Health service use in families where children enter public care: a nested case control study using the General Practice Research Database.
Health service use in families where children enter public care: a nested case control study using the General Practice Research Database.
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DOI：
10.1186/1472-6963-12-65
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发表时间：
2012-03-16
影响因子：
2.8
通讯作者：
Thorogood M
中科院分区：
文献类型：
--
作者：
Simkiss DE;Spencer NJ;Stallard N;Thorogood M
至少有3%的儿童在公共护理中度过了一些童年，作为一个群体，他们在教育，就业，健康和社会护理方面的结果很差。使用社会护理或政府数据集的研究已经确定了一些与儿童进入公共护理相关的风险因素，但风险因素在临床实践中的效用尚未确定。本文使用常规的初级卫生保健数据，看看是否可以在临床实践中确定儿童进入公共保健的风险因素。采用英国常规初级保健数据的巢式病例对照方法。卫生服务使用数据提取前12个月的情况下，儿童进入公共保健，并与12个月的数据进行比较，为4个对照组的母亲对每例对，匹配的年龄和性别的儿童和一般的做法。感兴趣的暴露是从一个系统的文献回顾与儿童进入公共护理的风险因素。使用条件logistic回归研究一种以上关注暴露的综合效应。产妇精神疾病（OR 2.51，95% CI 1.55 - 4.05），母亲出生时的年龄，社会经济状况（第5个五分位数与第1个五分位数OR 7.14，95% CI 2.92 - 17.4），母亲吸毒（OR 28.8，95% CI 2.29 - 363），未出席预约（OR 2.42，95% CI 1.42 - 4.14），儿童精神疾病（OR 2.65，95% CI 1.42 - 4.96）和儿童入院（OR 3.31，95% CI 1.21 - 9.02）均与儿童进入公共护理显著相关。母亲使用初级保健避孕服务与儿童进入公共保健呈负相关（OR 0.52，95%CI 0.31 - 0.87）。保健服务使用的差异可以确定从常规的初级保健数据的母亲儿童对儿童进入公共保健后，控制母亲的年龄和社会经济地位。不同风险因素之间的相互作用需要使用纵向数据集在累积风险模型中进行测试。
At least 3% of children spend some of their childhood in public care and, as a group, have poor outcomes across a range of education, employment, health and social care outcomes. Research, using social care or government datasets, has identified a number of risk factors associated with children entering public care but the utility of risk factors in clinical practice is not established. This paper uses routine primary health care data to see if risk factors for children entering public care can be identified in clinical practice. A nested case control methodology using routine primary care data from the United Kingdom. Health service use data were extracted for the 12 months before the case child entered public care and compared with 12 months of data for four control mother child pairs per case pair, matched on the age and sex of the child and the general practice. Exposures of interest were developed from a systematic review of the literature on risk factors associated with children entering public care. Conditional logistic regression was used to investigate the combined effect of more than one exposure of interest. Maternal mental illness (OR 2.51, 95% CI 1.55-4.05), maternal age at birth of the child, socio-economic status (5th quintile vs. 1st quintile OR 7.14, 95% CI 2.92-17.4), maternal drug use (OR 28.8, 95% CI 2.29-363), non attendance at appointments (OR 2.42, 95% CI 1.42-4.14), child mental illness (OR 2.65, 95% CI 1.42-4.96) and child admission to hospital (OR 3.31, 95% CI 1.21-9.02) were all significantly associated with children entering public care. Maternal use of primary care contraception services was negatively associated with children entering public care (OR 0.52, 95% CI 0.31-0.87). Differences in health service use can be identified from routine primary care data in mother child pairs where children enter public care after controlling for maternal age and socio-economic status. The interaction between different risk factors needs testing in a cumulative risk model using longitudinal datasets.
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