Comparing health outcomes for care experienced children and children in the general population in Scotland using linked administrative data

由地方当局照料的儿童（有照料经验的儿童，CEC）是社会上最脆弱的群体之一。2017年，苏格兰约有1.5万名儿童在家中接受了社会护理工作者的探视，或被安置在亲属、寄宿或寄养家庭。与其他年轻人相比，这些孩子往往处于不利地位，比如不得不频繁搬家或转学。目前，人们对CEC的健康状况知之甚少，也不知道与苏格兰其他儿童相比如何。少量证据表明，与其他儿童相比，这群儿童更有可能出现健康状况不佳的情况，比如心理健康状况更差。我们的研究旨在为苏格兰CEC的健康、怀孕和死亡率提供第一个国家级证据。我们的项目将2009年在校和接受护理的儿童的社会护理、住院、出生和死亡登记数据等不同的行政数据来源联系起来。将对这些儿童的护理经历（安置的类型、时间长短和数量）和健康结果进行为期7年的跟踪，直至2016年。然后将CEC的健康状况与2009年至2016年期间没有得到照顾的学龄儿童的健康状况进行比较。我们将调查以下研究问题：1。学龄CEC的健康、死亡率和怀孕率与苏格兰学龄儿童的一般人口不同吗？学龄CEC的健康、死亡率和怀孕率与苏格兰各地贫困类别的学龄儿童的一般人口不同吗？3 .哪些护理经历（社会护理安排的类型、时长和数量）会增加不良健康结果、死亡率和怀孕的风险？不同的护理经历如何与剥夺和家庭社会经济地位（SES）相互作用，影响不良健康结果、死亡率和怀孕的风险？前两个问题提供了对CEC相对于其他儿童健康状况的了解。我们将研究广泛的健康结果（住院率、处方的数量和类型），以确定CEC儿童与其他儿童之间的健康差距最大的健康结果。对于住院、处方和死亡率，我们将首先查看总体比率，然后进行具体原因分析，将疾病的主要原因分组。关注的主要原因是与心理健康有关的结果（因自残或使用抗抑郁药而住院）和因可通过有效医疗（如哮喘）或其他干预措施（如事故）预防的原因而导致的死亡。如有可能，我们亦会研究其他主要致病原因，例如呼吸系统疾病。这些结果将通过小区域剥夺来分析，看看健康差异是否以及在多大程度上可以用社会经济不平等来解释。在了解了两个人群之间的巨大差异之后，问题3和问题4将详细调查不同的护理路径、家庭经济地位、过去的健康状况和其他因素如何影响健康、死亡率和怀孕率。这些结果可以说明，经常更换看护地点的儿童是否会遇到更多的健康问题，或者某些类型的安置地点的儿童是否更有可能出现健康问题。这将有助于确定苏格兰CEC早期干预的地点和时间。研究结果将在学术期刊上发表，但我们也会为非学术读者撰写研究报告。本报告将介绍主要调查结果，面向与CEC合作的决策者、专业人员和服务提供者。我们将与苏格兰卓越照顾儿童中心合作编写报告，并在项目结束时的知识交流研讨会上介绍该报告。

Children who are in the care of their local authority (care experienced children, CEC) are one of the most vulnerable groups of people in the society. In 2017 approximately 15,000 children in Scotland were visited by social care workers at home or placed in kinship, residential or foster care. These children often experience disadvantage compared to other young people, such as having to move homes or change schools frequently. Currently, very little is known about the health of CEC or how this compares to other children in Scotland. The small amount of evidence there is suggests that this group of children are more likely to experience poor health, such as worse mental health compared to other children. Our research aims to provide the first national level evidence on the health, pregnancy and mortality rates for CEC in Scotland.Our project links different administrative data sources, such as social care, hospitalisation, birth and death registrations data, for children who were in school and experiencing care in 2009. The care experiences (the type, length and number of placements) and health outcomes for these children will be followed over seven years up to 2016. The health of CEC will then be compared to the health of school children who did not experience care between 2009 and 2016.We will investigate the following research questions:1. Do the health, mortality and pregnancy rates of school-aged CEC differ from the general population of school-age children in Scotland?2. Do the health, mortality and pregnancy rates of school-aged CEC differ from the general population of school-aged children within deprivation categories across Scotland?3. Which care experiences (type, length and the number of social care placements) increase the risks of adverse health outcomes, mortality and pregnancy?4. How do different care experiences interact with deprivation and family socioeconomic status (SES) to affect the risks of adverse health outcomes, mortality and pregnancy?The first two questions provide an understanding of the health of CEC relative to other children. We will look at a wide range of health outcomes (hospitalization rates, the number and type of prescriptions) to identify the ones for which health disparities between the CEC and other children are the greatest. For hospitalizations, prescriptions and mortality we will first look at overall rates, followed by cause-specific analysis that groups the major causes of illness. The main causes of interest are mental-health related outcomes (hospitalization due to self-harm or anti-depressant use) and mortality due to causes that could have been prevented with effective medical treatment (e.g. asthma) or by other interventions (e.g. accidents). If possible, we will also study other major causes of illness, such as respiratory diseases. These outcomes will be analysed by small-area deprivation to see if and to what extent the health disparities are explained by socioeconomic inequalities.After getting a sense of the broad differences between the two populations, questions 3 and 4 will investigate in detail how different care paths, family SES, past health and other factors impact health, mortality and pregnancy rates. These results can say whether children who have frequent changes in care placements experience more health problems or whether children in certain types of placements are more likely to have health problems. This will help identify the location and timing for early interventions among CEC in Scotland.The research results will be published in academic journals, but we will also write a research report for non-academic audiences. This report will present the main findings and is aimed at policy makers, professionals and service providers working with CEC. We will collaborate with the Centre for Excellence for Looked After Children in Scotland to develop the report and present this at a knowledge exchange workshop at the end of the project.