Open AccessHealth, educational and employment outcomes among children treated for a skin disorder: Scotland-wide retrospective record linkage cohort study of 766,244 children
Author(s) -
Michael Fleming,
James S. McLay,
David Clark,
Albert King,
Daniel Mackay,
Jill P. Pell
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0243383
Subject(s) - medicine , retrospective cohort study , educational attainment , absenteeism , unemployment , demography , record linkage , medical prescription , cohort , confounding , cohort study , population , pediatrics , family medicine , environmental health , psychology , surgery , nursing , social psychology , sociology , economics , economic growth
Background To compare health, educational and employment outcomes of schoolchildren receiving medication for a skin disorder with peers. Methods This retrospective population cohort study linked eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, school examinations, school absences/exclusions and unemployment to investigate educational (absence, exclusion, special educational need, academic attainment), employment, and health (admissions and mortality) outcomes of 766,244 children attending local authority run primary, secondary and special schools in Scotland between 2009 and 2013. Results After adjusting for sociodemographic and maternity confounders the 130,087 (17.0%) children treated for a skin disorder had increased hospitalisation, particularly within one year of commencing treatment (IRR 1.38, 95% CI 1.35–1.41, p<0.001) and mortality (HR 1.50, 95% CI 1.18–1.90, p<0.001). They had greater special educational need (OR 1.19, 95% CI 1.17–1.21, p<0.001) and more frequent absences from school (IRR 1.07, 95% CI 1.06–1.08, p<0.001) but did not exhibit poorer exam attainment or increased post-school unemployment. The associations remained after further adjustment for comorbid chronic conditions. Conclusions Despite increased hospitalisation, school absenteeism, and special educational need, children treated for a skin disorder did not have poorer exam attainment or employment outcomes. Whilst findings relating to educational and employment outcomes are reassuring, the association with increased risk of mortality is alarming and merits further investigation.