There are many more Health Data Research UK publications that are still behind paywalls for the time being, but we have chosen to celebrate our 100th open access publication as a token of our support for open access in science – free, unrestricted online access to research outputs such as journal articles and books, open to all, with no access fees – particularly when the research involves patient data or is publicly funded.
Professor Jill Pell, Associate Director for HDR UK Scotland based at the Institute of Health and Wellbeing, University of Glasgow, Scotland, and her team published research investigating the association between childhood Type 1 Diabetes and educational and health outcomes. They linked health records with educational outcome records to identify schoolchildren with diabetes across Scotland and investigate whether there is a link between insulin-dependent Type 1 Diabetes and both performance at school and subsequent health outcomes.
Jill and colleagues, primarily Dr Michael Fleming, UKRI Innovation / Rutherford Fund Fellow at Health Data Research UK, reported that children with diabetes were more likely to die, be admitted to hospital, be absent from school, and have learning difficulties compared to peers. They also found that, among children with diabetes, higher average blood glucose level was associated with increased absenteeism and school exclusion, poorer academic attainment and higher risk of unemployment. These results are important because the onset of type 1 diabetes peaks between 10 and 14 years of age, when the affected individuals are still at school.
Previous studies have reported increased morbidity, mortality and school absence amongst children with Type 1 Diabetes. Whilst evidence around academic attainment has been more conflicting, studies have also reported negative effects on cognitive function. However, previous studies have generally been limited by small sample size, lack of a control group, or by ascertaining cases from hospitalised cohorts which were likely limited to the most severe cases of diabetes and therefore unrepresentative of the whole population.
This nationwide study is the largest to date, and the first to investigate a wide range of health and educational outcomes together within the same cohort, revealing associations with children’s performance at school and beyond. The study analysed records of 800,000 schoolchildren attending local authority primary, secondary and special schools in Scotland between 2009 and 2013 inclusive. A diagnosis of diabetes was confirmed by insulin prescription, validated against the national diabetes register, to compare outcomes of children with diabetes versus their peers. The large cohort size enabled the researchers to adjust for a range of potential sociodemographic, obstetric, and maternal confounders and no previous studies have investigated as wide a range of outcomes. This demonstrates the power of health data research at scale.
Michael Fleming, UKRI Innovation / Rutherford Fund Fellow at Health Data Research UK, University of Glasgow said:
“Type 1 Diabetes is a chronic disease that exerts both a physical and a mental burden on those affected. Our research is important because it demonstrates that, in addition to suffering poorer health outcomes compared to their peers, children with diabetes also have poorer educational outcomes, which can further negatively affect their future prospects and therefore their health and wellbeing. Interventions are therefore required to help and support children with diabetes, monitor their HbA1c, and minimise school absence to ensure that it does not adversely affect educational attainment and other outcomes. To help with this it is important to further understand the mechanisms underpinning the observed associations. These are likely to involve both direct and indirect factors.”
This study pushed the boundaries in the number and variety of databases it was able to link at an individual level, including health records (dispensed prescriptions, diabetes register, maternity records, and hospital admissions) and education records (annual pupil census, school absences/exclusions, school examinations, and unemployment) in order to draw its conclusions.
This type of research is important to enable public health interventions to be put in place to reduce the impact of this kind of health condition on the lives of those affected. In this case, the authors recommend that interventions are required to minimise school absence and ensure that it does not affect educational attainment. HDR UK facilitates this study and others like it to bring to light relationships between disease and human behaviour that can be actioned to improve the health of the public. It is one of our ambitions to do this kind of analysis on the whole 66m population of the UK within the next 10 years.