Health service use in families where children enter public care : a nested case control study using the General Practice Research Database
Simkiss, Douglas E., Spencer, Nick, Stallard, Nigel and Thorogood, Margaret. (2012) Health service use in families where children enter public care : a nested case control study using the General Practice Research Database. BMC Health Services Research, Vol.12 (No.1). p. 65. ISSN 1472-6963
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Official URL: http://dx.doi.org/10.1186/1472-6963-12-65
Background: At least 3% of children spend some of their childhood in public care and, as a group, have poor
outcomes across a range of education, employment, health and social care outcomes. Research, using social care
or government datasets, has identified a number of risk factors associated with children entering public care but
the utility of risk factors in clinical practice is not established. This paper uses routine primary health care data to
see if risk factors for children entering public care can be identified in clinical practice.
Methods: A nested case control methodology using routine primary care data from the United Kingdom. Health
service use data were extracted for the 12 months before the case child entered public care and compared with
12 months of data for four control mother child pairs per case pair, matched on the age and sex of the child and
the general practice. Exposures of interest were developed from a systematic review of the literature on risk factors
associated with children entering public care.
Results: Conditional logistic regression was used to investigate the combined effect of more than one exposure of
interest. Maternal mental illness (OR 2.51, 95% CI 1.55-4.05), maternal age at birth of the child, socio-economic
status (5th quintile vs. 1st quintile OR 7.14, 95% CI 2.92-17.4), maternal drug use (OR 28.8, 95% CI 2.29-363), non
attendance at appointments (OR 2.42, 95% CI 1.42-4.14), child mental illness (OR 2.65, 95% CI 1.42-4.96) and child
admission to hospital (OR 3.31, 95% CI 1.21-9.02) were all significantly associated with children entering public care.
Maternal use of primary care contraception services was negatively associated with children entering public care
(OR 0.52, 95% CI 0.31-0.87).
Conclusions: Differences in health service use can be identified from routine primary care data in mother child
pairs where children enter public care after controlling for maternal age and socio-economic status. The interaction
between different risk factors needs testing in a cumulative risk model using longitudinal datasets.
|Item Type:||Journal Article|
|Subjects:||H Social Sciences > HQ The family. Marriage. Woman
R Medicine > RJ Pediatrics
|Divisions:||Faculty of Social Sciences > School of Health and Social Studies
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
|Library of Congress Subject Headings (LCSH):||Children -- Institutional care, Child health services, Children -- Health and hygiene|
|Journal or Publication Title:||BMC Health Services Research|
|Official Date:||16 March 2012|
|Page Range:||p. 65|
|Access rights to Published version:||Open Access|
1. Polnay L, Ward H: Promoting the health of looked after children,
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