Impacts of environmental exposures on critically ill children: a national cohort study

About the Project

Project background

Environmental exposures including air pollution, noise, greenspace and extreme temperature has each been investigated in relation to childhood health outcomes around the world[1]. The adverse association of air pollution[2] or heat exposure[3] with hospital admissions in children has been consistently reported across the studies. Children are particularly vulnerable to these environmental exposures due to their developing bodies and organ systems. In 2023, there were nearly 18,500 admissions (~50 admissions/day) to Paediatric Intensive Care Units (PICUs) across the UK, with a mortality rate of 3.7%[4]. These critically ill children are more likely from a more deprived social background or ethnic minority groups (i.e., Asian and Black), with respiratory diseases being the most common cause of PICU admissions. Environmental exposures, as a potential risk contributing to PICU admissions, have not been comprehensively explored. To date, there was only one published study investigating crude air pollution levels (over a large geographical area) and PICU admissions, which found no overall association after adjustment for area-level deprivation [5].

This PhD project aims to provide comprehensive evidence which integrates multiple exposures (air pollution, noise, greenspace, temperature) and focuses specifically on PICUs prevention and care pathways. We will use UK-wide administrative database - the Paediatric Intensive Care Audit Network (PICANet) - and other UK birth cohorts, to investigate these following research questions:

1. How do multiple environmental exposures, both in short- and long-term time frames, impact incidence of PICUs admissions?
2. How do multiple environmental exposures, both in short- and long-term time frames, impact mortality rate in PICUs?
3. How do multiple environmental exposures affect emergency readmissions after a short-period (up to a week) of discharge from PICUs?

A thorough literature review will be conducted in the beginning to inform the analytical phase of the project.

Outcome and demographic data will be retrieved from the databases, and the student will be expected to conduct environmental exposure data linkages (air pollution, traffic noise, residential greenness and temperature) at postcode/Lower Super Output Area level using state-of-art exposure models developed by the University of Leicester and other groups. Advanced statistical techniques will be applied to answer the research questions, with a strong focus to disentangle the independent effects of each environmental exposure, as well as to explore their potential synergistic effects.

Training opportunities

The student will be trained by a multidisciplinary supervision team over the course of study period. The student will be an integrated member of the Centre for Environmental Health and Sustainability (CEHS), which also hosts the NIHR Leicester Biomedical Research Centre (BRC) Environment Theme and NIHR-HPRU in Chemical Threats and Hazards. The student will have access to a wide range of professional and academic training opportunities provided by the University of Leicester, CEHS, BRC, and NIHR-HPRU. The student will also have opportunity to gain training on environmental science policy from our partners such as UK Health Security Agency.

Outputs

This PhD project will generate important academic outputs. We expect 3-4 manuscripts to be published in high-impact journals. In addition, based on the results, we will develop insightful and accessible materials for knowledge mobilisation and public/patient engagement activities in order to generate wider societal/policy impacts.

Supervisor contact details:

Dr Samuel Cai - yc368@leicester.ac.uk
Dr Sarah Seaton - sarah.seaton@leicester.ac.uk
Prof Anna Hansell - ah618@leicester.ac.uk