Great Ormond Street Institute of Child Health, University College London, London, UK.
Institute of Health Informatics, University College London, London, UK.
BMC Med. 2024 Sep 27;22(1):416. doi: 10.1186/s12916-024-03619-1.
A third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group.
Birth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group.
Overall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4-171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1-156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4-188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42-1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia.
Overall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health.
在英国出生的儿童中，有三分之一的父母至少有一方出生在英国境外（英国），但家庭迁移史很少作为儿童健康的社会决定因素进行研究。我们描述了截至 5 岁的儿童按父母移民和社会经济群体划分的住院率。
使用出生登记与医院病例统计数据相关联，得出了一个由 2008 年至 2014 年在英格兰公立医院出生的 4174596 名儿童组成的队列，随访至 5 岁。我们观察了母亲的 8 个出生地、最常见的 6 个出生国的母亲出生地和母亲和第二任父母（英国出生/非英国出生）的移民状况。我们使用了多因素剥夺指数（IMD）五分位数来表示社会经济剥夺情况。我们使用负二项/泊松回归模型来模拟父母移民群体与住院风险之间的关联，包括与 IMD 组的相互作用。
总体而言，父母双方均出生在国外的儿童的急诊入院率低于父母双方均在英国出生的儿童。英国出生（队列的 73.6%）母亲的子女急诊入院率最高（每 1000 名儿童年 171.6 次，95%置信区间[CI]171.4-171.9），其次是南亚出生的母亲（每 1000 名儿童 155.9 次，95%CI 155.1-156.7）。南亚组中估计的高比率是由出生于巴基斯坦的妇女的子女（每 1000 名儿童 186.8 次，95%CI 185.4-188.2）造成的。所有母亲出生地出生组都存在急诊入院的社会经济梯度，但在英国出生的母亲的子女中最为明显（发病率比 1.43，95%CI 1.42-1.44，高 vs. 低 IMD 组）。计划入院的模式也遵循类似的社会经济梯度，其中出生于中东和北非以及南亚的母亲的子女最高。
总体而言，我们发现来自最贫困背景的英国出生父母的子女急诊入院率最高。然而，当分解母亲的出生地和入院原因时，模式有所不同，这突出了对移民和健康研究采取细致方法的重要性。
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