The contribution of intellectual abilities to young adult's educational differences in health care use - A prospective cohort study

Objectives: To examine the contribution of 12-year olds' intellectual abilities to educational differences in health care use in young adulthood. The focus on this life-course phase, including the socioeconomic circumstances in which the participants were brought up, allows an in-depth examination of the influence of important social mobility processes.

Methods: A large dataset of 10,400 participants was used to establish the relationship between intellectual abilities in early 2000 (when the participants were 12 years of age) and the educational differences in health care use in 2012 (when the participants were 24 years of age). Outcome variables, i.e. educational attainment and hospital admissions, GP costs, hospital costs, and medication use, were matched from national registers. Logistic regression analysis was used to determine educational differences in health care use, unadjusted and adjusted for the intellectual abilities.

Results: The educational differences in health care use varied by type of usage (e.g. low education - high hospital admission: OR = 2.89, CI = 2.27, 3.67; low education - high medication use: OR = 1.49, CI = 1.30, 1.71). Also, independent of parental socioeconomic status, intellectual abilities contributed substantially to the educational differences in health care use. The percentage reduction of the ORs after adjustment for intellectual abilities ranged between 1.84% and 38% and was on average almost 25%.

Conclusion: Educational differences in health care use in young adulthood appear partly based on prior differences in intellectual abilities. Further research is needed with longer follow-ups during people's life-courses. Additionally, we need more insight in how this evidence can effectively be used in the complex challenge of tackling socioeconomic differences in health.