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.
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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)