Obesity and health outcomes in an ethnically diverse child population: methodological approaches using electronic health records linked at child and household level

Abstract

Childhood obesity is a growing and important problem, with one quarter of children leaving primary school in England with obesity. While social and economic factors are driving this epidemic, little is known about the household context or child health outcomes of obesity in diverse childhood populations at highest risk. I aimed to assess the health outcomes of childhood obesity and to examine patterns of obesity in children sharing the same household. I used primary and secondary care electronic health records (EHRs) linked to National Child Measurement Programme records in four inner London boroughs. Children sharing a household with an older child with excess weight are more likely to be living with obesity (adjusted odds ratio; 95% confidence interval [CI]: 4.59; 4.10,5.14) as are those living in single child households. I carried out a systematic review, finding fair/good-quality evidence for an association of childhood obesity with hip disorders, back pain, fractures and musculoskeletal complaints. I conducted multivariable and time-to-event analysis to assess the likelihood of adverse musculoskeletal and caries-related dental outcomes. Overall, 3.0% and 8.8% of 4-5- and 10-11-year-olds, respectively, had at least one EHR record of a musculoskeletal symptom/diagnosis, with girls more likely to be affected (adjusted hazard ratio; 95% CI: 1.64; 1.33,2.02; 1.22; 1.08,1.37 for 4-5- and 10-11-year-olds, respectively). The prevalence of dental extraction under general anaesthesia was low (1.1%, 0.5% for 4-5- and 10-11-year-olds, respectively). 4-5-year-old boys and 10-11-year-old girls with excess weight had reduced risk of dental extraction (0.74; 0.56,0.97 and 0.60; 0.40,0.88, respectively), possibly reflecting differential access to preventative and restorative dental care. These findings contribute to our understanding of the household patterns and childhood outcomes of obesity and highlight the value of novel linkage of EHRs. Further research is needed to support children and families living in households with obesity to identify effective evidence-based interventions.