Lucy K Smith

University of Leicester, Leiscester, England, United Kingdom

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Publications (17)140.29 Total impact

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    ABSTRACT: Maximising response rates to neurodevelopmental follow-up is a key challenge for paediatric researchers. We have investigated the use of telephone interviews and online questionnaires to improve response rates, reduce non-response bias, maintain data completeness and produce unbiased outcomes compared with postal questionnaires when assessing neurodevelopmental outcomes at 2 years. A prospective cohort study of babies born >=32 weeks gestation. Neurodevelopmental outcomes were assessed at 2-years of age using a parent questionnaire completed via post, telephone or online. Relative Risks with 95% confidence intervals (RR; 95%CI) were calculated to identify participant characteristics associated with non-response and questionnaire response mode (postal vs. telephone/online). The proportion of missing data and prevalence of adverse outcomes was compared between response modes using generalized linear models. Offering telephone/online questionnaires increased the study response rate from 55% to 60%. Telephone/online responders were more likely to be non-white (RR 1.6; [95%CI 1.1, 2.4]), non-English speaking (1.6; [1.0, 2.6]) or have a multiple birth (1.6; [1.1, 2.3]) than postal responders. There were no significant differences in the prevalence of adverse neurodevelopmental outcomes between those who responded via post vs. telephone/online (1.1; [0.9, 1.4]). Where parents attempted all questionnaire sections, there were no significant differences in the proportion of missing data between response modes. Where there is sufficient technology and resources, offering telephone interviews and online questionnaires can enhance response rates and improve sample representation to neurodevelopmental follow-up, whilst maintaining data completeness and unbiased outcomes.
    BMC Research Notes 04/2014; 7(1):219.
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    ABSTRACT: To investigate temporal trends in multiple birth rates and associated stillbirth and neonatal mortality by socioeconomic deprivation and maternal age in England. Population cohort study. England. All live births and stillbirths (1 January 1997 to 31 December 2008). Multiple maternity rate, stillbirth and neonatal death rate by year of birth, decile of socioeconomic deprivation and maternal age. The overall rate of multiple maternities increased over time (+0.64% per annum 95% CI (0.47% to 0.81%)) with an increase in twin maternities (+0.85% per annum 95% CI (0.67% to 1.0%)) but a large decrease in triplet and higher order maternities (-8.32% per annum 95% CI (-9.39% to -7.25%)). Multiple maternities were significantly lower in the most deprived areas, and this was most evident in the older age groups. Women over 40 years of age from the most deprived areas had a 34% lower rate of multiple births compared with similar aged women from the most deprived areas (rate ratio (RR) 0.66 95% CI (0.61 to 0.73)). Multiple births remain at substantially higher risk of neonatal mortality (RR 6.30 95% CI (6.07 to 6.53)). However, for stillbirths, while twins remain at higher risk, this has decreased over time (1997-2000: RR 2.89 (2.69 to 3.10); 2005-2008: RR 2.22 95% CI (2.06 to 2.40)). Socioeconomic inequalities existed in mortality for singletons and multiple births. This period has seen increasing rates of twin pregnancies and decreasing rates of higher order births which have coincided with changes in recommendations regarding assisted reproductive techniques. Socioeconomic differences in multiple births may reflect differential access to these treatments. Improved monitoring of multiple pregnancies is likely to have led to the reductions in stillbirths over this time.
    BMJ Open 01/2014; 4(4):e004514. · 1.58 Impact Factor
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    ABSTRACT: This article focuses on the survival rates of the most immature babies considered viable from around the world. It discusses the various factors in terms of definition, inclusion criteria and policy which can result in marked differences in the apparent rates of delivery (all births), live birth, admission to neonatal intensive care and ultimately survival seen between otherwise similar countries, different regions of the same country, and even adjacent hospitals. Such variation in approach can result in major differences in reported survival and consequentially have large effects on apparent rates of adverse long-term outcome.
    Seminars in Fetal and Neonatal Medicine 11/2013; · 3.51 Impact Factor
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    ABSTRACT: BACKGROUND: Social factors affect the risk of very preterm birth and may affect subsequent outcomes in those born preterm. We assessed the influence of neighbourhood socio-economic characteristics on the risk and outcomes of singleton very preterm birth (<32 weeks of gestation) in two European regions with different health systems. METHODS: Live births (n=1118) from a population-based cohort of very preterm infants in 2003 in Trent (UK) and Ile-de-France (France) regions were geocoded to their neighbourhood census tracts. Odds ratios for very preterm singleton birth by neighbourhood characteristics (unemployment rate, proportion manual workers, proportion with high school education only, non home ownership) were computed using infants enumerated in the census as a control population. The impact of neighbourhood variables was further assessed by pregnancy and delivery characteristics and short term infant outcomes. RESULTS: Risk of very preterm singleton birth was higher in more deprived neighbourhoods in both regions (OR between 2.5 and 1.5 in the most versus least deprived quartiles). No consistent associations were found between neighbourhood deprivation and maternal characteristics or health outcomes for very preterm births, although infants in more deprived neighbourhoods were less likely to be breastfed at discharge. CONCLUSIONS: Neighbourhood deprivation had a strong consistent impact on the risk of singleton very preterm birth in two European regions, but did not appear to be associated with maternal characteristics or infant outcomes. Differences in breastfeeding at discharge suggest that socio-economic factors may affect long term outcomes.
    BMC Pregnancy and Childbirth 04/2013; 13(1):97. · 2.52 Impact Factor
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    ABSTRACT: This article focuses on the survival rates of the most immature babies considered viable from around the world. It discusses the various factors in terms of definition, inclusion criteria and policy which can result in marked differences in the apparent rates of delivery (all births), live birth, admission to neonatal intensive care and ultimately survival seen between otherwise similar countries, different regions of the same country, and even adjacent hospitals. Such variation in approach can result in major differences in reported survival and consequentially have large effects on apparent rates of adverse long-term outcome.
    Seminars in Fetal and Neonatal Medicine 01/2013; · 3.51 Impact Factor
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    ABSTRACT: To assess time trends in socioeconomic inequalities in overall and cause-specific stillbirth rates in England. Population-based retrospective study. England. Stillbirths occurring among singleton infants born between 1 January 2000 and 31 December 2007. Cause-specific stillbirth rate per 10 000 births by deprivation tenth and year of birth. Deprivation measured using the UK index of multiple deprivation at Super Output Area level. Poisson regression models were used to estimate the relative deprivation gap (comparing the most and least deprived tenths) in rates of stillbirths (overall and cause-specific). Excess mortality was calculated by applying the rates seen in the least deprived tenth to the entire population at risk. Discussions with our local NHS multicentre ethics committee deemed that this analysis of national non-identifiable data did not require separate ethics approval. There were 44 stillbirths per 10 000 births, with no evidence of a change in rates over time. Rates were twice as high in the most deprived tenth compared with the least (rate ratio (RR) 2.1, 95% CI 2.0 to 2.2) with no evidence of a change over time. There was a significant deprivation gap for all specific causes except mechanical events (RR 1.2, 95% CI 0.9 to 1.5). The widest gap was seen for stillbirths due to antepartum haemorrhages (RR 3.1, 95% CI 2.8 to 3.5). No evidence of a change in the rate of stillbirth or deprivation gap over time was seen for any specific cause. A wide deprivation gap exists in stillbirth rates for most causes and is not diminishing. Unexplained antepartum stillbirths accounted for 50% of the deprivation gap, and a better understanding of these stillbirths is necessary to reduce socioeconomic inequalities.
    BMJ Open 01/2012; 2(3). · 1.58 Impact Factor
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    ABSTRACT: To investigate socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies. Retrospective population based registry study. East Midlands and South Yorkshire regions of England (representing about 10% of births in England and Wales). All registered cases of nine selected congenital anomalies with poor prognostic outcome audited as part of the United Kingdom's fetal anomaly screening programme with an end of pregnancy date between 1 January 1998 and 31 December 2007. Socioeconomic variation in the risk of selected congenital anomalies; outcome of pregnancy; incidence of live birth and neonatal mortality over time. Deprivation measured with the index of multiple deprivation 2004 at super output area level. There were 1579 fetuses registered with one of the nine selected congenital anomalies. There was no evidence of variation in the overall risk of these anomalies with deprivation (rate ratio for the most deprived 10th with the least deprived 10th: 1.05, 95% confidence interval 0.89 to 1.23). The rate ratio varied with type of anomaly and maternal age (deprivation rate ratio adjusted for maternal age: 1.43 (1.17 to 1.74) for non-chromosomal anomalies; 0.85 (0.63 to 1.15) for chromosomal anomalies). Of the nine anomalies, 86% were detected in the antenatal period, and there was no evidence that this varied with deprivation (rate ratio 0.99, 0.84 to 1.17). The rate of termination after antenatal diagnosis of a congenital anomaly was lower in the most deprived areas compared with the least deprived areas (63% v 79%; rate ratio 0.80, 0.65 to 0.97). Consequently there were significant socioeconomic inequalities in the rate of live birth and neonatal mortality associated with the presence of any of these nine anomalies. Compared with the least deprived areas, the most deprived areas had a 61% higher rate of live births (1.61, 1.21 to 2.15) and a 98% higher neonatal mortality rate (1.98, 1.20 to 3.27) associated with a congenital anomaly. Antenatal screening for congenital anomalies has reduced neonatal mortality through termination of pregnancy. Socioeconomic variation in decisions regarding termination of pregnancy after antenatal detection, however, has resulted in wide socioeconomic inequalities in liveborn infants with a congenital anomaly and subsequent neonatal mortality.
    BMJ (online) 01/2011; 343:d4306. · 17.22 Impact Factor
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    ABSTRACT: To investigate time trends in socioeconomic inequalities in cause specific neonatal mortality in order to assess changing patterns in mortality due to different causes, particularly prematurity, and identify key areas of focus for future intervention strategies. Retrospective cohort study. England. All neonatal deaths in singleton infants born between 1 January 1997 and 31 December 2007. Cause specific neonatal mortality per 10 000 births by deprivation tenth (deprivation measured with UK index of multiple deprivation 2004 at super output area level). 18 524 neonatal deaths occurred in singleton infants born in the 11 year study period. Neonatal mortality fell between 1997-9 and 2006-7 (from 31.4 to 25.1 per 10 000 live births). The relative deprivation gap (ratio of mortality in the most deprived tenth compared with the least deprived tenth) increased from 2.08 in 1997-9 to 2.68 in 2003-5, before a fall to 2.35 in 2006-7. The most common causes of death were immaturity and congenital anomalies. Mortality due to immaturity before 24 weeks' gestation did not decrease over time and showed the widest relative deprivation gap (2.98 in 1997-9; 4.14 in 2003-5; 3.16 in 2006-7). Mortality rates for all other causes fell over time. For congenital anomalies, immaturity, and accidents and other specific causes, the relative deprivation gap widened between 1997-9 and 2003-5, before a slight fall in 2006-7. For intrapartum events and sudden infant deaths (only 13.5% of deaths) the relative deprivation gap narrowed slightly. Almost 80% of the relative deprivation gap in all cause mortality was explained by premature birth and congenital anomalies. To reduce socioeconomic inequalities in mortality, a change in focus is needed to concentrate on these two influential causes of death. Understanding the link between deprivation and preterm birth should be a major research priority to identify interventions to reduce preterm birth.
    BMJ (online) 01/2010; 341:c6654. · 17.22 Impact Factor
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    ABSTRACT: To assess socioeconomic inequalities in survival and provision of neonatal care among very preterm infants. Prospective cohort study in a geographically defined population. Former Trent health region of the United Kingdom (covering about a twelfth of UK births). All infants born between 22+0 and 32+6 weeks' gestation from 1 January 1998 to 31 December 2007 who were alive at the onset of labour and followed until discharge from neonatal care. Survival to discharge from neonatal care per 1000 total births and per 1000 very preterm births. Neonatal care provision for very preterm infants surviving to discharge measured with length of stay, provision of ventilation, and respiratory support. Deprivation measured with the UK index of multiple deprivation 2004 score at super output area level. 7449 very preterm singleton infants were born in the 10 year period. The incidence of very preterm birth was nearly twice as high in the most deprived areas compared with the least deprived areas. Consequently rates of mortality due to very preterm birth per 1000 total births were almost twice as high in the most deprived areas compared with the least deprived (incidence rate ratio 1.94, 95% confidence interval 1.62 to 2.32). Mortality rates per 1000 very preterm births, however, showed little variation across all deprivation fifths (incidence rate ratio for most deprived fifth versus least deprived 1.02, 0.86 to 1.20). For infants surviving to discharge from neonatal care, measures of length of stay and provision of ventilation and respiratory support were similar across all deprivation fifths. The burden of mortality and morbidity is greater among babies born to women from deprived areas because of increased rates of very preterm birth. After very preterm birth, however, survival rates and neonatal care provision is similar for infants from all areas.
    BMJ (online) 01/2009; 339:b4702. · 17.22 Impact Factor
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    ABSTRACT: To explore the relationship between infection and socioeconomic deprivation among mothers of spontaneous very preterm infants to contribute to the understanding of the deprivation gap in the incidence of very preterm birth. We used comprehensive data from a large retrospective study of very preterm birth in a U. K. health region (representing approximately 1 in 12 U.K. births) between 1994 and 2005. We report the relationship between fetal or maternal infection before birth and deprivation quintile of all singleton live births at 22 0/7 to 32 6/7 weeks of gestation associated with spontaneous onset of labor. Overall, 24% of the 4,987 spontaneous very preterm singleton births had recorded evidence of maternal or fetal infection. Rates of infection increased significantly with increasing deprivation. Spontaneous very preterm births to mothers from the most deprived quintile were at 43% increased odds of being associated with infection compared with those from the least deprived quintile (odds ratio 1.43, 95% confidence interval 1.13-1.80) after adjusting for gestation, year of birth, and mother's age. Spontaneous very preterm births to mothers from more deprived areas are more likely to be associated with infection before birth. II.
    Obstetrics and Gynecology 09/2007; 110(2 Pt 1):325-9. · 4.80 Impact Factor
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    ABSTRACT: Background  Research into factors associated with survival in adults with intellectual disability is limited and no studies have controlled for changes in these factors over time.Material and Methods  All adults aged ≥20 years with moderate to profound intellectual disability (approximate IQ < 50) using specialist services in Leicestershire and Rutland, UK, were identified. The relationship between survival and physical, intellectual and social impairments was investigated, also adjusting for age, sex, ethnicity and exact year of birth.Results  Of 2453 adults studied, 402 (16%) died over a maximum follow-up period of 19 years. While physical, intellectual and social impairments were all associated with survival individually, physical impairment was the only impairment to significantly predict survival in the multi-variable analysis. Being non-mobile was associated with a sevenfold increased risk of death and being partially mobile with a twofold increased risk of death compared with being fully mobile [adjusted hazards ratios (HR) = 7.14; 95% confidence interval (CI) 4.99–10.21 and HR = 2.33; 95% CI 1.84–2.95]. Being male and earlier year of birth were also associated with shorter survival.Conclusions  The implications of these findings are discussed.
    Journal of Applied Research in Intellectual Disabilities 03/2007; 20(4):360 - 367. · 1.38 Impact Factor
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    ABSTRACT: Relative survival is used to estimate patient survival excluding causes of death not related to the disease of interest. Rather than using cause of death information from death certificates, which is often poorly recorded, relative survival compares the observed survival to that expected in a matched group from the general population. Models for relative survival can be expressed on the hazard (mortality) rate scale as the sum of two components where the total mortality rate is the sum of the underlying baseline mortality rate and the excess mortality rate due to the disease of interest. Previous models for relative survival have assumed that covariate effects act multiplicatively and have thus provided relative effects of differences between groups using excess mortality rate ratios. In this paper we consider (i) the use of an additive covariate model, which provides estimates of the absolute difference in the excess mortality rate; and (ii) the use of fractional polynomials in relative survival models for the baseline excess mortality rate and time-dependent effects. The approaches are illustrated using data on 115 331 female breast cancer patients diagnosed between 1 January 1986 and 31 December 1990. The use of additive covariate relative survival models can be useful in situations when the excess mortality rate is zero or slightly less than zero and can provide useful information from a public health perspective. The use of fractional polynomials has advantages over the usual piecewise estimation by providing smooth estimates of the baseline excess mortality rate and time-dependent effects for both the multiplicative and additive covariate models. All models presented in this paper can be estimated within a generalized linear models framework and thus can be implemented using standard software.
    Statistics in Medicine 01/2006; 24(24):3871-85. · 2.04 Impact Factor
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    ABSTRACT: Although the association between socioeconomic status and mortality is well documented, there is less work focusing on the association with morbidity in older people. This is partly due to the difficulties of measuring socioeconomic status at older ages. The work that does exist tends to use cross-sectional data and objective measures of socioeconomic status such as education, social class or income. However, these standard measures may be less relevant for older people. In this study, we explore the association between socioeconomic status and disability in older people using a range of individual, household and area level indicators of socioeconomic status, including a subjective measure of adequacy of income. We use cross-sectional data of 1470 participants aged 75 years or over on 31/12/1987 and registered with a UK primary care practice. Of these 719 participants with no disability at baseline were followed up until 2003 with measurements at up to seven time points to determine onset of disability. Disability was defined as difficulty with any one of five activities of daily living. In cross-sectional multivariate analysis, age, housing tenure, living status and a subjective measure of income adequacy were associated with prevalence of disability. In longitudinal analyses, self-perceived adequacy of income showed the strongest association with onset of disability; with those reporting difficulties managing having a median age of onset 80.5 years, 7 years younger than those who felt their income was adequate (median age 87.8 years). The prospective association between self-perceived adequacy of income and onset of disability decreased with age. This subjective measure of income adequacy may signify difficulties in budgeting, but could also capture differences in objective indicators of status not recorded in this study, such as wealth. Further work is needed to explore what causes older people to experience difficulty in managing their money and to understand the mechanisms behind its impact on their physical health.
    Social Science [?] Medicine 11/2005; 61(7):1567-75. · 2.73 Impact Factor
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    ABSTRACT: The reduction of delay in cancer diagnosis has been targeted as a way to improve survival. We undertook a qualitative synthesis of international research evidence to provide insight into patients' experiences of recognising symptoms of cancer and seeking help. We searched international publications (1985-2004) for delay in cancer diagnosis to identify the relevant qualitative research, and used meta-ethnography to identify the common themes across the studies. Our synthesis interpreted individual studies by identification of second-order constructs (interpretations offered by the original researchers) and third-order constructs (development of new interpretations beyond those offered in individual studies). We identified 32 papers (>775 patients and carers) reporting help-seeking experiences for at least 20 different types of cancer. The analysis showed strong similarities in patients with different cancer types. Key concepts were recognition and interpretation of symptoms, and fear of consultation. Fear manifested as a fear of embarrassment (the feeling that symptoms were trivial or that symptoms affected a sensitive body area), or a fear of cancer (pain, suffering, and death), or both. Such analyses allowed exploration of third-order constructs. The patient's gender and the sanctioning of help-seeking were important factors in prompt consultation. Strategies to understand and reduce patients' delay in cancer presentation can help symptom recognition but need to address patients' anxieties. The effect of the patient's sex in help-seeking also needs to be recognised, as does the important role of friends, family, and health-care professionals in the sanctioning of consultation. This meta-ethnography provides an international overview through the systematic synthesis of a diverse group of small-scale qualitative studies.
    The Lancet 01/2005; 366(9488):825-31. · 39.06 Impact Factor
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    Lucy K Smith, Ruth M Hancock
    Journal of Epidemiology &amp Community Health 08/2004; 58(7):616-7. · 3.39 Impact Factor
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    ABSTRACT: Standard survival methods can yield out-of-date estimates of long-term survival. Period analysis, based on life-table methodology, provides more up-to-date survival estimates by exploring survival during a restricted recent period of interest. It excludes the short-term survival of patients recruited at the start of the study. We use statistical models to further develop the method of period analysis, providing more up-to-date estimates of survival and the ability to explore differences in survival by covariates and adjust for case mix. We use cancer registry data for colorectal cancer in Leicestershire, UK, to illustrate the use of Cox proportional hazards (CPH) models to estimate period and standard survival. We compare these estimates with those obtained using life-table methodology. Period estimates were slightly higher than the standard estimates as they reflect recent improvements in short-term survival. The results for period analysis using the life-table approach and using CPH models were similar. However, CPH models allowed further investigation of other risk factors and the ability to control for potential confounding variables. Using period survival estimates, more up-to-date information is available to clinicians and others with an interest in monitoring survival. Period CHP models offer all the advantages of statistical modeling, and are straightforward to fit in standard statistical packages.
    Journal of Clinical Epidemiology 02/2004; 57(1):14-20. · 5.33 Impact Factor
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    BMJ (online) 02/2003; 326(7380):81-2. · 17.22 Impact Factor