Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study

Background Looked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders. Methods and findings Linkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care. Conclusions Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.

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

European Respiratory Journal ◽

10.1183/13993003.02309-2018 ◽

2019 ◽

Vol 54 (3) ◽

pp. 1802309 ◽

Cited By ~ 5

Author(s):

Michael Fleming ◽

Catherine A. Fitton ◽

Markus F.C. Steiner ◽

James S. McLay ◽

David Clark ◽

...

Keyword(s):

Health Outcomes ◽

Incidence Rate ◽

Rate Ratio ◽

Hospital Admissions ◽

Incidence Rate Ratio ◽

Educational Interventions ◽

Linkage Study ◽

Increased Risk ◽

Educational Need ◽

Psychosocial Morbidity

BackgroundThe 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.MethodsLinkage 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.ResultsThe 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.ConclusionsChildren with treated asthma have poorer education and health outcomes than their peers. Educational interventions that mitigate the adverse effects of absenteeism should be considered.

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Investigating the relationships between chronic ill health and educational outcomes in children

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.181 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Michael Fleming ◽

Daniel Mackay ◽

Jill Pell ◽

James McLay

Keyword(s):

Educational Outcomes ◽

Chronic Conditions ◽

Census Data ◽

Hospital Admissions ◽

Linkage Study ◽

Education Data ◽

Increased Risk ◽

Obstetric Factors ◽

Educational Need ◽

The Impact

ABSTRACT ObjectivesThis population wide record linkage study linked Scottish education data to a number of administrative health datasets to explore the impact of childhood chronic ill health on subsequent educational and health outcomes. Chronic conditions investigated in this study were diabetes, asthma, epilepsy, ADHD and depression. Specific educational outcomes of interest were academic attainment, school leaver destination, absence levels, exclusions and record of special educational need (SEN). Children were also followed up for hospital admissions and all-cause mortality. ApproachPupil 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 (acute, psychiatric and cancer), death records and their mother’s maternity records to enable a range of different chronic conditions to be studied whilst controlling for various confounders. Specific drugs are prescribed for some particular chronic conditions therefore children identified from prescribing data as receiving these drugs at the time of the school census were assumed to have these conditions. Hospital admissions and death records provided information on subsequent admissions and mortality. Linking all children to their mother’s maternity records provided ability to control for a range of obstetric factors, birth outcomes and maternal antecedents. ResultsDiabetes, asthma, epilepsy, ADHD and depression were significantly associated with increased numbers of absences at school and increased risk of SEN. All of the conditions with the exception of diabetes were significantly associated with poorer subsequent educational grade attainment. ADHD and depression were significantly associated with increased numbers of exclusions at school whilst asthma was significantly associated with less exclusion. Epilepsy, ADHD and depression were significantly associated with poorer leaver destination 6 months after leaving school. ConclusionCompared to peers, children who had ADHD or depression were most adversely affected experiencing poorer educational outcomes in all five of the educational domains investigated. Children with epilepsy experienced poorer outcomes across four domains. Children with diabetes and asthma experienced more absence and increased SEN and asthmatic children experienced poorer attainment. Children who have these chronic illnesses at school appear to be at an educational disadvantage therefore further understanding of the intricate relationships between health and education is an on-going important area of public health.

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One-Year Readmission and Emergency Department Presentation After an Epilepsy-Related Admission in People with Intellectual Disability: A Registry-Linkage Study

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1498 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Peiwen Liao

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Hospital Admissions ◽

Healthcare Services ◽

Linkage Study ◽

Adjusted Incidence Rate ◽

One Year ◽

Service Data ◽

Patients With Epilepsy ◽

The Impact

IntroductionIntellectual disability (ID) is a neurodevelopmental condition that affects approximately 1-2% of the population, and epilepsy is a common comorbidity in people with ID. Although hospital admission for epilepsy is also common, little is known about the impact of ID on healthcare use following an epilepsy admission. Objectives and ApproachUsing linked administrative health datasets that included hospital admissions and disability service data, we aimed to examine whether the presence of ID led to greater or lesser use of healthcare services following an epilepsy admission, as represented by all-cause unplanned readmissions and emergency department (ED) presentations. Comparing the rate of readmissions and ED presentations within 30, 90 and 365 days of the first epilepsy admission during the study period, the effect of ID was assessed using Poisson regression. ResultsA total of 18,987 patients had an epilepsy admission between 2005 and 2014, and of these, 3,256 (17.1%) had ID. Compared to patients without ID, patients with ID had a higher risk of unplanned readmissions within each follow-up period (adjusted incidence rate ratio (IRR) with 95% CI: 30 days: 1.48 (1.34, 1.65); 90 days: 1.42 (1.31, 1.54); 365 days: 1.49 (1.40, 1.59)). Differences were also found in the reasons for readmission, including more readmissions for neurological disorders. Similarly, the ED presentation risk was elevated in patients with ID (adjusted IRR: 30 days: 1.34 (1.23, 1.46); 90 days: 1.33 (1.24, 1.42); 365 days: 1.38 (1.30, 1.46)). Conclusion / ImplicationsIn patients with epilepsy, the presence of ID appears to increase the chance of a readmission or ED presentation following a hospital admission for epilepsy, with the reasons for readmission also potentially different. This suggests the potential for improvements in post-admission screening and management.

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Educational and health outcomes of children and adolescents receiving antidepressant medication: Scotland-wide retrospective record linkage cohort study of 766 237 schoolchildren

International Journal of Epidemiology ◽

10.1093/ije/dyaa002 ◽

2020 ◽

Vol 49 (4) ◽

pp. 1380-1391

Author(s):

Michael Fleming ◽

Catherine A Fitton ◽

Markus F C Steiner ◽

James S McLay ◽

David Clark ◽

...

Keyword(s):

Health Outcomes ◽

Record Linkage ◽

Antidepressant Medication ◽

Educational Needs ◽

Administrative Databases ◽

Special Educational Needs ◽

Education And Health ◽

Wide Range ◽

Adjusted Incidence Rate ◽

Educational Need

Abstract Background Childhood depression is relatively common, under-researched and can impact social and cognitive function and self-esteem. Methods Record linkage of routinely collected Scotland-wide administrative databases covering prescriptions [prescribing information system (PIS)], hospitalizations (Scottish Morbidity Records 01 and 04), maternity records (Scottish Morbidity Records 02), deaths (National Records of Scotland), annual pupil census, school absences/exclusions, special educational needs (Scottish Exchange of Educational Data; ScotXed), examinations (Scottish Qualifications Authority) and (un)employment (ScotXed) provided data on 766 237 children attending Scottish schools between 2009 and 2013 inclusively. We compared educational and health outcomes of children receiving antidepressant medication with their peers, adjusting for confounders (socio-demographic, maternity and comorbidity) and explored effect modifiers and mediators. Results Compared with peers, children receiving antidepressants were more likely to be absent [adjusted incidence rate ratio (IRR) 1.90, 95% confidence interval (CI) 1.85–1.95] or excluded (adjusted IRR 1.48, 95% CI 1.29–1.69) from school, have special educational needs [adjusted odds ratio (OR) 1.77, 95% CI 1.65–1.90], have the lowest level of academic attainment (adjusted OR 3.00, 95% CI 2.51–3.58) and be unemployed after leaving school (adjusted OR 1.88, 95% CI 1.71–2.08). They had increased hospitalization [adjusted hazard ratio (HR) 2.07, 95% CI 1.98–2.18] and mortality (adjusted HR 2.73, 95% CI 1.73–4.29) over 5 years’ follow-up. Higher absenteeism partially explained poorer attainment and unemployment. Treatment with antidepressants was less common among boys than girls (0.5% vs 1.0%) but the associations with special educational need and unemployment were stronger in boys. Conclusions Children receiving antidepressants fare worse than their peers across a wide range of education and health outcomes. Interventions to reduce absenteeism or mitigate its effects should be investigated.

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Education and health outcomes of children treated for chronic conditions

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1320 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Michael Fleming ◽

Catherine A Fitton ◽

Markus FC Steiner ◽

James S McLay ◽

David Clark ◽

...

Keyword(s):

Health Outcomes ◽

Chronic Conditions ◽

Census Data ◽

Hospital Admissions ◽

Academic Attainment ◽

School Absenteeism ◽

Education Data ◽

Educational Disadvantage ◽

Educational Need ◽

Childhood Chronic Conditions

Background with rationaleThis retrospective cohort study linked Scotland-wide education data to national health data to explore associations between childhood chronic conditions and subsequent educational and health outcomes. Main AimConditions studied were diabetes, asthma, epilepsy, attention deficit hyperactivity disorder (ADHD) and depression. We also explored neurodevelopmental multimorbidity (comorbid autism, learning disability, ADHD or depression). Educational outcomes were school absenteeism and exclusion, special educational need, academic attainment and subsequent unemployment. Health outcomes were hospital admissions and all-cause mortality. Methods/ApproachPupil 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, acute and psychiatric hospital admissions, death records and retrospective maternity records enabling conditions to be studied whilst adjusting for sociodemographic and maternity factors and comorbid conditions. Conditions were ascertained from prescribing data and school records. ResultsAll conditions were associated with increased school absenteeism, special educational need, and hospitalisation. All, excluding diabetes, were associated with poorer academic attainment and all, excluding ADHD were associated with increased mortality. ADHD and depression were associated with increased exclusion from school whilst epilepsy, ADHD and depression were associated with subsequent unemployment. Children experiencing neurodevelopmental multimorbidity had poorer outcomes across all educational domains. Depression was the biggest driver of absenteeism and ADHD was the biggest driver of exclusion. ConclusionIn addition to poorer health outcomes, schoolchildren with these chronic conditions appear to experience significant educational disadvantage compared to their peers. Therefore interventions and further understanding of the intricate relationships between health and education among children with these conditions is required.

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‘What about me?’ Stories of the educational experiences of care-experienced children and young people in a Scottish local authority

Adoption & Fostering ◽

10.1177/03085759211011736 ◽

2021 ◽

Vol 45 (2) ◽

pp. 173-190

Author(s):

Daniela Mercieca ◽

Duncan P Mercieca ◽

Leisa Randall

Keyword(s):

Academic Achievement ◽

Young People ◽

Local Authority ◽

School Attendance ◽

Educational Experiences ◽

Influential Factors ◽

Background Characteristics ◽

Children And Young People ◽

Looked After Children ◽

Home And School

This qualitative study explores the educational experiences of looked after children and young people in one Scottish local authority. The preoccupations of government are academic achievement and school attendance, but these are not the prime concerns of the children, carers and professionals involved. Moreover, they can be both enhanced and restricted by the background characteristics and care situations of the young people and the responses of schools to their needs and behaviour. Five influential factors emerged from interviews and focus groups with professionals, carers and young people: behaviour; school attendance; carers as educators; friendships; and communication between home and school. Each of them is discussed with extended quotations that convey the voices of participants.

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Healthcare use and costs in the last year of life: a national population data linkage study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002708 ◽

2021 ◽

pp. bmjspcare-2020-002708

Author(s):

Katharina Diernberger ◽

Xhyljeta Luta ◽

Joanna Bowden ◽

Marie Fallon ◽

Joanne Droney ◽

...

Keyword(s):

End Of Life ◽

Secondary Care ◽

Urban Areas ◽

Data Linkage ◽

Hospital Admissions ◽

Community Support ◽

Population Data ◽

Linkage Study ◽

Healthcare Use ◽

Admission Rates

BackgroundPeople who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.ObjectivesTo describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.MethodsRetrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).ResultsSecondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.ConclusionsHospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

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National record-linkage study of hospital admissions for schizophrenia in childhood and adolescence in England

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01817-3 ◽

2021 ◽

Author(s):

Olena Seminog ◽

Uy Hoang ◽

Michael Goldacre ◽

Anthony James

Keyword(s):

Hospital Admissions ◽

Population Based ◽

Linkage Study ◽

Incidence Rates ◽

Childhood And Adolescence ◽

Childhood Onset ◽

Affective Psychosis ◽

Health Service Provision ◽

Childhood Onset Schizophrenia ◽

Icd 10

Abstract Background There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was a male excess. Rates for schizophrenia were stable over time in 5–12 years old. In ages 13–17, rates for schizophrenia decreased between 2001–2004 and 2013–2016 in males, from 6.65 (6.04–7.31) down to 1.40 (1.13–1.73), and in females from 2.42 (2.05–2.83) to 1.18 (0.92–1.48). The hospitalisation rates for schizophrenia and non-affective psychosis, combined, in 13–17 years old decreased in males from 14.20 (13.30–15.14) in 2001–2004 to 10.77 (9.97–11.60) in 2013–2016, but increased in females from 7.49 (6.83–8.20) to 10.16 (9.38–11.00). Conclusions The study confirms that childhood-onset schizophrenia is extremely rare, with only 32 cases identified over a 15-year period in the whole of England. The incidence of schizophrenia and non-affective psychosis increased substantially in adolescence; however, the marked reduction in the proportion of those diagnosed with schizophrenia in this age group suggests a possible change in diagnostic practice.

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Exploiting Administrative Data to Understand the Mental Health of Children Known to Social Services

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1192 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Sarah McKenna ◽

Aideen Maguire ◽

Dermot O'Reilly

Keyword(s):

Mental Health ◽

General Population ◽

Health Outcomes ◽

Social Services ◽

Social Care ◽

Mental Health Outcomes ◽

Health And Social Care ◽

Self Harm ◽

Children In Care ◽

Care System

Background Research has consistently found a high prevalence of mental ill-health among children in out-of-home care. However, results have varied significantly by study location, type of care intervention, sample population and mental health measurement, and concerns have been raised about appropriate reference populations. In addition, little is known about children known to social services who remain with their birth families. Aim To examine mental ill-health amongst children known to social services based on care exposure including those who remain at home, those placed in foster care, kinship care or institutional care and the general population not known to social services. Methods Northern Ireland is unique in that has an integrated health and social care system and holds data centrally on all children known to social services. Social services data (1995-2015) will be linked to hospital discharge data (2010-2015), prescribed medication data (2010-2015), self-harm data (2010-2015) and death records (2010-2015) to investigate mental health outcomes in terms of psychiatric hospital admissions, psychotropic medication uptake, self-harm and suicide. Results Data cleaning has been completed and analysis is underway. Preliminary results will be available by December 2019. Descriptive statistics will provide a mental health profile of children in care compared not only to children in the general population but to those who are known to social services but remain in their own home. Regression models will determine which factors are most associated with poor mental health outcomes. Conclusion This project is the UK’s first population-wide data linkage study examining the mental health of children in the social care system, including looked-after children and those known to social services who remain in their own home. Project partners in the Department of Health recognise the potential of these findings to inform future policy relating to targeting interventions for children in receipt of social care services.

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Social services Interventions and the Mental Health and Mortality of care leavers: a population based data linkage study in Northern Ireland and Finland

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1252 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Aideen Maguire ◽

Anne Kouvonen ◽

Dermot O'Reilly ◽

Hanna Remes ◽

Joonas Pitkänen ◽

...

Keyword(s):

Mental Health ◽

Northern Ireland ◽

Health Outcomes ◽

Social Services ◽

Psychiatric Hospital ◽

Poor Mental Health ◽

Mental Health Outcomes ◽

Care Intervention ◽

Increased Risk ◽

Self Harm

BackgroundResearch has highlighted the poor mental health of looked after children compared to those never in care. However, little is known on what becomes of these children and their mental health trajectories after they leave the care of social services. In addition, previous studies are limited in their ability to differentiate between type of social care intervention received; kinship care, foster care or residential care. AimTo utilise nationwide social services data from two countries (Northern Ireland (NI) and Finland), with similar populations but different intervention policies, linked to a range of demographic and health datasets to examine the mental health outcomes of young adults in the years following leaving care. MethodsData from both countries on children born 1991-2000 were linked to social services data, hospital admissions, prescribed medication data and death records. Mental health outcomes were defined after the age of 18years (when statutory care provision ends) examined by care intervention and included admissions to psychiatric hospital, for self-harm and death by suicide. ResultsThe gender split in care in Finland is reflective of the population but more males are in care in NI. Initial results from Finnish data suggest those exposed to care in childhood have an increased risk of self-harm, psychiatric hospital admission and suicide after the age of 18years compared to those never in care. After adjusting for gender, age of entry to care and deprivation at birth those exposed to any care intervention had 3 times the risk of suicide (HR=3.06, 95% CI 1.18,7.98). Risk increased with duration in care but was equivalent across care intervention types. Analysis on the NI data is underway. ConclusionFull results will be available December 2019 and will explore which care pathways are most associated with poor mental health outcomes informing discussion around intervention opportunities and policy.

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