School academic performance of children hospitalised with a chronic condition

Abstract

Objective: To examine academic outcomes among children hospitalised with a chronic health condition.

Design: Population-level birth cohort.

Setting: New South Wales, Australia.

Participants: 397 169 children born 2000-2006 followed up to 2014.

Intervention/exposure: Hospitalisations with a chronic condition.

Main outcome measures: Academic underperformance was identified as 'below the national minimum standard' (BNMS) in five literacy/numeracy domains using the national assessment (National Assessment Program-Literacy and Numeracy) data. Multivariable logistic regression assessed the adjusted ORs (aORs) of children performing BNMS in each domain at each grade (grades 3, 5 and 7, respectively).

Results: Of children hospitalised with a chronic condition prior to National Assessment Program-Literacy and Numeracy (NAPLAN) (16%-18%), 9%-12% missed ≥1 test, with a maximum of 37% of those hospitalised ≥7 times, compared with 4%-5% of children not hospitalised. Excluding children who missed a NAPLAN test, more children hospitalised with a chronic condition performed BNMS across all domains and grades, compared with children not hospitalised (eg, for BNMS in reading at grade 3: n=2588, aOR 1.35 (95% CI 1.28 to 1.42); for BNMS in numeracy at grade 3: n=2619, aOR 1.51 (95% CI 1.43 to 1.59)). Increasing frequency and bed-days of hospitalisation were associated with 2-3 fold increased odds of performing BNMS across all domains and grades. Children hospitalised with mental health/behavioural conditions had the highest odds of performing BNMS across all domains at each grade.

Conclusions: Children hospitalised with a chronic condition underperform academically across literacy/numeracy domains at each school grade. Health and educational supports are needed to improve these children's academic outcomes.

Keywords: epidemiology; health services research.

Figure 1

Proportion of children missing a NAPLAN test at grade 3 due to any reason for those hospitalised with a chronic condition and those without any recorded hospitalisation (reference) prior to the test. Comparison group is children without any recorded hospitalisation prior to the test. We confirm that we have permission to reuse the image, because this was created by the first author. NAPLAN, National Assessment Program-Literacy and Numeracy.

Figure 2

Adjusted ORs (aORs) of children performing BNMS across NAPLAN domains by frequency of hospitalisations with a chronic condition. Comparison group is children without any recorded hospitalisation prior to the test. The aORs were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all covariates including child’s sex, child’s perinatal factors (gestational age, birth weight by gestation, plurality and Apgar score), maternal and familial socioeconomic factors (maternal parity, gestation of first antenatal care, maternal smoking, maternal age at child’s birth, maternal country of birth, Aboriginality, maternal postcode-level residential socioeconomic status and remoteness at child’s birth and parental highest educational attainment), child’s age at the NAPLAN test and child’s year of birth. We confirm that we have permission to reuse the image, because this was created by the first author. BNMS, below the national minimum standard; NAPLAN, National Assessment Program-Literacy and Numeracy.

Figure 3

Adjusted ORs (aORs) of children performing BNMS across NAPLAN domains by duration (bed-days) of hospitalisations with a chronic condition. Comparison group is children without any recorded hospitalisation prior to the test. The aORs were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all covariates including child’s sex, child’s perinatal factors (gestational age, birth weight by gestation, plurality and Apgar score), maternal and familial socioeconomic factors (maternal parity, gestation of first antenatal care, maternal smoking, maternal age at child’s birth, maternal country of birth, Aboriginality, maternal postcode-level residential socioeconomic status and remoteness at child’s birth, and parental highest educational attainment), child’s age at the NAPLAN test and child’s year of birth. We confirm that we have permission to reuse the image, because this was created by the first author. BNMS, below the national minimum standard; NAPLAN, National Assessment Program-Literacy and Numeracy.