Censuses made little impact on the result [OR 1.20; CI 1.06, 1.35].
ConclusionsDistribution of individual measures of socioeconomic status did not differ significantly between ruraland urban cancer patients. The relationship between distance to service, timely treatment and one-year survival were the same adjusting for both area-based and individual SES. Overall, it seems thatdistance to services, rather than personal characteristics, influences poorer rural cancer survival.

Background A large body of literature has shown that transition into widowhood has detrimental effects on the surviving spouse's health leading to elevated risks of mortality, poor mental health and hospitalisation. However, few studies have examined health outcomes before widowhood. Anticipatory grief and long term care giving are likely to lead to poor mental health conditions.
Aim This paper examined whether the risk of depression and anxiety rose before the widowhood event using linked administrative data.
Methods The study population was drawn from the Scottish Longitudinal Study (SLS) linked to prescribing data, available from 2009. We included all cohort members who were married in 2001 and who were aged 50 and over by 2009. We then followed the cohort for 5 years from 2009 to 2013 (N=~58,000). Andersen-Gill models were used to explore the risk of prescription of antidepressant and antianxiety drugs before and after loss of spouse adjusting for a number of confounders. The analysis was carried out separately for men and women.
Results We found that the risk of depression and anxiety were higher 6 months before widowhood for women (0-3 months, HR=1.17, 95%CI 1.07-1.28; 3-6 months, HR=1.15, 95%CI 1.05-1.27) but not for men (0-3 months HR=1.07, 95% CI 0.90-1.26; 3-6 months HR=1.01, 95% CI 0.84-1.21). The risk after widowhood for men became significantly higher lasting for 2 years (0-3 months HR=1.40, 95% CI 1.21-1.61; 21-24 months HR=1.24, 95% CI 1.01-1.52). For women the elevated risk remained at a heightened level up to 2 years (0-3 months HR=1.50, 95% CI 1.29-1.75; 21-24 months HR=1.29, 95% CI 1.03-1.60).
Conclusion It has been previously shown that widowhood has negative effects on a surviving partners' health. This research shows that this effect is also apparent in women before their partner's deaths.

BackgroundThere is debate within the literature as to whether social mobility inflates or constrains health inequalities. The role of geographical mobility is unknown.
ObjectivesWe were interested in exploring how spatial and social mobility might impact on health in older age using linked administrative and cohort data.
MethodsThe Scottish Mental Survey 1947 (a 1936 birth cohort of 70,805 individuals with age 11 cognitive ability test scores) was linked to the Scottish Longitudinal Study (a semi-random sample of 5.3% of the Scottish population), and the 1939 register to obtain measures of occupation and geographical location in 1939 and 1991. We examined the movement between three geographical areas (Edinburgh, Glasgow, Other) in Scotland. Four social mobility trajectories were derived. We modelled the relationship between social and geographic mobility and likelihood of having self-reported limiting long term illness (LLTI) at age 65.
FindingsThose who were geographically mobile to Edinburgh had the lowest rates of self-reported LLTI and those who remained resident in the Glasgow area had the highest rates. The lowest and highest rates of LLTI were found in the socially-static at the top and bottom of the social scale respectively, with intermediate rates seen in the upwardly and downwardly mobile. However neither social nor spatial mobility were significantly associated with health in later life in the fully adjusted model when highest educational qualifications and cognitive ability were included. Being female, having higher education qualifications and being in a higher social class in childhood and adulthood reduced the likelihood of poor health at age 65.
ConclusionsAlthough both social class and geographical location were associated with the likelihood of LLTI in later life, social and spatial mobility were not, when factors such as education and cognitive ability were controlled for.

BackgroundLocal authorities in Scotland have a responsibility to provide support for vulnerable children and young people, known as 'looked after children'. This support can include providing care for these children away from home, but there have been growing concerns that children with out of home placements may experience multiple placements before a stable home environment is established for them. As a result, policy changes have aimed to reduce the amount of instability which looked after children experience, but our current understanding of care placement stability in Scotland, and how this has changed over time, is limited.
ObjectivesThis project aims to develop our understanding of the patterns of instability experienced by children looked after away from home by applying state sequence analysis (SSA) administrative data regarding children's care placements from 2008 to 2017 ( 70,000 children). Data are provided by Scottish Government.
Methods and FindingsSSA is a method commonly used to describe developmental processes which consist of changes between different states - in this case, types of care placement - and provides a number of tools to describe in/stability in these processes. In this paper we use SSA to analyse sequences of placements for multiple cohorts of children to give a detailed description of how placement stability for looked after children in Scotland has changed over the last decade, with results show differences in the typical placement sequence patterns for children of different ages. We and also discuss some methodological challenges which arise when implementing SSA using administrative data.
ConclusionsCombining SSA and administrative data provides a useful way to describe the typical patterns of looked after care placements, and how these patterns have changed over time.

ABSTRACT
ObjectivesOutcomes at birth such as prematurity and birthweight are important determinants of later life health and social outcomes including education attainment, cognitive and behavioural development and a large number of health outcomes. Recently, it has become clear that characteristics of the physical environment, including air pollution, plays an important role in mediating outcomes of pregnancy. Vitamin D deficiency from lack of sunlight has also shown associations with pregnancy outcomes but this has not been replicated in intervention studies of vitamin D supplementation. Recent clinical evidence has pointed to a sunlight pathway that is independent of vitamin D, which instead mediates blood pressure through the production of Nitric Oxides in the skin from exposure to the UVA component of sunlight. This pathway might explain the lack of association with vitamin D supplementation and provides a plausible pathway for direct effects of sunlight exposure for pregnancy outcomes. In this study, we examined the effect of exposure to sunlight during pregnancy hypothesising that higher levels of exposure might reduce risks of premature birth and low birthweight.
ApproachWe used routinely collected maternity health data covering all births in Scotland in the period 2000-2010 (~ 550000 births). Using the mothers residential postcode at birth we attached estimates of UV exposure for each trimester of pregnancy based on a combination of MET office spatially detailed sun hours data and satellite derived solar insolation data. We modelled the effect of UV exposure for birthweight and risk of preterm birth with adjustment for confounding variables including smoking, parity and maternal stature. Sensitivity analysis using sibling pairs with discordant UV exposures was also explored to test the robustness of the findings to residual confounding.
ResultsResults are not available at time of writing but will be available for the conference presentation and will discuss the effects of UV exposure for both the risk of premature birth and low birthweight.
ConclusionsTogether with clinical evidence, findings from this study may serve to highlight a possible need to revisit public health advice regarding reducing UV exposure during pregnancy and may provide evidence for possible interventions including sun lamp therapy for pregnant mothers.

ObjectiveThere has been little work on the high level of mortality, noted that the time, in coal mining areas during the 1918 Influenza pandemic. Increased risk during viral infection from exposure to particulates (eg cigarette smoke, air pollution) has been studied.
ApproachWe use the historic administrative data for Scotland, 1900 to 1930, with standardised codes for occupation and cause of death, and a pseudo household design and Quasi Poisson models, where the spouses of miners are their controls, to test whether miners (aged 20 to 50) were more at risk of death during the main waves of the 1918 pandemic than a matched population. Secondly, we repeat the analysis for Labourers to test if [1] Sex or [2] hard labour and for clerks, if [3] Pulmonary Tuberculosis might explain the effect.
ResultsWe find that miners compared to their spouses were significantly more likely to die during all waves of the pandemic but considerably more so during the Autumn wave (RR 4.7). This difference was even greater for younger miners (20 to 35) (RR 7.6). In contrast labourers and clerks had a much lower and often non-significant comparative risk of death during all waves than their spouses. This was true even for those aged 20-35.
ConclusionsMale coal miners appear to have been at much higher risk of death compared to matched populations.
ImplicationsWorkers with exposure to airborne particulates should be a priority for public health planning during periods of high virus infections.

ObjectivesWe have developed a dynamic method for identifying household members from Electronic Health Records (EHR). We compared the 2021 Census estimates of household number and demography with similar estimates derived from primary care EHRs on the Census date using primary care EHRs for the population of north east London (NEL).
MethodWe included 2,115,017 patients registered with a general practitioner on the 2021 Census date in NEL and assigned households from encrypted Unique Property Reference Numbers. We compared household number and size by Local Authority (LA), Middle Layer Super Output Area (MSOA) and area's Index of Multiple Deprivation quintiles (IMDq) to Office for National Statistics (ONS) 2021 Census estimates and by LA to ONS Admin Based Housing Stock (ABHS) 2020 estimates. We assessed differences in EHR and Census 2021 populations by sex, age, LA, MSOA and IMDq. Sensitivity analyses will exclude those without a recent recorded clinical encounter.
ResultsEHR population estimates (2,115,017) were 116,346 (5.8%) higher than Census estimates (1,998,671), higher among men (9.2%) than women (2.5%) in almost all age groups, especially men aged 30-50 years and higher in the most (8.7%), than in the least (2.5%) deprived IMDq. EHR household estimates (660,789) were 68,047 (9.3%) lower than Census estimates (728,836), and 19,719 (3.1%) higher than ABHS occupied addresses (641,070). EHR household size estimates were 15.6%, 29.2%,12.5% and 8.4% lower for household sizes 1,2 3 and 4, and 13.3%, 42.1%, 82.1% and 195.8% higher for household sizes 5, 6,7 and 8 respectively when compared to Census estimates. EHR population and household estimates were respectively 5-10% higher and 5-11% lower for almost all NEL local authorities.
ConclusionEHR- and Census-derived population and household estimates differ, mainly in the prevalence of larger households. While data were extracted on the same date, person-level validation was not possible. Differences may reflect deregistration delay in EHR when changing residence. Analyses based on clinical encounters recency may identify registered patients who are no longer residents.

ObjectivesPromoting cycling as a means of transport is now on multiple policy agendas, including health, transport and climate change. In this work, we use administrative data to explore whether cycle paths, particularly off road compared to on road, might increase the proportion of people choosing to cycle to work.
MethodsOur work used data from Edinburgh and Glasgow, Scotland in 2011 at the time of the population census. We limited our data to those aged 16–74 with a current job on the night of the census. Cycle route data were made computer readable from cycle route maps from the time of the census. We looked at the characteristics of those who cycled to work and how proximity to cycle path differed between groups. We used logistic regression to model cycle commuting against distance from home to the nearest cycle path adjusting for confounders identified using a Directed Acyclic Graph.
ResultsIn this paper we will show how the propensity to cycle commute differs across population characteristics such as sex, age and the National Statistics Socio-economic classification and how the interaction of these factors affects propensity to cycle commute. We also show that living closer to on- and off-road cycle paths increases the likelihood of cycle commuting.
ConclusionUnderstanding interventions, such as developing on- and off-road cycle paths, that could increase the number and diversity of people cycle commuting (especially if they move from 'passive' to 'active' modes of travel) has the potential to reduce carbon emissions, congestion and air pollution, increase physical activity and therefore improve health.

IntroductionThe Digitising Scotland project (https://digitisingscotland.ac.uk/) has transcribed all Scottish birth, death, and marriage certificates from 1855 to 1974. The linkage of these data will provide formidable challenges for linkage experts and a multitude of opportunities for health and social science researchers.
Objectives and approachWe linked birth between November 1916 and December 1923 to death of women aged 15 to 49 who died between January 1917 and December 1923. We only linked a death up-to 42 days after a birth. We compared parent names with those of the deceased and her spouse, as well as their address, using string matching functions. Given the lack of ground truth data, we conducted a sensitivity analysis using different similarity thresholds to classify birth linked to death as matches (if their similarity was at least a given threshold), or otherwise as non-matches. We then calculated the maternal mortality rate (MMR) on a monthly basis for January 2017 to July 2018 (the pre-flu period), and October 1918 to March 1919 (the flu period) as the number of matched birth to death certificates divided by the average monthly number of birth in the month of death and the previous month.
ResultsPuerperal risk of death during this period was much higher than for the comparable female age group during the different phases of the 1918 flu. During the October 1918 wave, puerperal women were at greater risk than women of the same age, while the risk dropped below the expected in the summer of 1919. We carried out a sensitivity analysis by linking with different similarity thresholds and found our findings were robust to these decisions.
ConclusionsWe have shown how a large and complex data collection can be successfully linked, resulting in new opportunities for various studies in the health and socialsciences.

IntroductionAdministrative data arising via the operation of public service delivery systems hold great benefits for citizens and society providing they can be made available for research in a safe, socially-acceptable way. In recognition of this potential, the UK Administrative Data Research Network was established in 2013 to enable new research for public benefit. However, there are considerable challenges to be overcome for effective data use, and many of these are common to administrative data enterprises in general. Using this network as a practical case study, we set out to explore the challenges, and to share the 'good', suggest solutions to the 'bad', and improve the 'clunky' issues.
MethodsA qualitative survey replicating the data use pathway was carried out across the network, followed by a workshop to discuss the summarised findings and make further suggestions. This led to a set of recommendations to inform the development of an action plan for implementation.
ResultsThe survey respondents (N=27) and workshop participants (N=95) comprised multi‑disciplinary staff from across the network. The responses were summarised by consensus of three researchers and grouped into six areas: A) Data acquisition pathway; B) Approval processes; C) Controls on access & disclosure; D) Data and metadata; E) Researcher support; and F) Data reuse & retention, leading to an embedded set of 18 recommendations. Key developments promoted by this study were the development of themed research partnerships to progress data acquisition, and a policy of data retention and reuse for research.
ConclusionThe network has broken new ground in using administrative data for research. This study has enabled the development of an evidence-based action plan to address many challenges in the effective use of administrative data. It represents a practical worked example, widely relevant to enterprises working with administrative data across the world.
KeywordsAdministrative data research, data access, data linkage

BackgroundLosing independence is a concern for older people, and sadly a reality for many. In Scotland there is an ageing population and unlike the rest of the UK, a policy to provide free personal and nursing care for those in need of assistance; this makes loss of independence high on the agenda of government, local authorities, care providers, older people and their families alike.
ObjectivesThis study aimed to investigate the factors associated with entry to formal care for older people in Scotland. In addition to socio-demographic, geographical and health characteristics, this study considered three lesser studied or novel factors: living in a flat, population density and recent employment.
MethodsA Scottish Longitudinal Study project (https://sls.lscs.ac.uk/) provided a 5.3% representative sample of the Scottish population for longitudinal analysis. This included people aged 65 and older in 1991 whose care-entry status was then followed-up in 2001.
FindingsAssociations were found for age, sex, marital status, longterm illness, housing tenure, recent employment, urban/rural classification and population density. Notably, whilst living in rural areas had a protective association with formal care home entry (OR 0.35 [95% CI 0.29,0.43]), paradoxically, living in areas with a low population density was associated with greatly increased odds (OR 9.05 [95% CI 7.34, 11.19]).
ConclusionsThis study indicates that the factors associated with care-entry in the Scottish population are similar to those in other Western countries. Possible explanations and justifications for the apparently paradoxical association found for population density are discussed. This finding might be relevant in populations outside Scotland, and future research should explore this.

Religion frequently indicates membership of socio-ethnic groups with distinct health behaviours and mortality risk. Determining the extent to which interactions between groups contribute to variation in mortality is often challenging. We compared socio-economic status (SES) and mortality rates of Protestants and Catholics in Scotland and Northern Ireland, regions in which interactions between groups are profoundly different. Crucially, strong equality legislation has been in place for much longer and Catholics form a larger minority in Northern Ireland. Drawing linked Census returns and mortality records of 404,703 people from the Scottish and Northern Ireland Longitudinal Studies, we used Poisson regression to compare religious groups, estimating mortality rates and incidence rate ratios. We fitted age-adjusted and fully adjusted (for education, housing tenure, car access and social class) models. Catholics had lower SES than Protestants in both countries; the differential was larger in Scotland for education, housing tenure and car access but not social class. In Scotland, Catholics had increased age-adjusted mortality risk relative to Protestants but variation among groups was attenuated following adjustment for SES. Those reporting no religious affiliation were at similar mortality risk to Protestants. In Northern Ireland, there was no mortality differential between Catholics and Protestants either before or after adjustment. Men reporting no religious affiliation were at increased mortality risk but this differential was not evident among women. In Scotland, Catholics remained at greater socio-economic disadvantage relative to Protestants than in Northern Ireland and were also at a mortality disadvantage. This may be due to a lack of explicit equality legislation that has decreased inequality by religion in Northern Ireland during recent decades.

his project is funded by the Economic and Social Research Council grant number ES/L007487/1 (Administrative Data Research Centre–Scotland). FP,RD, PC, and MHB are also funded by the Medical Research Council [MC_UU_12017/13, MC_UU_12017/15] and the Scottish Government Chief Scientist Office [SPHSU13, SPHSU15] ; Peer reviewed ; Publisher PDF

Record linkage of administrative and survey data is increasingly used to generate evidence to inform policy and services. Although a powerful and efficient way of generating new information from existing data sets, errors related to data processing before, during and after linkage can bias results. However, researchers and users of linked data rarely have access to information that can be used to assess these biases or take them into account in analyses. As linked administrative data are increasingly used to provide evidence to guide policy and services, linkage error, which disproportionately affects disadvantaged groups, can undermine evidence for public health. We convened a group of researchers and experts from government data providers to develop guidance about the information that needs to be made available about the data linkage process, by data providers, data linkers, analysts and the researchers who write reports. The guidance goes beyond recommendations for information to be included in research reports. Our aim is to raise awareness of information that may be required at each step of the linkage pathway to improve the transparency, reproducibility, and accuracy of linkage processes, and the validity of analyses and interpretation of results.

Record linkage of administrative and survey data is increasingly used to generate evidence to inform policy and services. Although a powerful and efficient way of generating new information from existing data sets, errors related to data processing before, during and after linkage can bias results. However, researchers and users of linked data rarely have access to information that can be used to assess these biases or take them into account in analyses. As linked administrative data are increasingly used to provide evidence to guide policy and services, linkage error, which disproportionately affects disadvantaged groups, can undermine evidence for public health. We convened a group of researchers and experts from government data providers to develop guidance about the information that needs to be made available about the data linkage process, by data providers, data linkers, analysts and the researchers who write reports. The guidance goes beyond recommendations for information to be included in research reports. Our aim is to raise awareness of information that may be required at each step of the linkage pathway to improve the transparency, reproducibility, and accuracy of linkage processes, and the validity of analyses and interpretation of results.