Chronic health conditions and school performance among children and youth

Abstract

Purpose

Chronic health conditions are common and increasing among U.S. children and youth. We examined whether chronic health conditions are associated with low school performance.

Methods

This retrospective cohort study of 22,730 children and youth (grades 2–11) in San Jose, California, was conducted from 2007 through 2010. Health conditions were defined as chronic if reported in each of the first 2 years, and school performance was measured using standardized English language arts (ELA) and math assessments.

Results

Chronic health conditions were independently associated with low ELA and math performance, irrespective of ethnicity, socioeconomic status, or grade level. Adjusted odds ratios for the association between any chronic health condition and low (“basic or below”) performance were 1.25 (95% confidence interval [CI], 1.16–1.36; P < .001) for ELA and 1.28 (95% CI, 1.18–1.38; P < .001) for math, relative to students without reported health conditions. Further adjustment for absenteeism had little effect on these results. The strongest associations were found for ADHD, autism, and seizure disorders, whereas a weak association was found for asthma before but not after adjusting for absenteeism, and no associations were found for cardiovascular disorders or diabetes.

Conclusions

Chronic neurodevelopmental and seizure disorders, but not cardiovascular disorders or diabetes, were independently associated with low school performance among children and youth.

Introduction

Chronic health conditions have been measured in various ways [1], but are often defined as conditions that have lasted or are expected to last more than 3 months [2] or 1 year [3], and involve functional limitations or medical needs greater than usual for one's age. By virtually any measure, chronic health conditions have increased among children and youth in the United States during the past 50 years [4]. The prevalence of chronic conditions resulting in physical disability has increased from 1.8% to more than 7% since 1960, now affecting more than 5 million children and youth [5]. Other measures including conditions without physical disability indicate a prevalence of at least 15% to 18% [4]. Although some of the reported increases may be owing to changes in definitions and ascertainment, a substantial part has resulted from improved survival of children with serious congenital or acquired illnesses [1], as well as increasing incidence of neurodevelopmental disorders and asthma, which now affect 15% [6] and 9% [7] of U.S. children, respectively. The growth of such conditions is expected to have major economic and social consequences as these individuals enter adulthood, owing to higher health care expenditures and lower workforce participation and productivity [4].

Although the physical effects of chronic health conditions have been widely studied [1], less is known about cognitive outcomes such as school performance. These outcomes are particularly important because educational attainment is itself a determinant of future health [8]. To the extent that chronic health conditions in early life adversely affect school performance, a reciprocal relationship between education and health is reinforced, leading to greater disparities in each [9]. With few exceptions like attention-deficit hyperactivity disorder (ADHD) [10], [11], [12] and autism [13], the academic effects of chronic conditions are unclear because most studies have been small and have yielded inconsistent results. Some [14], [15] but not all [16], [17], [18], [19], [20] authors have reported that asthma is associated with low academic performance. Studies of other conditions, including seizure disorders and diabetes, have also yielded discrepant results [21], [22]. These studies have had various limitations, including insufficient sample sizes, inadequate adjustment for confounding, and the inability to examine these associations across a wide range of ages among children and youth.

We sought to address these limitations by conducting the largest study of this issue to date. A cohort of 22,730 children and youth was followed up from 2007 through 2010 to examine (1) whether chronic health conditions were associated with absenteeism, after adjusting for potential sociodemographic confounders and (2) whether chronic health conditions were associated with low school performance, after adjusting for potential sociodemographic confounders and further adjusting for absenteeism. We hypothesized that chronic health conditions would be independently associated with increased absenteeism, and with low school performance after adjusting for potential confounders and absenteeism.