The COVID-19 pandemic has highlighted stark inequities in health outcomes between ethnic groups in the UK. Prior to the pandemic, we knew that babies and children from different ethnic backgrounds experienced different birth and health outcomes in England (e.g. infant mortality, prevalence of congenital conditions). However, we still do not know whether there are inequities in their use of healthcare services, particularly preventive and avoidable care.
This study will investigate the relationship between ethnicity and healthcare use in England from birth to five years of age. We will use the GP and hospital electronic health records of patients from 2006 to 2021. We will compare babies and children from different ethnic groups in their use of preventive care (six-week baby check and routine vaccinations) and potentially avoidable hospitalisations, and investigate whether this relationship between ethnicity and healthcare use changed during the COVID-19 pandemic. We will also calculate any excess costs to the NHS that arise from ethnic group differences.
Findings will inform healthcare and public health policy, strategy and implementation (e.g. England’s public health strategy to reduce health inequities in the early years; the NHS Long Term Plan for ‘right care at the right time in the optimal care setting’).
Despite the increasing interest in ethnic inequities and health in England, little is known about the ethnic inequities in paediatric healthcare utilisation. This population-based cohort study aims to investigate the association between ethnicity and paediatric healthcare utilisation in England, specifically with regards to preventive care (six-week baby checks and routine vaccinations) and potentially avoidable admissions. It will also explore ethnic differences in the characteristics of utilisation, including timing of preventive care, admission length of stay and re-admission.
The study will use linked data from CPRD Aurum, the Pregnancy Register, Mother-Baby Link, Hospital Episode Statistics Admitted Patient Care (HES APC), Office for National Statistics Index of Multiple Deprivation (ONS IMD) and ONS Rural Urban Classification (RUC), following up children from birth to age five, 2006-2021. The main exposures of interest will be the ethnicity of the child and their mother. Descriptive analysis of summary statistics and proportions will be followed by statistical modelling. Dependent on the testing of model assumptions and model fit, it is anticipated that analysis of preventive care outcomes will primarily involve logistic regression, while avoidable hospitalisation outcomes will be modelled using generalised linear models (e.g. Poisson) and survival models (e.g. Cox proportional hazards). Covariates will be incorporated a prior into statistical models based on a conceptual framework developed prior to analysis. Interrupted time-series analysis will be used for pre vs during pandemic comparisons, and cost analysis (e.g. generalised linear models) will quantify differences between ethnic groups in terms of excess costs to the NHS.
This study’s findings will help the NHS, public health authorities, policy makers and commissioners to understand which ethnic groups may benefit from increased support to access and attend preventive care in childhood, as well as the cost implications for unequal distribution in the use of potentially avoidable care between groups.
PRIMARY OUTCOMES: evidence of a GP six-week baby check; routine vaccination completeness; rate of potentially avoidable admissions
SECONDARY OUTCOMES: timing of vaccine doses; timing of six-week baby check; re-admissions for following potentially avoidable admissions; length of stay during potentially avoidable admissions; excess costs arising from differences in potentially avoidable admissions between ethnic groups
Claire Carson - Chief Investigator - University of Oxford
Claire Zhang - Corresponding Applicant - Nuffield Department of Population Health
Aden Kwok - Collaborator - University of Oxford
Clare Bankhead - Collaborator - University of Oxford
Maria Quigley - Collaborator - University of Oxford
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Mother-Baby Link;CPRD Aurum Pregnancy Register;Rural-Urban Classification