Educational and health outcomes of children and adolescents receiving antiepileptic medication: Scotland-wide record linkage study of 766 244 schoolchildren

Fleming, M. , Fitton, C. A., Steiner, M. F.C., McLay, J. S., Clark, D., King, A., Mackay, D. F. and Pell, J. P. (2019) Educational and health outcomes of children and adolescents receiving antiepileptic medication: Scotland-wide record linkage study of 766 244 schoolchildren. BMC Public Health, 19, 595. (doi:10.1186/s12889-019-6888-9) (PMID:31101093) (PMCID:PMC6525436)

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Abstract

Background: Childhood epilepsy can adversely affect education and employment in addition to health. Previous studies are small or highly selective producing conflicting results. This retrospective cohort study aims to compare educational and health outcomes of children receiving antiepileptic medication versus peers. Methods: Record linkage of Scotland-wide databases covering dispensed prescriptions, acute and psychiatric hospitalisations, maternity records, deaths, annual pupil census, school absences/exclusions, special educational needs, school examinations, and (un)employment provided data on 766,244 children attending Scottish schools between 2009 and 2013. Outcomes were adjusted for sociodemographic and maternity confounders and comorbid conditions. Results: Compared with peers, children on antiepileptic medication were more likely to experience school absence (Incidence Rate Ratio [IRR] 1.43, 95% CI: 1.38, 1.48), special educational needs (Odds ratio [OR] 9.60, 95% CI: 9.02, 10.23), achieve the lowest level of attainment (OR 3.43, 95% CI: 2.74, 4.29) be unemployed (OR 1.82, 95% CI: 1.60, 2.07), be admitted to hospital (Hazard Ratio [HR] 3.56, 95% CI: 3.42, 3.70), and die (HR 22.02, 95% CI: 17.00, 28.53). Absenteeism partly explained poorer attainment and higher unemployment. Girls and younger children on antiepileptic medication had higher risk of poor outcomes. Conclusions: Children on antiepileptic medication fare worse than peers across educational and health outcomes. In order to reduce school absenteeism and mitigate its effects, children with epilepsy should receive integrated care from a multidisciplinary team that spans education and healthcare.

Item Type:Articles
Additional Information:The study was sponsored by Health Data Research UK.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Pell, Professor Jill and Mackay, Dr Daniel and Fleming, Dr Michael
Authors: Fleming, M., Fitton, C. A., Steiner, M. F.C., McLay, J. S., Clark, D., King, A., Mackay, D. F., and Pell, J. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:BMC Public Health
Publisher:BioMed Central
ISSN:1471-2458
ISSN (Online):1471-2458
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in BMC Public Health 19: 595
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
603761The Scottish eHealth Informatics Research Centre (E-HIRCs)Jill PellMedical Research Council (MRC)MR/K007017/1IHW - PUBLIC HEALTH
3031970Linking education and health data together to study relationships between various health factors and children's educational and health outcomesJill PellMedical Research Council (MRC)MR/S003800/1HW - Public Health