Suchergebnisse

ObjectiveTo assess the feasibility of using linked education and offending data (from the National Pupil Database, Department for Education and the Police National Computer, Ministry of Justice) to identify matched control groups to evaluate violence prevention interventions.
ApproachWe simulated a plausible intervention (multi-systemic therapy aimed at high-risk young people living in high-risk areas) aimed at reducing the rate of serious violent offending between the ages of 15 and 18 years. We separately simulated an intervention in London and one outside London. We selected eligible individuals aged 14 years for inclusion in the intervention group, modelled the predictors of serious violent offending. then used two different matching algorithms – prognostic score matching and (coarsened) exact matching – to identify matched controls. We compared their effectiveness by measuring the observed rates of serious violence in the two groups.
ResultsThe dataset we used dataset included just under 1.5 million individuals born between 1st September 1995 and 31st August 1998 with complete data. Consistent with previous research, factors associated with the risk of serious violence included deprivation, geographical region, sex, ethnicity, attainment, school absence and exclusion, being in care of the local authority or classified as in need, as well as prior offending and some school-level factors. Exact matching or coarsened exact matching was more successful than prognostic score matching at selecting suitable control groups, both within and outside London. Within London, exact matching on sex, ethnicity and any offending before age 14 gave a suitable control group; outside London it was necessary to match on a few additional characteristics in order to obtain well-balanced groups.
ConclusionThe linked dataset can feasibly be used to generate suitable matched control groups to evaluate violence prevention interventions; exact matching on key characteristics is potentially the optimal solution. Its utility in practice will depend on regular data updates and having an efficient mechanism for accessing the data for such purposes.

ObjectiveTo use longitudinal birth cohort data linked to police records to examine whether the relationship between adverse childhood experiences (ACEs) and police-recorded serious violence depends on the type, timing or duration of ACEs.
MethodsThe sample are 5070 participants (born 1991-1992) from the Avon Longitudinal Study of Parents and Children who allowed linkage to Avon and Somerset (A&S) local police data, lived in A&S from age 16-24 years, and had exposure and confounder data. The binary outcome (no, yes) is having a police record for a serious violence (SV) offence from age 16-24. ACEs were parent-reported from birth to age 11 and include measures of parental physical and emotional abuse. Logistic regression was used to examine associations between the timing of different ACEs and SV, adjusted for child sex, ethnicity, and family socioeconomic position.
Results6% of the participants had experienced physical abuse, 17% emotional abuse, and 121 individuals (2.4%) had at least one SV record. In adjusted models, there was evidence of an association between physical (OR 1.90, 95% 1.08-3.35) but not emotional (0.96, 0.60-1.54) abuse and risk of SV. Results suggest that those who experienced physical abuse in both early (<4 years) and later (4-11 years) childhood, or later childhood only, might have been at greater risk of SV than those who experienced it only during early childhood, although numbers were small and confidence intervals were consequently wide.
ConclusionResults to date suggest that associations with SV differ between ACE types, and that timing may be important. In our presentation, we will also present findings for other ACEs.

Objectives
• To compare self-reported and police-recorded serious violence using data from a longitudinal UK birth cohort linked to local (Avon and Somerset Constabulary) police records
• To assess the risk of police-recorded serious violence according to study participation status across the lifecourse
ApproachWe linked data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to local police records on charges, cautions and other out of court disposals. We compared the risk of self-reported serious violence at 8 time points from 15 to 25 years to police-recorded serious violence at these ages. We then compared the risk of police-recorded serious violence among those actively participating in ALSPAC to those not participating at various time points from pregnancy onwards. We used logistic regression to examine whether differences in risk could be explained by socio-demographic and family characteristics associated with ALSPAC participation.
ResultsThe sample included 12,662 participants who had received fair processing materials and had not opted out of linkage to police records. They linked to a total of 6,283 offences, of which 933 were classified as serious violence (involving a total of 530 individuals). Self-reported serious violence in the past year was particularly high at 15 years (23.5%); at other ages it ranged from 3.7% (22 years) to 8.7% (20 years). Police-recorded serious violence was lower at all ages, peaking at 1.0% at 17 and 18 years. The risk of police-recorded serious violence was higher among those not participating in ALSPAC than among active participants, particularly during adolescence and early adulthood. This difference was only partially explained by socio-demographic and other factors.
ConclusionA key advantage of linkage to police records is it enables outcomes to be measured irrespective of study participation status as relying only on active participants leads to bias. Combining self-reported and police-recorded outcomes allows us to derive measures of offending that take account of the biases inherent in each.

ABSTRACT
ObjectivesRates of common mental disorders may be increasing among children and adolescents, though evidence of this is mixed. Symptom questionnaires in population surveys may overestimate clinical disease. Conversely, lower participation of individuals with mental disorders may lead to underestimates in surveys. Clinical databases may have greater population coverage and contain information of more obvious clinical validity; however, several factors, including the help-seeking behaviour of individuals and the recording practices of clinicians, may influence burden-of-disease estimates based on these databases. The aim of the current investigation was to compare case definitions of common mental disorders (CMD) using linked electronic primary care data to definitions derived from self-reported data obtained in an observational study.
ApproachWe studied 1,562 adolescents who had completed the Revised Clinical Interview Schedule (CIS-R) in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 17-18 years and had linkage established to their electronic primary care records for at least 6 months after the time they completed the CIS-R. We used lists of Read codes corresponding to diagnoses, symptoms and treatment to create twelve definitions of CMD and also of depression alone. We calculated sensitivities and specificities of these, using CIS-R case definitions as the reference standard. All analyses were carried in Stata 13.0.
ResultsSensitivities ranged from 5.2% to 24.3% for depression and from 3.8% to 19.2% for CMD. The specificities of all definitions were above 98% for depression and above 96% for CMD. For both depression and CMD, the definition that included current diagnosis, treatment or symptoms identified the highest proportion of cases.
ConclusionsMost individuals meeting case definitions for CMD based on information in clinical records also met CMD case definitions based on symptoms reported in a contemporaneous survey. Conversely, many individuals identified as CMD cases based on reported symptoms had no evidence of CMD in their clinical records. A small number of individuals with CMD recorded in their clinical records had not reported symptoms of this in the survey. Overall, these data suggest that clinical databases are likely to yield underestimates of the burden of CMD in the population. Clinical records appear to yield highly valid diagnoses of common mental disorders which may be useful for studying risk factors and outcomes of these conditions. The greatest epidemiological value is likely to be obtained when the combination of information from both survey and clinical records is possible.

First published online: 21 July 2018 ; Attribution 4.0 International (CC BY 4.0) ; Frailty correlates with morbidity and is superior to chronological age in predicting mortality. Frailty of older migrants has important implications for the demands placed on healthcare systems. Examining 95,635 Europeans in the Survey of Health, Aging and Retirement in Europe, we investigated cross-sectional and longitudinal associations between migration and frailty at ages > 50 years. We examined whether associations differed by countries' level of healthcare coverage and access for migrants and tested mediation by home-ownership and citizenship. Cross-sectionally, first-generation migrants > 50 years old were, on average, 16.4% (95% confidence interval [CI]: 14.6, 18.2%) frailer than non-migrants after confounder-adjustment. This decreased to 12.1% (95% CI: 10.1, 14.1%) after adjustment for citizenship. The strength of association between migrant status and frailty was greater in migrants from low-or-middle-income countries, compared with mi-grants from high-income countries. Migrants into Northern, Western and Eastern Europe were 37.3% (95% CI:33.2, 41.5%), 12.2% (95% CI: 10.0, 14.6%) and 5.0% (95% CI: 0.5, 9.6%) frailer than non-migrants, respectively, but migrants into Southern Europe were no frailer than non-migrants. The strength of association between migrant status and frailty was greater in countries with lower healthcare coverage and access for migrants. However, citizenship attenuated this difference. Longitudinally, migrants were frailer than non-migrants at 50 years old and trajectories converged over time until migrants and non-migrants were equally frail by 80–90 years. Our work finds no evidence of the 'healthy migrant effect' outside of Southern Europe in older migrants and suggests that acculturation is a key determinant of migrant health. ; The project MiLifeStatus has received funding from the European Research Council (ERC) under the European Union's Horizon2020 research and innovation programme (grant agreement No 682626)

BACKGROUND: Control of alcohol licensing at local government level is a key component of alcohol policy in England. There is, however, only weak evidence of any public health improvement. We used a novel natural experiment design to estimate the impact of new local alcohol licensing policies on hospital admissions and crime. METHODS: We used Home Office licensing data (2007-2012) to identify (1) interventions: local areas where both a cumulative impact zone and increased licensing enforcement were introduced in 2011; and (2) controls: local areas with neither. Outcomes were 2009-2015 alcohol-related hospital admissions, violent and sexual crimes, and antisocial behaviour. Bayesian structural time series were used to create postintervention synthetic time series (counterfactuals) based on weighted time series in control areas. Intervention effects were calculated from differences between measured and expected trends. Validation analyses were conducted using randomly selected controls. RESULTS: 5 intervention and 86 control areas were identified. Intervention was associated with an average reduction in alcohol-related hospital admissions of 6.3% (95% credible intervals (CI) -12.8% to 0.2%) and to lesser extent with a reduced in violent crimes, especially up to 2013 (-4.6%, 95% CI -10.7% to 1.4%). There was weak evidence of an effect on sexual crimes up 2013 (-8.4%, 95% CI -21.4% to 4.6%) and insufficient evidence of an effect on antisocial behaviour as a result of a change in reporting. CONCLUSION: Moderate reductions in alcohol-related hospital admissions and violent and sexual crimes were associated with introduction of local alcohol licensing policies. This novel methodology holds promise for use in other natural experiments in public health.

Background Control of alcohol licensing at local government level is a key component of alcohol policy in England. There is, however, only weak evidence of any public health improvement. We used a novel natural experiment design to estimate the impact of new local alcohol licensing policies on hospital admissions and crime. Methods We used Home Office licensing data (2007–12) to identify (a) Interventions: local areas where both a cumulative impact zone (CIZ) and increased licensing enforcement were introduced in 2011, and (b) Controls: local areas with neither. Outcomes were 2009-2015 alcohol-related hospital admissions, violent and sexual crimes, and anti-social behaviour. Bayesian structural time-series were used to create post-intervention synthetic time-series (counterfactuals) based on weighted time-series in control areas. Intervention effects were calculated from differences between measured and expected trends. Validation analyses were conducted using randomly selected controls. Results Five intervention and 86 control areas were identified. Intervention was associated with an average reduction in alcohol-related hospital admissions of 6.3% (95% Credible Intervals -12.8%, 0.2%) and to lesser extent with a reduced in violent crimes, especially up to 2013 (-4.6% [95%CI -10.7%,1.4%]). There was weak evidence of an effect on sexual crimes up 2013 (-8.4% [95%CI -21.4%, 4.6%]), and insufficient evidence of an effect on anti-social behaviour as a result of a change in reporting. Conclusion Moderate reductions in alcohol-related hospital admissions and violent and sexual crimes were associated with introduction of local alcohol licensing policies. This novel methodology holds promise for use in other natural experiments in public health.