Adolescent extracurricular sport participation patterns and later healthcare use and expenditure: an 11-year linked cohort study in Hungary

Abstract Background Evidence on adolescent sport and subsequent healthcare use remains fragmented across individual service sectors. We examined whether extracurricular sport participation patterns across two adolescent assessments were associated with service-specific healthcare use and expenditure through young adulthood. Methods We linked school assessments with population-panel and national health-insurance records to follow 23,283 Hungarian students for 11 years (2011–2021). Regular extracurricular sport was assessed in grades 8 (2008) and 10 (2010) and classified as reported at neither assessment, grade 10 only, grade 8 only, or both assessments. Poisson pseudo-maximum likelihood models estimated associations with annual utilization and expenditure, adjusting for age, sex, family background, and baseline-school and calendar-year fixed effects. False-discovery-rate adjustment covered the 39 main comparisons. Sensitivity analyses examined measured health and socioeconomic selection and alternative specifications. Results The analyses included more than 250,000 person-years, with 99.3% of the complete-case cohort observed in all 11 follow-up years. Compared with students reporting sport at neither assessment, those reporting sport at both had 17% fewer dispensed prescriptions (adjusted rate ratio 0.830, 95% confidence interval 0.770–0.895), fewer primary-care contacts (0.958, 0.934–0.983), and more specialist outpatient visits (1.074, 1.040–1.110). Patient pharmaceutical spending was lower (mean ratio 0.920, 0.882–0.961), but observable publicly reimbursed expenditure showed no clear association (1.000, 0.854–1.170). Grade-8-only participation was also associated with fewer prescriptions (0.880, 0.819–0.945). Prescription estimates changed little after adjustment for inter-wave healthcare use and pre-exposure parental histories; a separate grade-10 cohort showed a smaller association in the same direction. Conclusions Reporting sport at both adolescent assessments was associated with lower prescription and primary-care use alongside higher specialist outpatient use through young adulthood. These contrasting associations highlight the importance of examining service-specific healthcare use alongside aggregate expenditure when evaluating adolescent sport.