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Journal ArticleDOI

Parental offending and children's emergency department presentations in New South Wales, Australia.

TL;DR: Children of parents, particularly of fathers, with a history of criminal offending have an increased incidence of ED presentation, including for potentially avoidable physical injury.
Abstract: Objectives Children whose parents have a history of criminal offending may be at risk of higher rates of emergency department (ED) presentation, along with other adverse health outcomes. We used data from a large, population-based record linkage project to examine the association between maternal and paternal criminal offending and the incidence of ED presentations among child offspring. Methods Data for 72 772 children with linked parental records were drawn from the New South Wales Child Development Study. Information on parental criminal offending (spanning 1994-2016) and child ED presentations (spanning 2005-2016; approximately ages 2-12 years) was obtained from linked administrative records. Cox proportional hazards regression analyses were conducted to examine the association between parental offending and the incidence of children's ED presentations for any reason and for physical injury, while accounting for important covariates. Results Child rates of ED presentation, particularly for physical injury, were higher among those with parental history of criminal offending, after adjusting for covariates. The magnitude of the association was higher for paternal criminal offending (ED presentation for any reason: HR=1.44 (95% CI 1.41 to 1.48); physical injury: HR=1.70 (95% CI 1.65 to 1.75)) than maternal criminal offending (any reason: HR=0.99 (95% CI 0.95 to 1.03); physical injury: HR=1.05 (95% CI 1.00 to 1.10)). Conclusion Children of parents, particularly of fathers, with a history of criminal offending have an increased incidence of ED presentation, including for potentially avoidable physical injury. These findings require replication and further research to understand the mechanisms underlying these associations.

Summary (3 min read)

KEY MESSAGE

  • The children of parents with a history of criminal offending are at a greater risk of a range of poor outcomes, including potentially avoidable adverse health events.
  • In a population cohort of 72,772 children and their parents, parental criminal offending was associated with a higher incidence of child emergency department presentation for any reason and for potentially avoidable physical injury, even after accounting for key confounding factors.

METHODS

  • Data were drawn from a population cohort of 91,635 children in the New South Wales Child Development Study (NSW-CDS; http://nsw-cds.com.au/), a longitudinal record linkage project based in the Australian state of NSW that combines data from multiple government agencies (i.e., health, education, justice, child protection services, and vital statistics) for children and their parents.
  • The minimum matching variables used were name, date of birth, residential address, and sex.26-27.
  • 26,28 For this study examining the association between parental criminal offending and children’s incidence of ED presentation, data were limited to the 72,772 children who had linked records available for both their mother and father.

Measures

  • Emergency department presentation 6 The NSW Ministry of Health’s Emergency Department Data Collection (EDDC) includes information on ED presentations from the majority of NSW public hospitals between January 1st 2005 and June 30th 2016.
  • Public hospitals provide 93% of all emergency department services in Australia,1 and, of the 150 ED centers in NSW, the largest 90 contribute data to the EDDC, covering the vast majority of the state population.
  • Children’s ED diagnoses were recorded by hospital staff at the point of care using the ICD-9CM (International Classification of Diseases-Clinical Modification), ICD-10AM (Australian Modification), or SNOMED (Systematized Nomenclature of Medicine) coding scheme.
  • The authors harmonized the ICD-9CM and SNOMED codes with the ICD-10AM.
  • Only the first diagnostic code was available for analysis.

Parental criminal offending

  • Maternal and paternal criminal records were obtained from the NSW Bureau of Crime Statistics and Research Reoffending Database from January 1st 1994 to December 31st 2015; these records contain all finalized criminal legal matters dealt by the NSW CJS for individuals convicted of at least one offence.
  • The children of mothers or fathers with a diagnosed mental disorder were identified if parents had at least one valid Chapter V (F00-F99) ICD-10AM primary or secondary diagnosis recorded in any of these data sets from January 1st 2000, to before the child’s first ED presentation during the observation period.

Statistical Analysis

  • All children with a linked mother and father record (n=72,772) were followed from birth to their first ED presentation for (i) any reason and (ii) physical injury occurring after the 1st of January 2005, or the end of the follow-up period (June 30th 2016), whichever came first.
  • Children without a recorded ED presentation during the study period were right censored (n = 13,318) and comprised the comparison group for all analyses.
  • Kaplan-Meier analyses using log rank chi-square tests were conducted to examine the impact of prior paternal and maternal criminal offending on days to any offspring ED presentation, and days to ED presentation for physical injury specifically.
  • For the Cox regression models, the authors report the Hazard Ratios (HR) and the 95% Confidence Intervals (95% CI) as measures of effect size and precision, respectively.
  • Analyses were conducted in IBM SPSS 24.31.

Ethical Standards

  • This research was conducted with ethical approval from the NSW Population and Health Services Research Ethics Committee (PHSREC AU/1/289807 and PHSREC AU/1/1AFE112), and data custodian approvals granted by the relevant government departments.
  • All procedures contributing to this work comply with the Helsinki Declaration of 1975, as revised in 2008.

Descriptive statistics

  • The majority of children had at least one ED presentation for any reason during the period of observation (81.7%, n = 59,454).
  • The most common reason for children’s first ED presentation during the observation period were: injury, poisoning and other external causes (18.1%); disease of the respiratory system (16.6%), and; abnormal clinical and laboratory findings (10.6%) (see Supplementary Table S1 for ICD-10AM diagnoses at ED presentation).
  • Children with at least one ED presentation for a physical injury comprised just under half the sample (44.2%, n = 32,194).
  • The most common reasons for children’s first ED presentation for physical injury during the study period were: transport accidents1 (20.0%); injuries to the head (18.2%), and; injuries to the wrist and hand (12.7%) (see Supplementary Table S2 for ICD-10AM diagnoses for physical injury).

Survival analyses

  • This translates to an incident rate of around 250 ED presentations per 1,000 person years for children with a father with a history of criminal offending, and 245 ED presentations per 1,000 person years for children with a mother with a history of criminal offending (See Table 2).
  • The median days to ED presentation for physical injury was also significantly fewer amongst children with a history of paternal 1 Transport accidents (ICD-10 AM code V01-V99) correspond to injuries either resulting from (i) collision between a vehicle and another vehicle(s), cyclist, pedestrian, or stationary object, or ; (ii) injuries resulting from a noncollision vehicle accident.
  • The univariate associations in Table 2 indicate that all covariates were significantly associated with higher incidence rates of ED presentation, both for any reason and for physical injury, with larger effect sizes observed for the latter outcome.

DISCUSSION

  • This study demonstrates a higher incidence of ED presentations for children of fathers with a history of criminal offending, even after accounting for potential confounding factors.
  • Second, EDDC records were only available from January 1st 2005 onwards and did not capture children who had an ED presentation before this time; early ED presentations for the older children in their sample might therefore have been missed.

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Content maybe subject to copyright    Report

Parental offending and children's emergency department
presentations in New South Wales, Australia
Author
Whitten, Tyson, Green, Melissa J, Laurens, Kristin R, Tzoumakis, Stacy, Harrs, Felicity, Carr,
Vaughan, Dean, Kimberlie
Published
2019
Journal Title
Journal of Epidemiology & Community Health
Version
Accepted Manuscript (AM)
DOI
https://doi.org/10.1136/jech-2019-212392
Copyright Statement
© The Author(s) 2019. This is the author-manuscript version of this paper. It is posted here
with permission of the copyright owner(s) for your personal use only. No further distribution
permitted. For information about this journal please refer to the publisher’s website or contact
the author(s).
Downloaded from
http://hdl.handle.net/10072/392571
Griffith Research Online
https://research-repository.griffith.edu.au

1
Parental offending and children’s emergency department presentations in New South Wales, Australia
Tyson Whitten
a
, BPsych/BCCJ (Hons), PhD; Melissa J. Green
a,b
, BA, MLitt, PhD; Kristin R. Laurens
a,c
, BSc
(Hons), PhD; Stacy Tzoumakis
d
, BSc, MSc, PhD; Felicity Harris
a
, BA, PGDipPsych, MClinEpi; Vaughan J.
Carr
a,b,e
, MB, BS, MD, FRCPC, FRANZCP; Kimberlie Dean
a,f
, BMedSci (Hons), MBBS, MRCPsych, MSc, PhD,
FRANZCP.
Affiliations:
a
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia;
b
Neuroscience Research Australia, Sydney, NSW, Australia;
c
School of Psychology and Counselling, and
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD,
Australia;
d
School of Social Sciences, University of New South Wales, Sydney, NSW, Australia;
e
Department of Psychiatry, Monash, University, Melbourne, VIC, Australia;
f
Justice Health & Forensic
Mental Health Network, Matraville, NSW, Australia.
Address correspondence to: Assoc. Prof. Kimberlie Dean, School of Psychiatry, University of New South
Wales, Sydney, NSW, Australia [k.dean@unsw.edu.au], +61 438 655 174.

2
KEY MESSAGE
What’s Known on This Subject? The children of parents with a history of criminal offending are at a
greater risk of a range of poor outcomes, including potentially avoidable adverse health events.
What This Study Adds: In a population cohort of 72,772 children and their parents, parental criminal
offending was associated with a higher incidence of child emergency department presentation for any
reason and for potentially avoidable physical injury, even after accounting for key confounding factors.

3
ABSTRACT
Objectives: Children whose parents have a history of criminal offending may be at risk of higher rates of
Emergency Department (ED) presentation, along with other adverse health outcomes. We used data
from a large, population-based record linkage project to examine the association between maternal and
paternal criminal offending and the incidence of ED presentations among child offspring.
Method: Data for 72,772 children with linked parental records were drawn from the New South Wales
Child Development Study. Information on parental criminal offending (spanning 1994-2016) and child ED
presentations (spanning 2005-2016; approximately ages 2-12 years) was obtained from linked
administrative records. Cox Proportional Hazards regression analyses were conducted to examine the
association between parental offending, and the incidence of children’s ED presentations for any
reason, and for physical injury, while accounting for important covariates.
Results: Child rates of ED presentation, particularly for physical injury, were higher among those with
parental history of criminal offending, after adjusting for covariates. The magnitude of the association
was higher for paternal criminal offending (ED presentation for any reason: HR = 1.44 [95% CI = 1.41-
1.48]; physical injury: HR = 1.70 [95% CI = 1.65-1.75]) than maternal criminal offending (any reason: HR =
0.99 [95% CI = 0.95-1.03]; physical injury: HR = 1.05 [95% CI = 1.00-1.10]).
Conclusion: The children of parents, particularly of fathers, with a history of criminal offending have an
increased incidence of ED presentation, including for potentially avoidable physical injury. These findings
require replication and further research to understand the mechanisms underlying these associations.

4
There were 7.8 million Emergency Department (ED) presentations across Australia in 2017.
1
Young children aged 0-4 years, especially boys, are among the most common groups presenting to the
ED, with presentations for unintentional or accidental injuries being particularly frequent in this age
group.
1-2
For some children, an ED presentation represents a potentially avoidable adverse health event
for which the understanding of risk factors could inform preventative efforts.
3
Children from families experiencing significant adversity, including parental mental illness
4-5
and
socioeconomic disadvantage,
3,6
are at a higher risk of adverse health events, including preventable
physical injuries that result in ED presentations.
7-11
Families that experience severe adversity are more
likely to engage in unsafe behaviours, be less aware of child safety precautions, and, owing to barriers in
accessing health services, are more likely to attend emergency departments as their usual source of health
care.
12-16
Parental offending is a known indicator of serious parental and family adversity
17-18
that may also
exacerbate factors that negatively impact offspring health.
19-20
Although relatively unexplored, parental contact with the Criminal Justice System (CJS) may be a
marker for children at risk of adverse health events and ED presentations. To date, only one study has
explored the association between parental criminal offending and offspring ED presentations in childhood
and adolescence.
21
This study found that state-recorded indicators of social adversity, including parental
mental illness, poverty, and parental contact with the CJS, were independently associated with an
increased risk of ED presentations that did not result in admission to hospital among children aged 17
years or less.
In the current study, we aimed to establish the incidence of ED presentation in childhood for
offspring of parents with a history of contact with the CJS, as well as the relative incidence of ED
presentation for physical injury in particular, in a population cohort of children and their parents from
New South Wales (NSW), Australia. We also considered the role of the sex of the parent and of the child,
as well as accounting for a range of potential explanatory factors associated with child health, including

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Frequently Asked Questions (2)
Q1. What have the authors contributed in "Parental offending and children's emergency department presentations in new south wales, australia author" ?

In this paper, the potential influence of severity and frequency of parental offending on child ED presentation, and the role of timing of exposure in relation to offspring development, was explored. 

Future research should explore the mechanisms underlying the association between parental, particularly paternal, criminal offending and child ED presentation, in the context of other related risk factors. The potential influence of severity and frequency of parental offending on child ED presentation, and the role of timing of exposure in relation to offspring development, deserves particular attention.