Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683716 children
Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683716 children
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DOI：
10.1183/13993003.02309-2018
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发表时间：
2019-09-01
影响因子：
24.3
通讯作者：
Pell, Jill P.
中科院分区：
文献类型：
--
作者：
Fleming, Michael;Fitton, Catherine A.;Pell, Jill P.
背景：全球儿童哮喘患病率呈上升趋势。这种情况会影响身体和心理社会的发病率；因此，对健康和教育结果的广泛影响是可信的。方法：将苏格兰范围内的8个数据库联系起来，提供2009至2013年间在苏格兰学校就读的683716名儿童的数据，这些数据库涵盖处方、住院、分娩记录、死亡证明、年度小学生普查、考试、缺课/缺课和失业。结果：45900名哮喘儿童(6.0%)的住院风险增加，尤其是在治疗的第一年内(发病率比1.98，95%可信区间1.93~2.04)，死亡率也有所增加(发病率比1.77，95%可信区间1.30~2.40)。心理(OR 1.76，95%CI 1.49~2.08)和身体(OR 2.76，95%CI 2.57~2.95)健康原因的特殊教育需求较多，学校考试成绩较差(OR 1.11，95%CI 1.06~1.16)。较高的缺勤率(发病率比1.25，95%可信区间1.24-1.26)部分解释了他们的学业成就较差。结论：接受治疗的哮喘儿童的教育和健康结局比同龄人差。应考虑采取教育干预措施，减轻缺勤的不利影响。
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.