Article Text
PDF
Abstract
Objective To assess whether there is a higher incidence of musculoskeletal consultations in general practice among children with obesity.
Design Longitudinal
Setting 285 north-east London general practitioners (GPs).
Participants 63 418 (50.9% boys) Reception and 55 364 (50.8% boys) Year 6 National Child Measurement Programme (NCMP) participants, linked to GP electronic health records (EHRs).
Main outcome measure A GP consultation with a recorded musculoskeletal symptom or diagnosis.
Methods We calculated proportions with a musculoskeletal consultation by ethnic-adjusted weight status (underweight <2nd; overweight ≥91st; obese ≥98th centile), sex, ethnicity, and area-level deprivation. We estimated mutually-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) using Cox’s proportional regression models stratified by school year and sex.
Results We identified 1868 (3.0%) Reception and 4477 (8.1%) Year 6 NCMP participants with at least one musculoskeletal consultation. In adjusted analyses, Reception year girls with a body mass index (BMI) classified as overweight (HR 1.24, 95% CI 1.02 to 1.52) or obese (HR 1.67, 95% CI 1.35 to 2.06) were more likely to have at least one musculoskeletal consultation. Year 6 girls with obesity were more likely (HR 1.20, 95% CI 1.07 to 1.35), and boys with a BMI in the underweight range were less likely (HR 0.39, 95% CI 0.21 to 0.73), to have a musculoskeletal consultation.
Conclusions Girls living with obesity at the start or end of primary school are more likely to attend their GP for a musculoskeletal consultation. Routine linkage of NCMP data to EHRs provides useful insights into childhood health conditions related to excess weight in early childhood. Recognition of obesity as a contributing factor for musculoskeletal symptoms may inform clinical management, particularly in girls.
- Obesity
- Child Health
- Primary Health Care
Data availability statement
Data may be obtained from a third party and are not publicly available. NCMP data were accessed under data processing agreements with each of the local authorities as data controllers in line with Public Health England guidance. These agreements preclude onward sharing of data. Access to general practice data is enabled by data sharing agreements between the Discovery Data Service and general practice data controllers. The Discovery Programme Board has approved data access by the REAL Child Health programme team for research on the condition that it is not onwardly shared.
Statistics from Altmetric.com
Data availability statement
Data may be obtained from a third party and are not publicly available. NCMP data were accessed under data processing agreements with each of the local authorities as data controllers in line with Public Health England guidance. These agreements preclude onward sharing of data. Access to general practice data is enabled by data sharing agreements between the Discovery Data Service and general practice data controllers. The Discovery Programme Board has approved data access by the REAL Child Health programme team for research on the condition that it is not onwardly shared.
Footnotes
Contributors CD and JR obtained funding for the study. NF, GH and CD conceptualised and designed the analyses. KH extracted the data. NF carried out the background literature search, conducted the analyses, generated tables and figures and drafted the initial manuscript. All authors contributed to the interpretation of analyses and reviewed and revised the manuscript. All authors were involved in writing the paper and had final approval of the submitted and published manuscript. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. CD is the guarantor and accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This research was funded by a grant from Barts Charity ref: MGU0419. This work was supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests None declared.
Patient and public involvement statement This research was done without patient or public involvement. Neither were invited to comment on the study design and were not consulted to develop relevant outcomes or interpret results.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.