# Exploring the relationship between education and academic ability in childhood with healthcare utilization in adulthood: findings from the Aberdeen Children of the 1950s (ACONF)

## TL;DR

This study finds that childhood education and academic ability are linked to lower healthcare use in adulthood, with school leaving age playing a key role.

## Contribution

The study demonstrates that early education and academic ability influence adult healthcare utilization, partially mediated by school leaving age.

## Key findings

- Lower childhood education and academic ability were associated with more outpatient appointments and hospital admissions in adulthood.
- The associations remained significant after adjusting for adult mediators, but were reduced.
- Including school leaving age in the model attenuated the relationship between childhood education and adult healthcare use.

## Abstract

We explored the association between education and academic ability in childhood and both outpatient appointments and hospital admissions in adulthood, accounting for adult factors, including long-term conditions. The analytical sample consisted of 7183 participants in the Aberdeen Children of the 1950s. Three outcomes were measured using routine Scottish medical records over a five-year period (2004–2008): (1) ≥5 outpatient appointments, (2) ≥2 hospital admissions, or (3) ≥3 outpatient appointments plus ≥1 hospital admission. We constructed a childhood (age 6–11) education and academic ability domain and calculated predicted risk scores of the three outcomes for each cohort member. Nested logistic regression models investigate the association between domain predicted risk scores and odds of each of the three outcomes accounting for childhood confounders and self-reported adult mediators. Adjusting for childhood confounders, lower childhood education and academic ability were positively associated with ≥5 outpatient appointments (OR 1.03, 95% CI 1.01–1.05), ≥2 hospital admissions (OR 1.04, 95% CI 1.03–1.6), and ≥3 outpatient appointments plus ≥1 hospital admissions (OR 1.04, 95% CI 1.02–1.06). Accounting for adult mediators, associations remained statistically significant, but their effect sizes were reduced. When school leaving age was included in the model, the association between the exposure and all three outcomes were attenuated. Education and academic ability in early life may be related to the burden of multiple hospital admissions and outpatient appointments later in life. However, the age at which the participant left school seems to substantially mediate this relationship underscoring the positive impact of time spent in education.