Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683,716 children

Michael Fleming (Corresponding Author), Catherine A Fitton, Markus F C Steiner, James S McLay, David Clark, Albert King, Daniel F Mackay, Jill P Pell

Research output: Contribution to journalArticlepeer-review

37 Citations (Scopus)
5 Downloads (Pure)


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.

Original languageEnglish
Article number1802309
Number of pages10
JournalEuropean Respiratory Journal
Issue number3
Early online date5 Sept 2019
Publication statusPublished - Sept 2019

Bibliographical note

This study formed part of a wider PhD thesis undertaken by M. Fleming within the University of Glasgow (Glasgow, UK) and published in 2017. Certain sections of this paper appear in the thesis [26].

Support statement: Supported by Health Data Research UK ( (grant reference number MR/S003800/1), which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation, and Wellcome. The sponsor and funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication. Funding information for this article has been deposited with the Crossref Funder Registry.


  • asthma
  • educational outcomes
  • health
  • population cohort
  • record linkage


Dive into the research topics of 'Educational and health outcomes of children treated for asthma: Scotland-wide record linkage study of 683,716 children'. Together they form a unique fingerprint.

Cite this