RT Journal Article
SR Electronic
T1 Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683,716 children
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1802309
DO 10.1183/13993003.02309-2018
A1 Michael Fleming
A1 Catherine A. Fitton
A1 Markus F.C. Steiner
A1 James S. McLay
A1 David Clark
A1 Albert King
A1 Daniel F. Mackay
A1 Jill P. Pell
YR 2019
UL http://erj.ersjournals.com/content/early/2019/05/30/13993003.02309-2018.abstract
AB 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 (IRR 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 (IRR 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Fleming has nothing to disclose.Conflict of interest: Dr. Fitton has nothing to disclose.Conflict of interest: Dr. Steiner has nothing to disclose.Conflict of interest: Dr. McLay has nothing to disclose.Conflict of interest: Dr. Clark has nothing to disclose.Conflict of interest: Mr. King has nothing to disclose.Conflict of interest: Dr. Mackay has nothing to disclose.Conflict of interest: Dr. Pell has nothing to disclose.