University College London Great Ormond Street Institute of Child Health, London, UK.
Evidence Based Practice Unit, UCL and Anna Freud Centre for Children and Families, London, UK.
Int J Epidemiol. 2024 Aug 14;53(5). doi: 10.1093/ije/dyae138.
Monitoring the incidence of chronic health conditions (CHCs) in childhood in England, using administrative data to derive numerators and denominators, is challenged by unmeasured migration. We used open and closed birth cohort designs to estimate the cumulative incidence of CHCs to age 16 years.
In closed cohorts, we identified all births in Hospital Episode Statistics (HES) from 2002/3 to 2011/12, followed to 2018/19 (maximum age 8 to 16 years), censoring on death, first non-England residence record or 16th birthday. Children must have linked to later HES records and/or the National Pupil Database, which provides information on all state school enrolments, to address unmeasured emigration. The cumulative incidence of CHCs was estimated to age 16 using diagnostic codes in HES inpatient records. We also explored temporal variation. Sensitivity analyses varied eligibility criteria. In open cohorts, we used HES data on all children from 2002/3 to 2018/19 and national statistics population denominators.
In open and closed approaches, the cumulative incidence of ever having a CHC recorded before age 16 among children born in 2003/4 was 25% (21% to 32% in closed cohort sensitivity analyses). There was little temporal variation. At least 28% of children with any CHC had more than one body system affected by age 16. Multimorbidity rates rose with later cohorts.
Approximately one-quarter of children are affected by CHCs, but estimates vary depending on how the denominator is defined. More accurate estimation of the incidence of CHCs requires a dynamic population estimate.
使用行政数据推导出分子和分母来监测英格兰儿童期慢性健康状况（CHC）的发生率，但这受到未测量的移民的影响。我们使用开放式和封闭式出生队列设计来估计至 16 岁时 CHC 的累积发生率。
在封闭式队列中，我们从 2002/3 年至 2011/12 年在医院入院统计（HES）中确定了所有出生记录，随访至 2018/19 年（最大年龄 8 至 16 岁），以死亡、首次非英格兰居住记录或 16 岁生日为截止日期。为了解决未测量的移民问题，儿童必须与后来的 HES 记录和/或国家学生数据库相关联，该数据库提供了所有公立学校注册的信息。CHC 的累积发生率使用 HES 住院记录中的诊断代码估计至 16 岁。我们还探讨了时间变化。敏感性分析改变了资格标准。在开放式队列中，我们使用了 2002/3 年至 2018/19 年期间所有儿童的 HES 数据和全国统计人口分母。
在开放式和封闭式方法中，2003/4 年出生的儿童在 16 岁之前记录有 CHC 的累积发生率为 25%（在封闭式队列敏感性分析中为 21%至 32%）。几乎没有时间变化。至 16 岁时，至少有 28%的 CHC 儿童有一个以上的身体系统受到影响。多系统疾病的发病率随着后来的队列而上升。
大约四分之一的儿童患有 CHC，但估计值因分母的定义而异。更准确地估计 CHC 的发病率需要动态人口估计。
