Body mass index and use of healthcare services in children: analyses from the Born in Bradford cohort study

The prevalence of childhood obesity in the UK is among the highest in Europe, but it is not well-known how childhood obesity affects the health of children from different ethnic backgrounds and what burden it carries for healthcare systems in childhood. South Asian people in the UK are shown to have a higher risk of obesity-associated diseases and their patterns of healthcare utilisation vary from that of White British people mostly due to different health-seeking behaviours and barriers to healthcare access. In this thesis, I explored the utilisation of primary and secondary healthcare services and associated healthcare costs by children’s weight status in a multi-ethnic birth cohort and investigated potential effect modification by ethnicity. I conducted a systematic-review and meta-analysis of the association between children’s weight status and healthcare utilisation. This informed analyses of the Born in Bradford (BiB) cohort with linked primary and secondary healthcare data, which enabled analyses of healthcare utilisation and costs by children’s weight status and ethnicity using negative binomial regression models. The prevalence of obesity was 10.1% in Pakistani children and 9.9% in White British children, the two main ethnic groups in the BiB cohort. In the cohort analyses: obese children had significantly higher rates and costs of primary care consultations, primary care prescriptions and A&E visits, when compared to normal weight children. There was no effect modification by ethnicity, however independent of weight status, Pakistani children had significantly higher rates and costs compared to White British children across all measures of healthcare utilisation. This thesis suggests that childhood obesity results in higher utilisation and costs of primary and secondary healthcare services during primary school years, indicative of higher clinical need and poor health in obese children compared to normal weight children. The findings highlight the importance of implementing effective childhood obesity interventions and prevention strategies that are tailored to the specific needs of a multi-ethnic population.