Suchergebnisse

ABSTRACT
ObjectiveFailing to graduate high school is linked to many risk factors, including family history academic achievement. This research examines how important an older sibling's academic achievement is in predicting whether a younger sibling will graduate high school.
MethodThis study used linkable administrative databases housed at the Manitoba Centre for Health Policy (MCHP). The cohort consists of 33,843 individuals born in Manitoba between April 1, 1983 and March 31, 1994, who stayed in the province until at least their 20th birthday, had at least one older sibling, and had no missing values on key variables. Logistic regression, controlling for a variety of confounders, is used to determine how much having an older sibling who didn't graduate high school impacts the odds of a younger sibling not graduating high school.
ResultsThe adjusted odds of not graduating high school within 6 years of entering grade nine for individuals who had at least one older sibling who did not graduate high school was 4.81 (p < 0.0001, 95% CI 4.4-5.2) times higher than for individuals whose older sibling(s) graduated high school. Individuals living in low income neighborhoods at birth or age 18, individuals living in rural northern Manitoba at birth or age 18, and individuals who moved before age 18 were significantly less likely to finish high school. High school graduation rates for those living in the lowest income quintile at age 18 whose older siblings graduated high school were higher than those living in the highest income quintile at age 18 and had at least one older sibling who did not graduate high school.
ConclusionThe influence of an older sibling's educational achievement has significant implications for younger siblings' odds of high school graduation. This is likely due to social learning (younger sibling modeling actions of older sibling), and the shared parental influence and social risk experienced by both siblings.

IntroductionEducational attainment is known to be related to family size, birth order, and the educational achievement of an older sibling.
ObjectiveThis study examines younger siblings in large families, exploring the extent to which each older sibling's educational attainment is associated with attainment of the younger sibling.
MethodsLinkable administrative data were used to create a population-based cohort of third children in three child families born in Manitoba, Canada between April 1, 1984 and March 31, 1994, who stayed in the province until at least age 20 (n = 5,771). Logistic regression models were used to examine the relationship between the youngest siblings' educational achievement and that of their older two siblings, adjusting for a series of confounders.
ResultsYoungest siblings have the greatest odds of graduating from high school if both older siblings graduated. Females also had greater odds of graduating if only one of those older siblings had graduated; this did not increase the odds for males. Associations in educational attainment were stronger when siblings were born close together. For siblings born further apart, these associations were stronger if those siblings were of the same sex as the youngest sibling.
ConclusionsIn large families, the educational attainment of each older sibling is associated with the educational attainment of the younger sibling; associations differ depending on the birth order and sex of the older siblings. Families in which older siblings do not graduate from high school may be experiencing numerous challenges. Children with older siblings who fail to graduate may benefit from additional supports to increase their likelihood of graduation.

IntroductionLarge population-based data sets present similar analytic issues across such fields as: population health, clinical epidemiology, education, justice, and children's services. Step-wise approaches and generalized tools can bring together several pillars: big (typically administrative) data, programming, and study design/analysis. How can we improve efficiency and explore alternative designs?
Objectives and ApproachLinked data sets typically contain: 1) files presenting longitudinal histories 2) substantive files noting various events (concussions, burns, loss of a loved one, public housing entry) and several possible covariates and outcomes.
Step-wise approaches enable automating tasks by developing general tools (decreasing programmer input) and facilitating alternative designs. Macros improve upon the classic 'one design, one data set' perspective. Two case studies highlight tradeoffs in retrospective cohort studies (quasi-experiments) among sample size, length of follow-up, and the number of time periods.
ResultsStudy 1: Step 1 calculated the number of mothers with a child placed in care during various index years. Taking 1 year before and after placement generated 5,991 eligible mothers; selecting 5 years before/after decreased the N to 2,281. Step 2 selected appropriate in-province residents. Step 3 handled missing covariates and outcomes, while Step 4 ran alternative designs.
One example (of several) compared maternal mental health outcomes using 8 time periods (in 2 years) before/after the event with outcomes using 16 time periods (in 4 years) before/after. Besides showing increasing maternal problems, the 4-year follow-up sometimes produced different statistically significant periods than the 2-year follow-up.
Study 2. Swedish/Canadian comparisons of mothers with children placed in foster care highlighted growing differences in maternal pharmaceutical use.
Conclusion/ImplicationsPresenting design alternatives is straightforward and applicable across disciplines. Ongoing work is facilitating comparisons of 'experimental' and control groups. Literature-derived guidelines and simulation-based techniques should lead to better design decisions. Automated model assessment can help analyze robustness, statistical power, residuals, and bias, suggesting artificial intelligence approaches.

IntroductionMothers have increased mental illness such as anxiety and depression after the death of a child.
Objectives and ApproachThe mental health of all mothers who experience the death of an infant (< 1 years old) in Manitoba, Canada between April 1, 1999, and March 31, 2011 (n = 534) is examined in the four years leading up to, and the four years following, the death of their child to determine how long increased levels of mental-health realted outcomes remain elevated after the death of an infant. Mental
health-related outcomes of these mothers are compared with a matched (3:1) cohort of mothers who did not experience the death of a child (n = 1,602).
ResultsCompared with mothers who did not experience the death of a child, mothers experiencing this event had higher rates of anxiety diagnoses and psychotropic prescriptions starting 6 months before the death. Elevated rates of anxiety continued for the first year and elevated rates of psychotropic prescriptions continued for six months after the death of the child. Mothers who experienced the death of a child had higher rates of depression diagnoses in the year after the death. Relative rates (RR) of depression (RR = 4.94), anxiety (RR = 2.21), and psychotropic medication use (RR = 3.18) were highest in the six months after the child's death.
Conclusion/ImplicationsElevated rates of depression, anxiety, and psychotropic medication use after the death of a child end within one year of the child's death.

ABSTRACTBackgroundRisk factors for teenage pregnancy are linked to many factors, including a family history of teenage pregnancy. This research examines whether a mother's teenage childbearing or an older sister's teenage pregnancy more strongly predicts teenage pregnancy in a younger sister. MethodsThis study used linkable administrative databases housed at the Manitoba Centre for Health Policy (MCHP). The original cohort consisted of 17,115 women born in Manitoba between April 1, 1979 and March 31, 1994, who stayed in the province until at least their 20th birthday, had at least one older sister, and had no missing values on key variables. Propensity score matching (1:2) was used to create balanced cohorts for two logistic regression models; one examining the impact of an older sister's teenage pregnancy on a younger sister's teenage pregnancy and the other analyzing the effect of the mother's teenage childbearing on a younger sister's teenage pregnancy odds.ResultsThe adjusted odds of becoming pregnant between ages 14 and 19 for teens with at least one older sister having a teenage pregnancy were 3.06 (99% CI 2.53 - 3.64) times higher than for women whose older sister(s) did not have a teenage pregnancy. Teenage daughters of mothers who had their first child before age 20 had 1.51 (99% CI 1.29 - 1.78) times higher odds of pregnancy than those whose mothers had their first child after age 19. Educational achievement was adjusted for in a sub-population examining the odds of pregnancy between ages 16 and 19. After this adjustment, the odds of teenage pregnancy for teens with at least one older sister who had a teenage pregnancy were reduced to 2.34 (99% CI 1.92-2.86) and the odds of pregnancy for teen daughters of teenage mothers were reduced to 1.35 (99% CI 1.15-1.59).ConclusionGiven that an older sister's teenage pregnancy has a much stronger impact than a mother's teenage pregnancy, this study suggests social modeling to be a stronger risk factor for teenage pregnancy than living in an adverse environment created by a mother's adolescent childbearing. This study contributes to understanding of the broader topic "who is influential about what" within the family.

IntroductionStudies on the relationship between exposure to maternal depression in early childhood and childhood development have been limited by small samples, lack of information on timing of maternal depression, and use of a composite measure of childhood development.
Objectives and ApproachWe linked multiple Manitoba datasets to examine the relationship between exposure to maternal depression in early childhood and childhood development at school entry across five domains, and age at exposure to maternal depression on developmental outcomes using a population-based cohort (n = 52,103). Maternal depression was defined using physician visits, hospitalizations, and pharmaceutical data, while developmental vulnerability was assessed using the well-validated Early Development Instrument. Relative risk of developmental vulnerability was assessed using log-binomial regression models, adjusted for maternal and childhood characteristics at the birth of the child.
ResultsChildren exposed to maternal depression before age 5 had a 17% higher risk of having at least one developmental vulnerability at school entry than children not exposed to such depression before age 5. Exposure to maternal depression before age 5 was most strongly associated with social competence (aRR = 1.28, 95% CI 1.20, 1.38), physical health and well-being (aRR = 1.28, 95% CI 1.20, 1.36), and emotional maturity (aRR = 1.27, 95% CI 1.18, 1.37). For most developmental domains, exposure to maternal depression before age 1 and between ages 4 and 5 had the greatest association with developmental vulnerability.
Conclusion / ImplicationsOur findings that children exposed to maternal depression were at higher risk of developmental vulnerability at school entry is consistent with previous studies. However, we found that the association between exposure to maternal depression and development varied across developmental domains, and the relationship varied depending on the age of exposure to maternal depression. Ongoing analyses of discordant cousins will shed more light on the causal nature of this relationship.

ObjectivesPerinatal risk factors can vary by immigration status. To advance knowledge on sociobehavioral health risks among pregnant and childbearing immigrant women, we compared perinatal health indicators between immigrant and non-immigrants, overall, and according to key immigrant characteristics (refugee status, secondary migration, birth region, and duration of residence).
ApproachWe conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women in Manitoba, Canada, aged 15-55 years, who had newborn screening data completed by public health nurses within two weeks postpartum from 2000 to 2017. The screening data was linked to a Canadian national immigration database. Additional databases were linked to collect demographic and perinatal clinical information. Logistic regression models were used to examine the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use and late prenatal care initiation.
ResultsMore immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.90, 95% Confidence Interval (CI): 6.53, 7.28) but exhibited lower odds of other outcomes. In the analysis restricted to immigrants, recent immigrants (< 5 years of stay) had higher odds of being socially isolated (aOR: 9.29, 95% CI: 7.80, 11.06) and late prenatal care (aOR: 1.73, 95% CI: 1.23, 2.42) compared to long-term immigrants, but lower odds relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with social isolation, relationship distress, depression, and late prenatal care whereas secondary migration was protective for social isolation, relationship distress, and smoking. Relationship distress and behavioral health indicators varied by maternal birth region.
ConclusionThe novel linkage of birth screening data with the immigration data advances knowledge on immigrant perinatal health by identifying risk patterns for multiple psychosocial and behavioral health indicators, highlighting subgroups at higher and lower risk of exposures that may contribute to adverse perinatal health outcomes.

ObjectiveThe objective is to examine the association between trajectories of childhood residential and school mobility and academic achievement (literacy, numeracy) in Grade 3 using linked whole-population administrative data in Manitoba, Canada. Secondarily, we assessed childhood residential/school mobility based on neighbourhood income levels (moving in/out of low- or mid-/high-income neighbourhoods).
ApproachThis retrospective cohort study used linkable, de-identified administrative data (health, education, national census, provincial survey) from the provincial Population Research Data Repository housed at the Manitoba Centre for Health Policy (MCHP). Among kindergarteners from 2005 to 2014 (n = 83,894), those not having continuous residency in Manitoba, valid education assessments, and relevant family-level covariates were excluded. We followed this eligible cohort from kindergarten to Grade 3 based on various neighbourhood income trajectories of residential and school mobility. To assess Grade 3 literacy and numeracy scores based on trajectories, log-binomial regression models were conducted using SAS® version 9.4.
ResultsThe total cohort included 36,754 children; at the end of kindergarten, 14.2% resided in low-income neighbourhoods, and 84.8% lived in mid-/high-income neighbourhoods. Moving between two low-income neighborhoods between kindergarten to Grade 3 was associated with an increased risk of poor Grade 3 numeracy and literacy scores (numeracy aRR=1.39 [1.16,1.67]; literacy aRR=1.31 [1.08,1.59]). When moving between neighborhood income levels, the association was stronger for children moving into low-income neighbourhoods (e.g., mid-/high-income to low-income: numeracy aRR=1.41 [1.19,1.67]) than children moving into mid/high-income neighbourhoods (e.g., low-income to mid-/high-income: numeracy aRR=1.31 [1.08,1.59]). Changing schools between kindergarten and Grade 3 was also associated with poorer numeracy and literacy scores in Grade 3 (numeracy aRR=1.31 [1.22,1.40]; literacy aRR=1.34 [1.24,1.44]); however, the strength varied based on residential mobility patterns.
ConclusionMoving homes/schools can differentially impact children's educational attainment depending upon the income level of residing neighborhood(s). Stakeholders should recognize different levels of risks related to mobility and provide support accordingly to reduce the adverse impact. Support systems should be tailored to not only children but also families and neighbourhoods.

Introduction: When designing prospective and retrospective longitudinal cohort studies, investigators must make decisions about study duration (i.e. length of follow-up) and frequency of outcome measurement. The impact of these decisions have been previously investigated in the prospective setting, but have not been described for retrospective cohort studies.

Objectives: To examine the impact and potential challenges of longitudinal design decisions in retrospective cohort studies and illustrate the effects of varying study duration and frequency of outcome measurement in the retrospective setting using a numeric example.

Methods: Linked administrative data from Manitoba was used. The cohort included all mothers who experienced the death of an infant between April 1, 1999 and March 31, 2012 and a matched (3:1) group of mothers who did not experience death. A generalized linear mixed model was used to model differences in the trend in the number of healthcare contacts for the two groups. Holding sample size constant, the model was fit to the data for combinations of duration and frequency. Estimated standard errors and regression coefficients were compared.

Results: A total of 2576 mothers were included; 644 experienced death of an infant and 1932 were matched to this group. Thirteen combinations of frequency (1, 2, 3, 4 periods/year) and duration (1, 2, 3, 4 years) were compared. As frequency increased from 1 to 4 periods/year, the standard error of the group-time-time interaction decreased up to 98.9%. As duration increased from 1 to 4 years, the standard error of the interaction decreased up to 96.9%. As frequency and duration increased, the coefficients trended toward zero.

Conclusions: Retrospective designs using administrative data offer greater flexibility to select time-related design elements than prospective designs, but present potential new challenges. Recommendations about how to select and report time-related design decisions in retrospective cohort studies should be included in reporting guidelines.

IntroductionSeparation from one's child can have significant consequences for parental health and well-being.
Objectives and ApproachWe aimed to investigate whether parents whose children were placed in care had higher rates of avoidable (amenable and preventable) mortality. Data were obtained from the Swedish national registers. Mortality rates among parents whose children were placed in care between 1990 and 2012 (17 505 mothers, 18 286 fathers) were compared with a 5:1 matched cohort of parents whose children were not placed. We computed rate differences and hazard ratios of all-cause and avoidable mortality.
ResultsWhen compared with parents who did not have a child placed in care, there were an additional 21 avoidable deaths per 10 000-person years among mothers and an additional 27 avoidable deaths per 10 000-person years among fathers whose children were placed in care. Among mothers, death due to preventable causes were 3·83 times greater (95% CI 2·82-5·21) and deaths due to amenable causes were 3·12 times greater (95% CI 2·07-4·69) for those whose children were placed in care. Among fathers, death due to preventable causes was 1·75 times greater (95% CI 1·41-2·16) and deaths due to amenable causes were 1·52 times greater (95% CI 1·08- 2·13) for those whose children were placed in care. Avoidable mortality rates were higher among mothers whose children were young when placed in care and parents whose children were all placed in care.
Conclusion/ImplicationsMothers who had a young child placed and parents whose children were all placed in care are at much higher risk of avoidable mortality than parents whose children were not placed in care. Targeted public health interventions and more attentive health care could reduce risk of avoidable mortality in this group of parents.

IntroductionAdolescent girls in care of child protection services are more likely to become pregnant than adolescent girls not in care, and mothers who were in care are more likely to have their children placed in care.
Objectives and ApproachLinkable administrative data were used to determine whether adolescent mothers in care are at greater risk of having their child placed in care before age two. A population-based cohort of adolescent mothers whose first child was born in Manitoba, Canada between April 1, 1998, and March 31, 2013 (n = 5,942) was used. Adjusted odds ratios (AOR) of having that first child taken into care before their second birthday were compared between mothers who were in care (n = 576) and mothers who were not in care (n = 5, 366) at the birth of their child using logistic regression models.
ResultsAdolescent mothers who were in care had greater odds of having their child taken into care before the child's second birthday (AOR = 7.53; 95% CI = 6.19-9.14). Specifically, their children had higher odds of being taken into care in their first week of life (AOR = 11.64; 95% CI = 8.83-15.34), between one week and their first birthday (AOR = 3.63; 95% CI = 2.79-4.71)., and between their first and second birthday (AOR = 2.21; 95% CI = 1.53-3.19).
Conclusion/ImplicationsFindings support an intergenerational cycle of involvement with child protection services. More and better services are required for adolescent mothers who give birth while in care of child protection services.

IntroductionFetal Alcohol Spectrum Disorder (FASD) is a significant public health concern. Prenatal care (PNC) settings are integral to preventing prenatal alcohol exposure as physicians delivering PNC services are in a unique position to reduce alcohol consumption during pregnancy. However, few studies have investigated PNC use among women who drink during
Objectives and ApproachAnalysis was conducted of women with children born in Manitoba between April 1, 1984 and Mach 31, 2012, with follow up till 2013 using linkable administrative and novel clinic data. Study group included women whose child(ren) were diagnosed with FASD from 1999 to 2012 (n=702) at a centralised FASD diagnostic clinic. Comparison group included women from the general population whose children who did not have an FASD diagnosis (n=2097), matched on the index child's birthdate, postal code, and SES. Adequacy of PNC utilization was defined using the revised Graduated Index of Prenatal Care Utilization.
ResultsThis is the first population-based study to investigate rates of PNC usage of women who have given birth to children with FASD. Rates of inadequate PNC were higher among the study group (adjusted RR 2.47, 95% CI 2.08 to 2.94), as well as no PNC (adjusted RR 3.55, CI 2.42 to 5.22). Among the study group 63% accessed PNC, with 59% receiving intermediate, adequate, or intensive PNC.
Conclusion/ImplicationsResults represent opportunity for screening and brief intervention programs to be delivered in PNC health care settings, as well as outreach programs to facilitate the uptake of PNC among high risk women.

IntroductionEctopic pregnancy occurs in 1% to 2% of the all recognized pregnancies, yet half of women who have an ectopic pregnancy do not have any known risk factors. A potential but unstudied risk factor for ectopic pregnancy is benzodiazepine use, which could affect muscle contraction in the fallopian tube.
Objectives and ApproachWe compared the risk of ectopic pregnancy among women with and women without benzodiazepine prescriptions before conception. using data from United States commercial insurance claims (IBM® MarketScan® Databases). We performed a cohort study of 1,691,366 pregnancies between November 1, 2008 and September 30, 2015, and used unadjusted and inverse probability of treatment (IPT) weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Sub-group analysis was conducted on women who had anxiety and women who had insomnia diagnoses in the year before conception.
ResultsOf the 1,691,366 pregnant women, 1.06% filled at least two benzodiazepine prescriptions in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10,000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis.
Conclusion / ImplicationsThis study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women and their health care providers make more fully informed decisions about benzodiazepine use in their reproductive years.