Impact of Asthma on Educational Attainment in a Socioeconomically Deprived Population: A Study Linking Health, Education and Social Care Datasets

PLOS ONE, Dec 2019

Background Asthma has the potential to adversely affect children's school examination performance, and hence longer term life chances. Asthma morbidity is especially high amongst UK ethnic minority children and those experiencing social adversity, populations which also have poor educational outcomes. We tested the hypothesis that asthma adversely affects performance in national school examinations in a large cohort from an area of ethnic diversity and social deprivation. Methods and Findings With a novel method (using patient and address-matching algorithms) we linked administrative and clinical data for 2002–2005 for children in east London aged 5–14 years to contemporaneous education and social care datasets. We modelled children's performance in school examinations in relation to socio-demographic and clinical variables. The dataset captured examination performance for 12,136 children who sat at least one national examination at Key Stages 1–3. For illustration, estimates are presented as percentage changes in Key Stage 2 results. Having asthma was associated with a 1.1% increase in examination scores (95%CI 0.4 to 1.7)%,p = 0.02. Worse scores were associated with Bangladeshi ethnicity −1.3%(−2.5 to −0.1)%,p = 0.03; special educational need −14.6%(−15.7 to −13.5)%,p = 0.02; mental health problems −2.5%(−4.1 to −0.9)%,p = 0.003, and social adversity: living in a smoking household −1.2(−1.7 to −0.6)%,p<0.001; living in social housing −0.8%(−1.3 to −0.2)% p = 0.01, and entitlement to free school meals −0.8%(−1.5 to −0.1)%,p<0.001. Conclusions Social adversity and ethnicity, but not asthma, are associated with poorer performance in national school examinations. Policies to improve educational attainment in socially deprived areas should focus on these factors.

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Impact of Asthma on Educational Attainment in a Socioeconomically Deprived Population: A Study Linking Health, Education and Social Care Datasets

Education and Social Care Datasets. PLoS One 7(11): e43977. doi:10.1371/journal.pone.0043977 Impact of Asthma on Educational Attainment in a Socioeconomically Deprived Population: A Study Linking Health, Education and Social Care Datasets Pat Sturdy Stephen Bremner Gill Harper Les Mayhew Sandra Eldridge John Eversley Aziz Sheikh Susan Hunter Kambiz Boomla Gene Feder Keith Prescott Chris Griffiths Monica Uddin, Wayne State University, United States of America Background: Asthma has the potential to adversely affect children's school examination performance, and hence longer term life chances. Asthma morbidity is especially high amongst UK ethnic minority children and those experiencing social adversity, populations which also have poor educational outcomes. We tested the hypothesis that asthma adversely affects performance in national school examinations in a large cohort from an area of ethnic diversity and social deprivation. Methods and Findings: With a novel method (using patient and address-matching algorithms) we linked administrative and clinical data for 2002-2005 for children in east London aged 5-14 years to contemporaneous education and social care datasets. We modelled children's performance in school examinations in relation to socio-demographic and clinical variables. The dataset captured examination performance for 12,136 children who sat at least one national examination at Key Stages 1-3. For illustration, estimates are presented as percentage changes in Key Stage 2 results. Having asthma was associated with a 1.1% increase in examination scores (95%CI 0.4 to 1.7)%,p = 0.02. Worse scores were associated with Bangladeshi ethnicity 21.3%(22.5 to 20.1)%,p = 0.03; special educational need 214.6%(215.7 to 213.5)%,p = 0.02; mental health problems 22.5%(24.1 to 20.9)%,p = 0.003, and social adversity: living in a smoking household 21.2(21.7 to 20.6)%,p,0.001; living in social housing 20.8%(21.3 to 20.2)% p = 0.01, and entitlement to free school meals 20.8%(21.5 to 20.1)%,p,0.001. Conclusions: Social adversity and ethnicity, but not asthma, are associated with poorer performance in national school examinations. Policies to improve educational attainment in socially deprived areas should focus on these factors. - Funding: This study was supported by Asthma UK (Health Charity) project 05/048. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Asthma is the commonest long-term disorder affecting children in the UK and most economically-developed countries. [1] Health status and education of children are closely linked. [2] In a recent review on asthma in children [3], no mention was made of asthmas impact on educational performance, an important omission given the increasing recognition for a move to assessing impact of long-term conditions on patient/parental-centred outcomes. There is debate about the possible effect of asthma on childrens educational performance, with studies producing conflicting results, some finding an adverse effect [4,5,6], some no effect [7,8,9,10], and others a beneficial effect. [11,12] Taras [13] proposed asthma was related to poor exam performance and called for evaluations focusing on populations at increased risk. Populations at particular risk are children of low socioeconomic status and children of south Asian and Black ethnic minority origin: both experience increased asthma morbidity and poor educational attainment. [14,15] However, no study has examined the impact of asthma on school examination performance in children from large ethnically diverse socio-economically deprived populations. Results of such a study would help guide policy by identifying and then targeting potentially modifiable factors that relate to poor educational attainment. We therefore tested the hypothesis that asthma worsens educational attainment in children from socio-economically deprived, multiethnic populations. Tower Hamlets, in east London, is the UKs third most deprived borough. [16] Its population is largely White or Bangladeshi, providing an ideal setting for this study. The study received Local Research Ethics Committee approval. Study participants Fifteen general practices in Tower Hamlets were approached and 14 participated in this cross-sectional study covering 1st July 2001 to 30th June 2005. These practices provided care for almost 50% of the boroughs children. Inclusion criteria for practices were use of the EMIS computer system (one of the main software suppliers to UK general practices), [17] and a list of over 5,000 patients (to maximise our dataset). We undertook MIQUEST (Morbidity Information QUery and Export SynTax) searches on all patients aged under 20 on 30 June 2005. For confidentiality, clinical data were collected separately from administrative data. We included all who had sat at least one national Ke (...truncated)


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Pat Sturdy, Stephen Bremner, Gill Harper, Les Mayhew, Sandra Eldridge, John Eversley, Aziz Sheikh, Susan Hunter, Kambiz Boomla, Gene Feder, Keith Prescott, Chris Griffiths. Impact of Asthma on Educational Attainment in a Socioeconomically Deprived Population: A Study Linking Health, Education and Social Care Datasets, PLOS ONE, 2012, Volume 7, Issue 11, DOI: 10.1371/journal.pone.0043977