Using Scotland-wide record linkage to investigate the educational and health outcomes of children treated for chronic conditions

Objectives: This study linked Scottish education data to a number of administrative health datasets to explore associations between childhood chronic ill health and subsequent educational and health outcomes. Chronic conditions investigated were diabetes, asthma, epilepsy, attention deficit hyperactivity disorder (ADHD) and depression. Educational outcomes were number of days absent from school, number of school exclusions, special educational need (SEN), academic attainment and unemployment. Health outcomes were all-cause and cause-specific hospital admission, total number of hospital admissions, total length of hospital admission and all-cause mortality. Approach: Pupil census data and associated education records for all children attending primary and secondary schools in Scotland between 2009 and 2013 were linked to national prescribing data, hospital admissions, death records and retrospective maternity records enabling outcomes to be studied whilst controlling for socioeconomic, demographic and obstetric factors including birth outcomes and maternal antecedents. Specific medications are prescribed for some particular chronic conditions; therefore, children identified as receiving these medications whilst at school were assumed to have these conditions. Results: Children treated for each of the five conditions had more frequent absenteeism from school and were more likely than their peers to have SEN. However, only children treated for depression, epilepsy or ADHD experienced poorer academic attainment and increased odds of unemployment. Furthermore, children treated for depression or ADHD were significantly more likely to be excluded from school. Children treated for asthma experienced poorer academic attainment but no increased odds of unemployment and the association with attainment disappeared after adjusting for their increased absenteeism. Children treated for each of the five conditions had an increased risk of hospital admission and children treated for depression or epilepsy also had an increased risk of recurrent hospitalisation and longer stays in hospital. All of the chronic conditions, with the exception of ADHD, were associated with increased mortality. Conclusion: All five of the chronic conditions investigated in this thesis were associated with adverse educational and health outcomes. The number of outcomes affected varied by condition. Treated depression, epilepsy and ADHD were associated with the most wide-ranging impacts. Children treated for depression fared worse than their peers across all nine outcomes, and children treated for epilepsy and ADHD across eight and six respectively. In contrast, children treated for asthma and diabetes fared worse than their peers in respect of around half the outcomes investigated. Children with these chronic conditions at school appear to experience significant educational and health disadvantage; therefore further work is required to understand the underlying mechanisms and to develop effective interventions to reduce their risk