That's What Friends Are For: Adolescent Peer Social Status, Health-Related Quality of Life and Healthcare Costs

Background Social connections at all stages of life are essential for physical and mental well-being. Of particular importance are social relationships during adolescence that shape adult health behaviors and health outcomes. Objective The aim of this study was to estimate the association between adolescent peer status in school and later-life quality-adjusted life-years (QALYs) and healthcare costs. Methods This study used social network and health outcomes data from Wave I (ages 12-18 years) and Wave III (ages 18-24 years) of the US National Longitudinal Study of Adolescent Health (n = 10,578) to compare QALYs and healthcare costs (in 2012 US$) by adolescent peer status in US schools. Generalized linear models controlled for school fixed effects, individual and family characteristics, and US census block neighborhood effects. Non-parametric bootstrapping accounted for residual skewness in QALYs and healthcare costs. Net monetary benefit (NMB) was calculated by converting adjusted 5-year QALYs into US$ values and subtracting 5-year healthcare costs. NMB was then compared across quintiles of adolescent peer status in school at Wave I. Results Results obtained from non-parametric bootstrapping indicate that adolescents with higher peer status in school experience significantly better health and lower healthcare costs over the next 5 years. At US$ 50,000 per QALY, adolescents with 8 or more friends achievedNMBof US$ 214,300 (95 % CI 212,800- 215,800) over a 5-year span, in comparison to adolescents with 0-1 friends, who attained US$ 209,900 (95 % CI 207,900- 211,700) NMB. This difference translates into approximately US$ 4,440 (95 % CI 2,036- 6,825) per socially disengaged adolescent in additional health costs and/or reduced QALYs over 5 years. Conclusion The study calls for randomized controlled trials targeting adolescent peer group structures in schools as a means to promote better health and lower healthcare costs in adulthood.