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Exploring interaction effects of social determinants of health with hospital admission type on academic performance:
Joanna F Dipnall1,2, Jane Lyons3,4,5,6, Ronan Lyons3,4,6
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia joanna.dipnall@monash.edu.
Insights
Social determinants of health (SDH) significantly impact educational outcomes following childhood hospitalisation. Interventions are needed to mitigate these effects, especially for vulnerable children.
Area of Science:
- Public Health
- Pediatrics
- Educational Psychology
Background:
- Childhood hospitalisation can affect academic performance.
- Socio-demographic factors, known as social determinants of health (SDH), may influence this relationship.
Purpose of the Study:
- To examine how SDH moderate the link between childhood hospitalisation types and academic achievement.
- To identify specific SDH that exacerbate or mitigate the impact of hospitalisation on education.
Main Methods:
- Utilised a large cohort of children in Wales (N=369,310) from 2009-2016.
- Linked multiple data sources via the Secure Anonymised Information Linkage databank.
- Measured binary educational achievement at ages 11, 14, and 16.
Main Results:
- Females generally had better academic achievement than males.
- Injury hospitalisations negatively impacted academic achievement, particularly for males.
- Children from deprived backgrounds and those with special educational needs (SEN) showed lower academic achievement, with injury admissions worsening outcomes for deprived children.
Conclusions:
- SDH play a crucial role in moderating the impact of hospitalisation on educational outcomes.
- Routine in-hospital screening for SDH and targeted post-hospital interventions are recommended.
- Addressing SDH is vital to support educational attainment for hospitalised children.
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.
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