Abstract Background Chronic Obstructive Pulmonary Disease (COPD) significantly impacts patients' quality of life and healthcare systems, especially among socio-economically deprived populations. Hospitalisations due to COPD exacerbations are critical events, often indicating declining health and higher mortality risk. This study examines the incidence and outcomes of COPD hospitalisations in National Health Service (NHS) Greater Glasgow and Clyde from 2015 to 2022, with a focus on socio-economic inequalities and the effects of the COVID-19 pandemic on hospitalisation trends. Methods We conducted a retrospective cohort study using routinely collected hospital episode data, linked to mortality records, for a population of 1.2 million. Incident COPD hospitalisations were identified via International Classification of Diseases version 10 (ICD-10) codes, with no prior hospital admission in the preceding three years. Recurrent hospitalisations were those occurring within 3 years of the discharge of an incident event. We employed negative binomial regression to analyse hospital admission rates and Cox regression for time to recurrent hospitalisation and mortality outcomes, adjusting for demographic and comorbidity factors and testing for interactions with socio-economic status. Before getting the study sample, data linkage was done by the oGRE analyst team. Results From 2015–2022, 8,852 incident COPD hospitalisations were recorded. The mean patient age was 70 years, and 61% were female. Incident hospitalisation rates declined by 13–48% from 2017 onwards. Mortality following incident hospital admission increased post-2020 (HR for 2022 vs. 2015 = 1.42, 95% CI 1.19–1.71). Recurrent hospitalisation rates declined significantly over the study period. Socio-economic inequalities were prominent, with the most deprived individuals experiencing higher hospitalisation and mortality rates. Conclusion Our study highlights a reduction in COPD hospitalisations and recurrent admissions in recent years, potentially due to enhanced disease management strategies and pandemic-related healthcare changes. However, increased mortality post-hospitalisation and persistent socio-economic inequalities underscore the need for targeted interventions. Addressing these inequities through innovative care models and community-based support remains crucial to improving outcomes for patients with COPD.

Asthma exacerbations during pregnancy can adversely affect maternal and foetal health. However, prenatal exposure to asthma medication may itself impact child outcomes. This study aims to determine whether prenatal exposure to asthma medication was associated with a range of neurodevelopmental outcomes. A birth cohort was constructed using linked health and education records of children liveborn in Wales from 2009 to 2016, with up to 12 years follow-up. Generalized estimating equations with a binomial distribution and logit link function were employed to evaluate special educational need (SEN) and its causes, including autism spectrum disorder (ASD), communication problems, behavioural, emotional, and social difficulties, learning difficulties, physical and medical difficulties, and sensory impairment. Cox proportional hazard models were used to investigate attention deficit hyperactivity disorder (ADHD). Of the 179,024 offspring, 11,991 (6.7

Objectives To determine whether the onset of physical health problems/sensory impairments is associated with incident challenging behaviours.Design A retrospective, population-based cohort study using longitudinal data from primary care records. HRs were estimated using Cox proportional hazards models accounting for recurrent events and time-varying exposures.Setting UK primary care data sourced from the Clinical Practice Research Datalink (CPRD) Aurum and Gold databases, covering over 850 000 person-years between 2009 and 2019.Participants 166 989 individuals with recorded intellectual disabilities were included in the cohort.Primary outcome measures Incident identification of challenging behaviours before or after a recorded incident of physical health problems/sensory impairment. Physical health problems/sensory impairments assessed included constipation, epilepsy, pain, visual impairment, hearing impairment, bowel incontinence, urinary incontinence and sleep problems.Results 21.21% (n=35 415) of the cohort had challenging behaviour recorded at least once in primary care records over the 11-year study period, equating to an incidence rate of 0.10 per person-year. 40.9% of episodes of challenging behaviour were associated with an incident physical health problem/sensory impairment. All eight physical health problems/sensory impairments were significantly associated with higher HRs for challenging behaviours after full adjustment for demographic and mental health covariates. These associations held across multiple sensitivity analyses. The strongest associations were found for bowel incontinence (HR=2.24; 95% CI 2.01 to 2.50), urinary incontinence (HR=1.93; 95% CI 1.77 to 2.11), constipation (HR=1.89; 95% CI 1.74 to 2.05) and sleep problems (HR=1.74; 95% CI 1.58 to 1.90).Conclusions This is the first longitudinal study to establish a temporal association between the onset of physical health problems/sensory impairments and challenging behaviours in people with intellectual disabilities. These findings highlight the need for proactive identification and management of physical health problems/sensory impairments as part of assessment processes to prevent or reduce the impact of challenging behaviours.

BackgroundSince asthma exacerbations during pregnancy risk maternal and fetal health, continued medication is important. However, some studies have reported adverse neurodevelopmental outcomes following prenatal exposure to asthma medication. Therefore, this systematic review aimed to collate the existing evidence on the associations between prenatal exposure to asthma medication and neurodevelopmental and educational outcomes.Methods and findingsA systematic review was conducted in accordance with PRISMA guidelines and the PECO framework. PubMed, Medline and Embase databases were searched for studies investigating prenatal exposure to one or more asthma medication and neurodevelopmental or educational outcomes published, in English, between January 2003 and September 2024, and updated in November 2025. Studies of asthma medication used for other indications were excluded. Study quality was assessed using the Newcastle-Ottawa scale. Random-effects meta-analyses were conducted where appropriate and heterogeneity was evaluated using Cochran's Q and I2 tests. Of 16,824 studies identified by the initial search, seven were eligible for inclusion. All investigated beta-2-adrenergic agonists (B2AA), with one including B2AA as mono- and polytherapy-and one study also investigated inhaled corticosteroids (ICS) exposure. Two reported associations with autism spectrum disorder (ASD) and one with attention-deficit hyperactivity disorder (ADHD). An updated search identified one additional eligible study, which examined both ADHD and ASD, as well as other neurodevelopmental disorders. The included eight studies (n = 3,867,170 participants) comprised cohort (n = 5) and case-control (n = 3) designs and reported inconsistent results. Meta-analysis of three studies (n = 1,380,871) indicated significant associations with ASD for exposure to B2AA both preconception (aOR 1.34, 95% CI [1.19,1.52]) and during pregnancy (aOR 1.29, 95% CI [1.16,1.42]). Heterogeneity was low, with no evidence of significant publication bias. Limitations of the included studies comprised residual confounding and exposure misclassification. Additionally, studies included in the meta-analysis were few in number and did not adequately distinguish between medication effects and underlying maternal asthma.ConclusionMeta-analysis suggested an association between prenatal exposure to B2AA and ASD. An association with ADHD, reported in a single study, requires corroboration. To date, based on our search strategy, no association has been reported with communication skills, motor skills, problem-solving and personal-social skills, or cerebral palsy.

The long-term consequences of attention deficit hyperactivity disorder (ADHD) in females remain underrecognized both in research and clinical practice. Multimorbidity (two or more long-term conditions) is increasingly viewed as a key outcome yet its prevalence, complexity and sociodemographic determinants are understudied in this group. Here, in this longitudinal cohort study, we examined the combined influence of childhood socioeconomic deprivation and ADHD diagnosis on multimorbidity risk in women in early adulthood (that is, aged 18-32 years) and used latent class analysis to explore clustering patterns. Three findings emerged: females with childhood ADHD had a significantly higher risk of adult multimorbidity; childhood ADHD and socioeconomic deprivation increased this risk both in isolation and synergistically, with 39% of the multimorbidity burden attributable to their interaction; and distinct multimorbidity clusters emerged, with the most adverse marked by psychiatric complexity. These results highlight girls with ADHD from disadvantaged backgrounds as a high-risk group requiring earlier, integrated care.

Hypertensive disorders of pregnancy (HDP) require medication but neurodevelopmental consequences of prenatal exposure to antihypertensive medication are unclear. We linked five national health and education databases to conduct a cohort study of 179,024 children born in Wales between 2009 and 2016 and investigated associations between maternal HDP and antihypertensive medication and educational and neurodevelopmental outcomes, adjusting for sociodemographic, maternal, and pregnancy confounders. Among, 3,440 (1.9%) mothers who had HDP or who received antihypertensive medication during pregnancy; 629 (0.3%) had treated HDP, 950 (0.5%) untreated HDP, and 1861 (1.0%) received antihypertensive medication without documented HDP. Autistic spectrum disorder (ASD) was associated with prenatal exposure to antihypertensive medication (adjusted OR 1.67, 95% CI 1.26–2.21, p < 0.001); specifically, beta-blockers (adjusted OR 1.96, 95% CI 1.39–2.78). Untreated maternal HDP was not associated with ASD. Learning and communication difficulties were associated with beta-blockers and methyldopa, as well as untreated HDP, suggesting confounding by indication. Neither HDP nor anti-hypertensive medication were associated with attention deficit hyperactivity disorder (ADHD). In this large, unselected cohort, prenatal beta-blocker exposure was associated with ASD independent of maternal hypertension. Further research should be undertaken regarding the biological mechanisms and choice of antihypertensive therapy in pregnancy should be carefully selected to balance maternal benefits and potential neurodevelopmental risks in offspring.

INTRODUCTION:There is now emerging evidence to suggest a longitudinal association between specific neurodevelopmental conditions (NDCs) in childhood or adolescence (ie, autism, attention deficit hyperactivity disorder (ADHD) and tic disorders) and certain physical long-term conditions (LTCs) in adulthood. However, to date, this literature has never been comprehensively collated and appraised. As a result, our understanding of all the future health risks that young people with NDCs may collectively be at risk of is limited, and the factors which drive these adult health outcomes also remain obscure. METHODS AND ANALYSIS:A search strategy has been developed in collaboration with two medical librarians and will be used to conduct systematic searches of MEDLINE, EMBASE, APA PsycINFO, CINAHL and Web of Science. Prospective longitudinal studies exploring the association between three common NDCs in childhood or adolescence (ie, ADHD, autism and tic disorders <18 years of age) and any physical LTC in adulthood (ie, >18 years of age) will be selected through title and abstract review, followed by a full-text review. Data extracted will include the definition of exposure and outcome, mediators or moderators investigated, confounders adjusted for, and crude and adjusted effect estimates. Risk of bias assessment will be conducted. Results will be synthesised narratively and, if the data allow, a meta-analysis will also be conducted. ETHICS AND DISSEMINATION:Ethics approval is not applicable for this study since no original data will be collected. The results of the review will be widely disseminated locally, nationally and internationally through peer-reviewed publications, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and conference presentations. PROSPERO REGISTRATION NUMBER:CRD42024516684.

OBJECTIVE:To systematically review and meta-analyse evidence of the associations between prenatal exposure to antiseizure medications (ASMs) and educational outcomes in childhood, including educational difficulties, learning difficulties and academic performance. METHODS:We conducted a systematic review following the PICOS framework and PRISMA guidelines. MEDLINE (Ovid), CINAHL, PubMED, ERIC, and PsycINFO databases, along with Google Scholar, were searched from inception to 28 June 2024. Study quality was assessed using the Newcastle-Ottawa Scale and ROBINS-E. Relevant outcomes included record of special education needs, school-related behavioural problems, learning difficulties, and examination scores in core academic subjects. Pooled estimates were derived where appropriate and bias and heterogeneity assessed using funnel plots, Egger's tests, and I2 tests. RESULTS:Seventeen studies (12 cohort, 5 case-control) were included, encompassing 854,142 participants. Pooled estimates indicated that prenatal exposure to ASMs was associated with increased educational difficulties (RR 1.3, 95 % CI 1.01-1.69, p = 0.04), with sodium valproate showing the strongest association (RR 2.38, 95 % CI 1.25-4.53, p = 0.01). Carbamazepine and other first-generation ASMs showed no significant associations. Narrative findings suggested associations between newer-generation ASMs and educational difficulties, but limited data precluded quantitative synthesis. Studies assessing academic outcomes suggested lower academic performance among children exposed to sodium valproate or ASM polytherapy but could not undergo meta-analysis due to methodological heterogeneity. CONCLUSIONS:Prenatal exposure to first-generation ASMs, especially sodium valproate, was associated with increased educational support needs. Newer-generation ASMs appear to have a more favourable risk profile, though evidence remains limited, underscoring the need for further high-quality research to inform clinical practice.

BACKGROUND:NICE guidelines recommend GPs use the kidney failure risk equation (KFRE) to identify people with chronic kidney disease (CKD) at higher risk of kidney failure. Albuminuria results are required to calculate KFRE. AIM:Analyse the implementation of KFRE into clinical practice and investigate if albuminuria testing varied amongst patients with CKD, particularly for underserved groups. DESIGN AND SETTING:Retrospective cohort study of 23,063 adults in Glasgow from 2013 to 2022. METHOD:We evaluated albuminuria testing rates and the predictive performance of KFRE in estimating 5-year kidney failure risk amongst people with CKD. Logistic regression models quantified associations between demographic/clinical variables and albuminuria testing. Amongst people who developed kidney failure, we retrospectively assessed the impact of KFRE on the timing of meeting criteria for referral to renal services. RESULTS:Albuminuria testing was performed in 44.5% of 10,874 adults with CKD. Females (adjusted odds ratio (aOR) 0.86: 95% CI 0.79-0.93) and those with hypertension (aOR 0.69: 95% CI 0.63-0.77) were less likely to have albuminuria testing. Those aged 40-50 years (aOR 1.83: 95% CI 1.15-2.91), with diabetes (aOR 2.35: 95% CI 2.14-2.58) and living in the least socioeconomically deprived areas (aOR 1.11: 95% CI 1.00-1.23) were more likely to have albuminuria testing. Of 1,352 individuals with incident kidney failure, incorporating KFRE into referral guidelines helped identify high-risk patients early. CONCLUSION:KFRE could be calculated for less than half of people due to lack of albuminuria testing. Focus should be given to improving albuminuria testing and inequities identified to allow wider implementation of KFRE.

Background:Where possible, medication is avoided during pregnancy as it can cross the placenta and potentially cause congenital malformations, impair growth and have longer-term functional or cognitive sequelae. However, medication is sometimes required for pre-existing or new-onset conditions such as hypertension disorders during pregnancy; the longer-term outcomes of which remain unclear. This systematic review aimed to synthesise the evidence on prenatal exposure to antihypertensive medication and longer-term neurodevelopmental and educational outcomes up to 18 years of age. Methods:We searched Medline Ovid, PubMed, Excerpta Medica Database, and Web of Science from inception (1946) until 04 July 2025, selecting observational and experimental studies. The inclusion criteria for eligible studies were pregnant women with or without any hypertension disorder of pregnancy, mothers taking antihypertensive medication during pregnancy comparing them with those not exposed, children ≥1 years of age, and children with one of the predefined neurodevelopmental and educational outcomes. The studies' quality was evaluated using the National Heart, Lung, and Blood Institute assessment tool. Results:Of 11 studies included (five cohorts, two case-control and four randomised controlled trials), 10 were of high quality, while only one was of low quality. Six of the 11 studies demonstrated significant associations between prenatal exposure to antihypertensive medication and at least one adverse neurodevelopmental outcome in children. One study reported an increased risk of autism spectrum disorder following calcium channel blockers and beta-blockers exposure, one reported the risk of fine motor problems following calcium channel blockers exposure, one reported increased risk of low intelligence quotient following exposure to methyldopa, one reported an increased risk of attention deficit hyperactivity disorder following exposure to beta-blockers, one reported speech problems following exposure to more than one antihypertensive medications, and one reported an increased risk of sleeping disturbance following exposure to clonidine. Methodological heterogeneity, small sample sizes, and inadequate confounder adjustment were common limitations. Conclusions:The association between prenatal antihypertensive exposure and neurodevelopmental outcomes warrants further research, focusing on the impacts of specific medication classes on a range of outcomes in the same study population.

Current evidence suggests the possibility that autistic people may be at more risk of COVID-19 infection, hospitalisation, and mortality than the general population. Previous studies, however, are either limited in scale or do not investigate potential risk factors. Research into risk factors focused on general population samples. The current study aims to investigate these risk factors in the autistic population. Using data-linkage and a whole-country population, this study modelled associations between autism and COVID-19 hospitalisation and mortality risk in adults, investigating a multitude of clinical and demographic risk factors. Autistic adults had higher rates of hospitalisation, Standardised Incident Ratio 1.6 in 2020 and 1.3 in 2021, and mortality, Standardised Mortality Ratio 1.52 in 2020 and 1.34 in 2021, due to COVID-19 than the general population. In both populations, age, complex multimorbidity and vaccination status were the most significant predictors of COVID-19 hospitalisation and mortality. Effects of psychotropic medication varied by class. Although similar factors exhibited a positive association with heightened risk of severe COVID-19 in both the autistic and general populations, with comparable effect sizes, mortality rates were elevated among the autistic population compared to the general population. Specifically, complex multimorbidity and classification of prescribed medications may emerge as particularly significant predictors of severe COVID-19 among individuals within the autistic population due to higher prevalence of complex multimorbidity in the autistic population and variability in the association between medication classes and severe COVID-19 between both populations, though further research is needed.

Background Studies on avoidable mortality in adults with intellectual disabilities are limited, as are studies on causes of death.Objectives We aimed to quantify mortality rates, and causes, and identify factors (i.e., age, sex, Scottish Index of Multiple Deprivation (SIMD)) related to avoidable mortality in adults with intellectual disabilities.Design A record linkage national cohort study.Setting A cohort of adults with intellectual disabilities with or without co-occurring autism, aged 25+ years and a randomly selected comparison group aged 25+ years without intellectual disabilities or autism identified from Scotland’s Census, 2011. Census records were linked to the National Records of Scotland Statutory Register of Deaths database to ascertain all deaths from 2011 to 2019.Participants We analysed data on 14 477 adults with intellectual disabilities aged 25+ years and a randomly selected comparison group of 506 207 adults aged 25+ without intellectual disabilities identified from Scotland’s Census 2011.Primary and secondary outcome measures We ran χ2 tests and t-tests to investigate individual characteristics and differences in age at death for adults with intellectual disabilities compared with peers in the general population. Cox proportional hazard models were fitted to calculate risk of mortality (all-cause, avoidable, treatable, preventable) unadjusted and adjusted for age, sex and SIMD. We then calculated mortality rates, using crude and indirect standardisation methods.Results During the 8.5-year follow-up, 23.7% (crude death rate of 3033.3 per 100 000) of adults with intellectual disabilities died compared with 13.8% of controls. The median age at death among adults aged 25+ with intellectual disabilities was 65.0 years compared with 80.0 years for adults without intellectual disabilities. For all-cause mortality, the age-standardised mortality ratio (SMR) in the population with intellectual disabilities was 3.1 (95% CI 3.0 to 3.2). The SMRs were higher for the youngest age groups, women and in the most affluent areas. This was also the case for SMRs for avoidable, treatable and preventable deaths. For the population of adults with intellectual disabilities, 31.7% of recorded deaths were considered avoidable, 21.1% were treatable and 19.9% were preventable. In the controls, 18.2% of deaths were considered avoidable, 8.8% treatable and 14.7% preventable. Down syndrome and dementia were the two most commonly recorded underlying causes of death for people with intellectual disabilities while malignant neoplasm of bronchus and lung and acute myocardial infarction were most commonly recorded in the general population.Conclusions Risk of all-cause, avoidable, treatable and preventable mortality was higher for adults with intellectual disabilities than their peers. The highest SMRs were observed for youngest adults, women and individuals living in the most affluent areas.

Where possible, medication is avoided during pregnancy as it can cross the placenta and potentially cause congenital malformations, impair growth and have longer-term functional or cognitive sequelae. However, medication is sometimes required for pre-existing or new-onset conditions such as hypertension disorders during pregnancy; the longer-term outcomes of which remain unclear. This systematic review aimed to synthesise the evidence on prenatal exposure to antihypertensive medication and longer-term neurodevelopmental and educational outcomes up to 18 years of age. We searched Medline Ovid, PubMed, Excerpta Medica Database, and Web of Science from inception (1946) until 04 July 2025, selecting observational and experimental studies. The inclusion criteria for eligible studies were pregnant women with or without any hypertension disorder of pregnancy, mothers taking antihypertensive medication during pregnancy comparing them with those not exposed, children ≥1 years of age, and children with one of the predefined neurodevelopmental and educational outcomes. The studies' quality was evaluated using the National Heart, Lung, and Blood Institute assessment tool. Of 11 studies included (five cohorts, two case-control and four randomised controlled trials), 10 were of high quality, while only one was of low quality. Six of the 11 studies demonstrated significant associations between prenatal exposure to antihypertensive medication and at least one adverse neurodevelopmental outcome in children. One study reported an increased risk of autism spectrum disorder following calcium channel blockers and beta-blockers exposure, one reported the risk of fine motor problems following calcium channel blockers exposure, one reported increased risk of low intelligence quotient following exposure to methyldopa, one reported an increased risk of attention deficit hyperactivity disorder following exposure to beta-blockers, one reported speech problems following exposure to more than one antihypertensive medications, and one reported an increased risk of sleeping disturbance following exposure to clonidine. Methodological heterogeneity, small sample sizes, and inadequate confounder adjustment were common limitations. The association between prenatal antihypertensive exposure and neurodevelopmental outcomes warrants further research, focusing on the impacts of specific medication classes on a range of outcomes in the same study population.

The long-term consequences of ADHD in females remain under-recognised both in research and clinical practice. Multimorbidity (≥2 long-term conditions) is increasingly viewed as a key outcome, yet its prevalence, complexity, and sociodemographic determinants are understudied in this group. In this longitudinal cohort study, we examined the combined influence of childhood socioeconomic deprivation and ADHD on multimorbidity risk in females and used latent class analysis to explore clustering patterns. Three findings emerged: females with childhood ADHD had significantly higher risk of adult multimorbidity; childhood ADHD and socioeconomic deprivation both increased this risk in isolation and synergistically, with 39% of the multimorbidity burden attributable to their interaction; and distinct multimorbidity clusters emerged, with the most adverse marked by psychiatric complexity. These results highlight girls with ADHD from disadvantaged backgrounds as a high-risk group requiring earlier, integrated care.

Objective Historical reductions in cardiovascular disease (CVD) due to lifestyle and treatment improvements are now threatened by factors such as increasing obesity and diabetes, but the relative importance of different risk factors varies by CVD condition. This study describes secular trends in CVD events by individual condition from 2012 to 2022.Methods In a cohort of 452 094 Greater Glasgow and Clyde residents aged ≥51 years, linked hospital admission and death data were used to ascertain total annual events for ischaemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), stroke, abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD). Poisson regressions with robust standard errors were used to examine the relative change in event rates over time, overall and by subgroup.Results Overall, the event rate ratios (RRs) for IHD, MI, AF and AAA all fell between 2012 and 2021 after adjustment for age, sex and deprivation. However, on subgroup analysis, the RRs increased between 2012 and 2022 among those aged 51–64 years for HF (RR 1.5), stroke (RR 1.4) and PAD (RR 1.8).Conclusions Overall declines in most types of CVD mask an increasing burden of events relating to HF, stroke and PAD among individuals aged 51–64 years.

Objectives To investigate hospitalisation rates for the ambulatory care-sensitive conditions of epilepsy, asthma and insulin-dependent diabetes in school-aged children and young people with intellectual disabilities in comparison with their peers.Design Record-linkage cohort study. Scotland’s Pupil Census, 2008–2013, was used to identify pupils with and without intellectual disabilities and was linked with the Prescribing Information Service to identify pupils with epilepsy, asthma and insulin-dependent diabetes, and the Scottish Morbidity Records-01 to identify hospital admissions.Setting The general child population of Scotland.Participants School pupils aged 4–19 years; 18 278 with intellectual disabilities and 777 912 without intellectual disabilities.Outcomes Overall, emergency and non-emergency hospitalisations for epilepsy, asthma and/or diabetes; and length of stay.Results Epilepsy and asthma were more prevalent in pupils with intellectual disabilities (8.8% and 8.9%, respectively, compared with 0.8% and 6.9% among pupils without intellectual disabilities, p<0.001), whereas insulin-dependent diabetes was not (0.5% prevalence). After adjusting for prevalence, pupils with intellectual disabilities and epilepsy had more epilepsy-related admissions than their peers (adjusted Hazard Ratio (aHR) 2.24, 95% CI 1.97, 2.55). For emergency admissions, these stays were longer compared with controls (adjusted incidence rate ratio (aIRR) 2.77, 95% CI 2.13, 3.59). Pupils with intellectual disabilities and asthma had similar admission rates due to asthma as control pupils with asthma (aHR 0.81, 95% CI 0.62, 1.06), but emergency admissions were longer (aIRR 2.72, 95% CI 1.49, 4.96). Pupils with intellectual disabilities and insulin-dependent diabetes had similar admission rates to controls (aHR 0.94, 95% CI 0.63, 1.41) but with shorter admissions (aIRR 0.71, 95% CI 0.51, 0.99).Conclusions Our findings suggest pupils with intellectual disabilities may receive poorer community healthcare than their peers for the common conditions of epilepsy and asthma. Hospital admissions are disruptive for both the child and their family. Epilepsy and asthma are associated with avoidable deaths; hence, a better understanding of these hospitalisations is important.

Objectives To investigate the associations between treated and untreated asthma during pregnancy and neurodevelopmental outcomes in the offspring, including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and learning difficulties, and to determine whether these associations are specific to one or more class of asthma medication. Methods A population-based retrospective birth cohort was constructed using linked health and education records of children liveborn in Wales between 2009 and 2016, with up to 13 years follow-up, to mothers registered with a Secure Anonymised Information Linkage (SAIL)-contributing general practice for at least two years before delivery. Generalized estimating equations with a binomial distribution and logit link function were employed to evaluate associations between treated and untreated maternal asthma and special education needs (SEN) in the offspring. Survival analyses were used to investigate associations with ADHD. Results Among 179,024 children (49.4% female, mean age 5.68 years (SD 1.11)), 11,991 (6.7%) had mothers with treated asthma, 4,927 (2.8%) mothers with untreated asthma, and 5,265 (2.9%) mothers who took asthma medication without a recorded asthma diagnosis. SEN was recorded in 50,955 (28.5%) children. Prenatal exposure to short-acting beta agonists (SABA) was associated with increased risk of SEN (aOR 1.23, 95% CI 1.18-1.28) and ADHD (aHR 1.39, 95% CI 1.23-1.56), with similar risks for inhaled corticosteroids (ICS). Untreated maternal asthma was also associated with SEN (aOR 1.14, 95% CI 1.07-1.23) and ADHD (aHR 1.70, 95% CI 1.42-2.05), suggesting that asthma itself contributes to risk. In contrast, ASD was associated with SABA with or without other asthma medication (aOR 1.20, 95% CI 1.05-1.37) and not with untreated maternal asthma. Conclusion Prenatal exposure to SABA was associated with a higher risk of ASD. Asthma treatment is required during pregnancy but treatment choices need to carefully balance potential maternal and offspring risks.

Objectives To understand how we can better initiate and run international collaborations to deliver tangible and impactful findings using population-wide linked health and education data. Approach Representatives from 14 countries (America, Australia, Canada, Chile, Denmark, England, Finland, Germany, New Zealand, Northern Ireland, Norway, Scotland, Sweden, Wales) summarised the potential for research using their linked administrative health and education data. The scope for collaboration and comparison of research findings across countries was explored. Results Several substantive research themes emerged, including the quantifying of differences in educational outcomes by health conditions and other early life factors, using health data to better identify and explore the special educational needs identified in educational records, using linked health and education data to identify and explore reasons for absenteeism from school. Conclusions The workshop showcased the primary themes for research and the data assets available within each country for comparative work. Further work is required to more robustly document the available detail within these datasets, collaboratively develop protocol templates for comparative studies, and develop pilot, proof of concept, studies.

Importance: Cancer diagnosis following an emergency department presentation (unscheduled care) is associated with lower cancer survival and poor patient-reported outcomes. Previous research has suggested considerable heterogeneity in cancer diagnosis patterns across different health jurisdictions. Objective: We studied cancer diagnosis patterns (diagnosis in scheduled versus unscheduled care) in one of the largest administrative regions in the United Kingdom and examined variations across different demographic groups. Methods: The study sample consisted of all new cancer diagnoses in National Health Service (NHS) Greater Glasgow and Clyde (GGC), which serves 1.2 million people, in 2018, 2019 (before pandemic), 2021, and 2022 (after pandemic). The outcome of interest was cancer diagnosis following an emergency department presentation. Logistic regression was used to assess cross-sectional associations between demographic factors, cancer types, and the outcome. Results: Over a four-year period, N = 40,223 individual new cancer diagnoses were recorded; N = 12,940 cases (32.2%) were diagnosed after an emergency presentation, with a trend toward higher rates in 2021–2022 compared to 2018–2019. People living in areas of high socioeconomic deprivation and those with multiple long-term conditions had higher odds of being diagnosed with cancer after an emergency attendance (unscheduled care). Age had a “J-shaped” relationship with the risk of cancer diagnosis following emergency presentation, with the lowest risk observed between 45 and 60 years. Finally, central nervous system, hematological, and pancreatic cancers were consistently more likely to get diagnosed in unscheduled care than other cancer types. Conclusion: Further research on patient- and healthcare organization-related factors that may contribute to cancer diagnoses in unscheduled care is needed so that potentially modifiable factors can be improved.

Objective To provide contemporary data on cancer mortality rates within the context of incidence in the population with intellectual disabilities.Methods Scotland’s 2011 Census was used to identify adults with intellectual disabilities and controls with records linked to the Scottish Cancer Registry and death certificate data (March 2011–December 2019). The control cohort without intellectual disabilities and/or autism were used for indirect standardisation and calculation of crude incident rates/crude mortality rates, and age–sex standardised incident rate ratios/standardised mortality ratios (SIR/SMR), with 95% CIs.Results Adults with intellectual disabilities were most likely diagnosed cancers of digestive, specifically colorectal (14.2%), lung (9.3%), breast (female 22.9%), body of the uterus (female 9.3%) and male genital organs (male 17.6%). Higher incident cancers included metastatic cancer of unknown primary origin (female SIR=1.70, male SIR=2.08), body of uterus (female SIR=1.63), ovarian (female SIR=1.59), kidney (female SIR=1.85) and testicular (male SIR=2.49). SMRs were higher, regardless of a higher, similar or lower incidence (female SMR=1.34, male SMR=1.07). Excess mortality risk was found for colorectal (total SMR=1.54, male SMR=1.59), kidney (total SMR=2.01 u, female SMR=2.85 u), female genital organs (SMR=2.34 (ovarian SMR=2.86 u, body of uterus SMR=2.11), breast (female SMR=1.58) and metastatic cancer of unknown primary origin (female SMR=2.50 u, male SMR=2.84).Conclusions Adults with intellectual disabilities were more likely to die of cancer than the general population. Reasons for this may include later presentation/diagnosis (so poorer outcomes), poorer treatment/compliance or both. Accessible public health approaches are important for people with intellectual disabilities, and healthcare professionals need to be aware of the different cancer experiences faced by this population.