A new population-scale research resource is bringing together data from across health, education and social care to help researchers better understand the factors that shape children’s health and wellbeing in Wales.
Children in Wales: The Cohort for Health and Wellbeing Inequality (CWTCH) has been developed using routinely collected, anonymised data within the SAIL Databank at Swansea University. The new cohort provides researchers with a comprehensive resource for investigating inequalities from pregnancy and early childhood through to adolescence and young adulthood.
CWTCH includes data relating to almost one million children born in, or resident in, Wales between 2000 and 2024. Importantly, the cohort can link children with their mothers and households, creating opportunities to explore how health, social and economic circumstances interact over time.
The research team is a partnership between the University of Liverpool and Swansea University, who developed CWTCH to address important gaps in existing evidence about child health inequalities in Wales. While previous research cohorts have provided valuable insights, they have often been limited by age, sample size or the specific research questions they were originally designed to answer.
Operating as the national Trusted Research Environment (TRE) for Wales, UK, SAIL provides researchers with access to a wide range of anonymised, linkable population data while maintaining strict controls around privacy, security and governance. For the CWTCH project, this enabled the research team to bring together information from multiple sources to create a longitudinal picture of children’s lives.
The cohort draws on birth and maternity information, primary and secondary care data, education records, social care data and residential information. It also incorporates measures of deprivation, including the Welsh Index of Multiple Deprivation and Townsend deprivation scores, alongside indicators such as Free School Meal eligibility.
Dr Sarah Aldridge, who led the CWTCH cohort work, said, “This breadth of information means researchers can examine inequalities from multiple perspectives rather than looking at health outcomes in isolation. SAIL Databank has provided the infrastructure that makes it possible to bring these different sources of information together at population scale. By creating a consistent, longitudinal cohort, we can look beyond individual health outcomes and begin to understand how social, educational, household and health circumstances interact throughout childhood and into adulthood.”
A key strength of CWTCH is its longitudinal nature. Rather than providing a snapshot at a single point in childhood, the resource can follow individuals over time, supporting research into how experiences in early life may influence later health, education and social outcomes.
The cohort currently provides more than 19.6 million person-years of observation for children, alongside extensive follow-up for mothers. Its population-scale coverage also means researchers can investigate outcomes affecting relatively small groups that may be difficult to study using traditional research cohorts.
The researchers have demonstrated the potential of CWTCH through a series of examples examining inequalities in child mortality, emergency hospital admissions, school exclusions and educational attendance.
For example, the data can be used to examine differences in emergency admissions according to levels of area deprivation, or differences in school attendance between children who have and have not been eligible for Free School Meals. Researchers can also explore differences in exclusion rates according to special educational needs or additional learning needs. These examples demonstrate how linking information held across different sectors can provide a much broader understanding of the circumstances associated with inequality.
The resource also provides opportunities for intergenerational research. Through its links between children and their mothers, CWTCH can support research into how circumstances before, during and after pregnancy may influence children’s health and wellbeing.
The research team describe CWTCH as a flexible and scalable resource that can be refreshed as new data become available within SAIL Databank. The code and documentation used to create the cohort has also been made openly available, allowing accredited researchers to reproduce or adapt the resource for their own research questions.
The research team hopes CWTCH will support future studies into child and maternal health, education, social care and socioeconomic inequalities, generating evidence for policy makers and practitioners about where interventions could have the greatest impact.
Work is ongoing within ADR Wales to explore the continued development and sustainability of the CWTCH data as a Research Ready Data Asset (RRDA). As part of this, options are being considered to enhance the accessibility and usability of the data for future researchers through appropriate governance and data infrastructure arrangements.
All access to data remains subject to SAIL Databank’s established, robust governance and approval processes. For researchers and data practitioners, an application to use the data can be found here: https://saildatabank.com/data/apply-to-work-with-the-data/.
Based at Swansea University, SAIL Databank is powered by the Secure eResearch Platform (SeRP) and is funded by Welsh Government through Health and Care Research Wales and the Economic and Social Research Council (ESRC).
Read the full paper at https://doi.org/10.1093/ije/dyag180
