Association of asthma severity and educational attainment at age 6-7 years in a birth cohort: Population based record-linkage study

Annette Evans* (Corresponding Author), Daniel Farewell, Joanne Demmler, Amrita Bandyopadhyay, Colin Powell, Shantini Paranjothy

*Corresponding author for this work

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There is conflicting research about the association between asthma and poor educational attainment that may be due to asthma definitions. Our study creates seven categories of current chronic and acute asthma to investigate if there is an association for poorer educational attainment at age 6–7 years, and the role of respiratory infections and school absence.
A population-based electronic cross-sectional birth cohort 1998-2005, in Wales, UK, using health and education administrative datasets. Current asthma or wheeze categories were developed using clinical management guidelines in General Practice (GP) data, acute asthma was inpatient hospital admissions
and respiratory infections were the count of GP visits, from birth to age 6-7 years. We used multilevel logistic regression grouped by schools to ascertain if asthma or wheeze was associated with not attaining the expected level in teacher assessment at Key Stage 1 (KS1) adjusting for socio14 demographics, perinatal, other respiratory illness, and school characteristics. We tested if absence from school was a mediator in this relationship using the difference method.
There were 85,906 children in this population representative cohort with 7 years follow-up. In adjusted multilevel logistic regression only asthma inpatient hospital admission was associated with increased risk for not attaining the expected level at KS1 (aOR 1·14 95% CI (1·02-1·27)). Lower respiratory tract infection (LRTI) GP contacts remained an independent predictor for not attaining the expected level of education. Absence from school was a potential mediator of the association between hospital admission and educational attainment.
Clinicians and educators need to be aware that children who have inpatient hospital admissions for asthma or wheeze, or repeated LRTI may require additional educational support for their educational outcomes.
Original languageEnglish
Pages (from-to)116-125
Number of pages10
Early online date11 Nov 2020
Publication statusPublished - 15 Jan 2021

Bibliographical note

We are very grateful to David Fone for help in the concept of the study. SP received a Translational Health Research Platform Award from the National Institute for Social Care and Health Research (grant reference: TPR08-
15 006) for the development of WECC.JD was supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. SP was an applicant in the Centre for the Improvement of Population Health through E-records Research (CIPHER), one of four UK e-health Informatics
Research Centres funded by a joint investment from: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish
Government Health Directorates), the Economic and Social Research Council, the
Engineering and Physical Sciences Research Council, the Medical Research Council,the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (Grant reference: 7 MR/K006525/1).


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