Impact of health interventions on educational outcomes: an exemplar study of the management of breech infants. Researchers: Jill Pell, Rachael Wood, Albert King, Danny Mackay, Lucy Reynolds, Carole Morris, Athea Springbett Aim: To conduct the first Scotland-wide linkage of childhood health and education data and demonstrate its utility by studying the impact of guidelines changing the mode of delivery of breech infants on their educational outcomes. Project Outline/Methodology: We linked four databases at the individual level: ScotXed pupil census (2006-2011); SQA qualifications; ScotXed school leavers destination and SMR02 obstetric care. Birth certificates were used to link offspring to mothers and the CHI database to link across the health-education boundary. Twin pregnancies were excluded. Breech vaginal deliveries were compared with breech elective caesarean sections and cephalic (head first) vaginal deliveries. Key Results Of the 674,705 children, 2,130 (0.3%) were breech vaginal deliveries, 13,054 (1.9%) breech elective caesarean sections and 461,571 (68.4%) cephalic vaginal deliveries. The percentage of breech infants delivered vaginally fell from 23% among children who started school in 2006 to 7% among children who started in 2011. Low (0-3) APGAR scores were more common following breech vaginal delivery (4.3%) than cephalic vaginal deliveries and breech caesarean sections (both 0.4%). Records of special educational need were more common (6.5% vs 2.8% & 2.6%) and examination passes above standard grade were less common (41.7% vs 43.2% & 48.6%). The differences persisted after adjusting for potential confounding factors. Overall, 0.4% of records of special education need could be attributed to breech vaginal delivery. This fell from 0.9% among children who started school in 2006 to 0.3% among those who started in 2011.
Conclusions Our project demonstrated the feasibility and usefulness of cross-sectoral record linkage. Specifically, it was technically feasible to link administrative data from the health and education sectors and achieve levels of completeness and accuracy sufficient for research purposes without having children’s names available. What does this study add to the field? Previous studies have linked different datasets held within the health sector using anonymised health identiers such as the CHI number or linked data across sectors using full names. Our study demonstrated that in situations where the latter is not possible (because of lack of consent or access) it is nontheless feasible to undertake useful cross-sectoral linkages. Implications for Practice or Policy The linkage process identified ways of improving the governance structures to avoid duplication and reduce delays. Where to next? Both the causes and outcomes of health extend beyond the health sector into sectors such as education, housing, criminal justice, social services and employment. We should build on the experience gained during our project and link health sector data to a wide range of healthrelevant data held outside the health sector. Further details from: Professor Jill Pell Henry Mechan Professor of Public Health Institute of Health and Wellbeing University of Glasgow 1 Lilybank Gardens Glasgow G12 8RZ
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