Exploring the Relationship Between Education and Academic Ability in Childhood with Healthcare Utilisation in Adulthood: Findings from the Aberdeen Children of the 1950’s (ACONF)

Abstract

Background: Interactions with secondary care, including multiple outpatient appointments and hospital admissions, represents a common and often burdensome aspect of healthcare utilisation for people living with multiple long-term conditions. Lifecourse factors such as education and academic ability may play a role in shaping the risk of healthcare utilisation later in adulthood. We explored the association between education and academic ability in childhood and both outpatient appointments and hospital admissions in adulthood, accounting for the mediating role of adult factors, including long-term conditions. Method: The analytical sample consisted of 7183 participants in the Aberdeen Children of the 1950s. Three outcomes were measured using routine healthcare records (SMR00/SMR001/SMR004) over a five-year period (2004-2008) using the "burden" cut-offs of: (1) 5 or more outpatient appointments, (2) 2 or more hospital admissions, or (3) 3 or more outpatient appointments plus 1 or more hospital admission. We constructed a childhood (age 6-11) education and academic ability domain and calculated predicted risk scores of the three outcomes for each cohort member. Nested logistic regression models investigate the association between domain predicted risk scores and odds of each of the three outcomes accounting for childhood confounders (maternal age, Rutter behaviour, physical grade at birth, birthweight, sex mothers pre-marital occupation, and fathers social class) and self-reported adult mediators, including body mass index, smoking, employment status, housing tenure, having long-term conditions, and age left school. Result: Adjusting for childhood confounders, lower childhood education and academic ability was associated with 5 or more outpatient appointments (OR1.03 95%CI 1.01-1.05), 2 or more hospital admissions (OR1.04 95%CI 1.03-1.6) and combined 3 or more outpatient appointments plus 1 or more hospital admissions (OR1.04 95%CI 1.02-1.06). Accounting for adult mediators (including long-term conditions), associations remained statistically significant, but their effect sizes were slightly reduced. When age left school was included in the final model, the association between the exposure and the combined outpatient appointments and hospital admissions (OR1.02 95%CI 1.00-1.04), 2 or more hospital admissions (OR1.02 95%CI 0.99-1.05) and 5 or more outpatient appointments (OR1.01 95%CI 0.99-1.03) were attenuated. Conclusions: Education and academic ability in early life may be related to the burden of multiple hospital admissions and outpatient appointments later in life. This relationship was not fully explained by accounting for multiple long-term conditions and other potential mediating factors in adulthood. However, the age at which the participant left school seems to substantially mediate this relationship underscoring the positive impact of time spent in formal education on health during the lifecourse.