Health, educational and employment outcomes among children treated for a skin disorder: Scotland-wide retrospective record linkage cohort study of 766,244 children

Michael Fleming*, James S. McLay, David Clark, Albert King, Daniel F. Mackay, Jill P. Pell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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To compare health, educational and employment outcomes of schoolchildren receiving medication for a skin disorder with peers.


This retrospective population cohort study linked eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, school examinations, school absences/exclusions and unemployment to investigate educational (absence, exclusion, special educational need, academic attainment), employment, and health (admissions and mortality) outcomes of 766,244 children attending local authority run primary, secondary and special schools in Scotland between 2009 and 2013.


After adjusting for sociodemographic and maternity confounders the 130,087 (17.0%) children treated for a skin disorder had increased hospitalisation, particularly within one year of commencing treatment (IRR 1.38, 95% CI 1.35-1.41, p


Despite increased hospitalisation, school absenteeism, and special educational need, children treated for a skin disorder did not have poorer exam attainment or employment outcomes. Whilst findings relating to educational and employment outcomes are reassuring, the association with increased risk of mortality is alarming and merits further investigation.

Original languageEnglish
Article number0243383
Number of pages15
JournalPloS ONE
Issue number12
Publication statusPublished - 11 Dec 2020

Bibliographical note

The authors would like to acknowledge the support of the electronic Data Research and Innovation Services (eDRIS) within Public Health Scotland for their involvement in obtaining approvals, provisioning, and linking data and the use of the secure analytical platform within the National Safe Haven.

Funding: The study was sponsored by Health Data Research UK ( (grant reference number MR/S003800/1 awarded to Dr Michael Fleming) 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 Trust. 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.

Data Availability Statement

Data Availability Statement: The datasets generated and analysed during the study are not publicly available. All health data are owned by Public Health Scotland (https://www., and all education data are owned by the
ScotXed Unit, which is part of the Educational Analytical Services Division within the Learning and Justice Directorate of the Scottish Government
( Interested researchers may apply at these sites for data access. The authors applied for permission to access, link and analyse these data and undertook mandatory training in data protection, IT security and information governance. The study was approved by the National Health Service (NHS) Public Benefit
and Privacy Panel and covered by a data processing agreement between Glasgow University and Public Health Scotland and a data sharing agreement between Glasgow University and ScotXed. The electronic Data Research and
Innovation Service (eDRIS) within Public Health Scotland helped the authors obtain approvals, linked the data, and uploaded the final datasets into
a secure analytical platform within the National Safe Haven for the researchers to analyse. The researchers did not receive any special privileges or access to the third party data.


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