Hospital admissions and school dropout: a retrospective cohort study of the 'selection hypothesis'

Background: School dropout is an important predictor of poor health and of high relevance for public health (in accord with the 'causation hypothesis'). Rather than examining how dropout affects health, we set out to examine how poor health might affect school dropout (in accord with the 'selection hypothesis'). Hospital admissions are potentially indicative of more serious disease and might be expected to result in learning backlogs. Methods: Longitudinal data of the Dutch Secondary Education Pupil Cohort 1993 (VOCL'93) and the National Medical Registration (LMR) were combined. The study population consisted of 16 239 pupils who were followed from first grade at secondary school until they left fulltime education. Pupils were monitored regarding both their educational careers and their hospital admissions. Nine percent had a hospital admission and 10% became a school dropout. Results: Hospital admissions were only predictive of later school dropout for pupils starting in the highest type of secondary education (pre-university education) [OR 1.54 (95% CI 1.05-2.26)], not for pupils with lower educational levels. Pre-university pupils who had been hospitalized for more than 9 days [OR 2.34 (95% CI 1.08-5.09)] or who were hospitalized more than three times [OR 4.20 (95% CI 1.75-10.04)] had particularly heightened odds of school dropout. Conclusion: Our findings further support the 'selection hypothesis' and confirm the relevance of dropout for public health. Public health workers and educational professionals should probably aim at intensified monitoring of children who have been hospitalized and simultaneously aim at improving accessibility to (higher quality) education in the hospital.