Social Science & Medicine · Jun 4, 2026

Examining associations between school suspension and expulsion in early life and later-life cognitive health: A mediation analysis of lifecourse educational pathways

By Duarte CD, Khadka A, Ahern J et al.

Exclusionary school discipline (e.g., suspension, expulsion) - a documented facilitator of structural marginalization - is associated with lower midlife cognitive health, a predictor of later-life dementia risk. No studies have examined through which mechanisms this might unfold. Using National Longitudinal Survey of Youth (1979) data, a study of US adults followed prospectively since adolescence (N = 8138), we evaluated if lifecourse educational trajectories mediate this relationship. First, we estimated associations between exposure to early-life exclusionary discipline (no vs. any suspension/expulsion prior to 1980) and participants' age 14-48 educational trajectories. We then evaluated whether these lifecourse educational trajectories mediate the association between exclusionary school discipline and later-life cognitive health (global cognition z-score; mean age at cognitive assessment: 55.2 years) using inverse odds weighting to estimate total, natural direct (NDE), and natural indirect (NIE) effects. Participants who were men, Black, had lower childhood socioeconomic status, or were born in the southern US were overrepresented in early-life exclusionary discipline. Suspension/expulsion was associated with educational trajectories characterized by lower attainment (e.g., less-than high school, HS), completed later in life (e.g., General Educational Development HS equivalency exam, GED, after long delay/late 30s), and following early exit from HS without a diploma (e.g., some college after GED). Suspension/expulsion was also associated with lower later-life global cognition (z-score mean difference: -0.226; 95%CI: -0.230, -0.223) and this relationship was mediated by the education trajectories (mediation proportion: 47.2%; NIE: -0.107, 95%CI: -0.110, -0.104; NDE: -0.120, 95%CI: -0.124, -0.115). Findings suggest exclusionary school discipline - an exposure modifiable at multiple policy levels - is associated with later-life cognitive health by interrupting educational progress or pushing students out of the education system altogether.

doi.org/10.1016/j.socscimed.2026.119475 Open access PubMed 42284660 Populations