Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683 716 children

Abstract

Background: The global prevalence of childhood asthma is increasing. The condition impacts physical and psychosocial morbidity; therefore, wide-ranging effects on health and education outcomes are plausible.

Methods: Linkage of eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions and unemployment, provided data on 683 716 children attending Scottish schools between 2009 and 2013. We compared schoolchildren on medication for asthma with peers, adjusting for sociodemographic, maternity and comorbidity confounders, and explored effect modifiers and mediators.

Results: The 45 900 (6.0%) children treated for asthma had an increased risk of hospitalisation, particularly within the first year of treatment (incidence rate ratio 1.98, 95% CI 1.93-2.04), and increased mortality (HR 1.77, 95% CI 1.30-2.40). They were more likely to have special educational need for mental (OR 1.76, 95% CI 1.49-2.08) and physical (OR 2.76, 95% CI 2.57-2.95) health reasons, and performed worse in school exams (OR 1.11, 95% CI 1.06-1.16). Higher absenteeism (incidence rate ratio 1.25, 95% CI 1.24-1.26) partially explained their poorer attainment.

Conclusions: Children with treated asthma have poorer education and health outcomes than their peers. Educational interventions that mitigate the adverse effects of absenteeism should be considered.

FIGURE 1

Flow diagram illustrating the number of pupils included and excluded from the cohort at each stage of data cleaning. CHI: Community Health Index; SMR: Scottish Morbidity Record; P1–P7: first year through to seventh year of primary (elementary) school; S1–S6: first year through to sixth year of secondary (high) school. The CHI database contains CHI numbers (unique identifiers used on health records) and identifiers for patients registered with a general practitioner.

FIGURE 2

Forest plot of the association between treatment for asthma and special educational need by sex and age. Adjusted for age, sex, deprivation quintile, ethnic group, maternal age, maternal smoking, parity, mode of delivery, gestation at delivery, sex- gestation-specific birthweight centile and 5-min Apgar score.

FIGURE 3

Poisson piecewise regression model of the risk of hospitalisation over 5 years follow-up from first record of treatment: a) any-cause hospitalisation and b) respiratory hospitalisation by sex. IRR: incidence rate ratio. Adjusted for age, sex, deprivation quintile, ethnic group, maternal age, maternal smoking, parity, mode of delivery, gestation at delivery, sex-gestation-specific birthweight centile and 5-min Apgar score.