Exploring interaction effects of social determinants of health with hospital admission type on academic performance: a data linkage study

Joanna F Dipnall; Jane Lyons; Ronan Lyons; Shanthi Ameratunga; Marianna Brussoni; Frederick P Rivara; Fiona Lecky; Amy Schneeberg; James E Harrison; Belinda J Gabbe

doi:10.1136/archdischild-2024-327096

Exploring interaction effects of social determinants of health with hospital admission type on academic performance: a data linkage study

Arch Dis Child. 2024 Nov 7:archdischild-2024-327096. doi: 10.1136/archdischild-2024-327096. Online ahead of print.

Authors

Joanna F Dipnall^{1

2}, Jane Lyons^{3

4

5

6}, Ronan Lyons^{3

4

6}, Shanthi Ameratunga^{3

7

8}, Marianna Brussoni^{9

10

11}, Frederick P Rivara¹², Fiona Lecky^{13

14}, Amy Schneeberg^{10

15}, James E Harrison¹⁶, Belinda J Gabbe^{3

4}

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia [email protected].
² Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia.
³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK.
⁵ Administrative Data Research Wales, Wales, UK.
⁶ National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK.
⁷ School of Population Health, University of Auckland, Auckland, New Zealand.
⁸ Population Health Gain, Te Whatu Ora (Health New Zealand) - Service Improvement and Innovation, Auckland, New Zealand.
⁹ Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁰ British Columbia Children's Hospital Research Institute, British Columbia Injury Research and Prevention Unit, Vancouver, British Columbia, Canada.
¹¹ Human Early Learning Partnership, University of British Columbia, Vancouver, British Columbia, Canada.
¹² Departments of Pediatrics and Epidemiology, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.
¹³ Centre for Urgent and Emergency Care Research, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
¹⁴ Emergency Department, Salford Royal Hospital, Salford, UK.
¹⁵ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁶ Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Austrlia.

PMID: 39515833
DOI: 10.1136/archdischild-2024-327096

Abstract

Objective: To investigate the moderating effects of socio-demographic social determinants of health (SDH) in the relationship between types of childhood hospitalisation (ie, none, injury, non-injury, injury+non-injury) and academic performance.

Design, setting and patients: Children residing in Wales 2009-2016 (N=369 310). Secure Anonymised Information Linkage databank linked Tagged Electronic Cohort Cymru (five data sources) from the Wales Electronic Cohort for Children.

Main outcome measure: Binary educational achievement (EA) measured across three key educational stage time points: grade 6 (mean age 11 years, SD 0.3), 9 (mean age 14 years, SD 0.3) and 11 (mean age 16 years, SD 0.3).

Results: Of the 369 310 children, 51% were males, 25.4% of children were born in the lowest two Townsend deciles. Females were more likely to meet EA than males (adjusted risk ratio (aRR) (95% CI): 1.047 (1.039, 1.055)). EA was lower for injury admissions in males and any admission type in females (interactions: female×non-injury 0.982 (0.975, 0.989); female×injury+non-injury 0.980 (0.966, 0.994)). Children born into a more deprived decile were less likely to achieve EA (0.979 (0.977, 0.980)) and worsened by an injury admission (interactions: townsend×injury 0.991 (0.988, 0.994); Townsend×injury+non-injury 0.997 (0.994, 1.000)). Children with special educational needs (SEN) were less likely to meet EA (0.471 (0.459, 0.484) especially for an injury admission (interactions: SEN×injury 0.932 (0.892, 0.974)).

Conclusion: SDH moderated the impact of hospital admission type on educational outcomes prompting future investigation into the viability of in-hospital routine screening of families for SDH and relevant post-hospital interventions to help reduce the impact of SDH on educational outcomes post-hospitalisation.

Keywords: Adolescent Health; Child Health; Emergency Service, Hospital; Healthcare Disparities; Paediatrics.