Wales cohort study: school attainment more strongly linked to deprivation than to congenital anomalies
A registry-linked study of children born in Wales in 1998–2007: those with major congenital anomalies met national standards less often, but deprivation was more strongly associated.
Researchers from Swansea University and partner institutions analysed educational attainment of children born in Wales between 1 January 1998 and 31 December 2007, followed up to 31 December 2019. The retrospective population-based study, published in PLoS Medicine, covered more than 256,000 children at age 11 and more than 128,000 at age 16. Children with major congenital anomalies were less likely to reach national academic standards, but attainment was more strongly associated with socioeconomic deprivation, the authors report doi.org
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Data and attainment results
The team used the SAIL Databank to link routinely collected health and education records, including hospital admissions, the Welsh congenital anomaly register, free school meal (FSM) eligibility, special education needs (SEN) provision and exam results. Logistic regression was adjusted for maternal and child deprivation, medicated comorbidities, hospitalisation, gestation length, sex, year of birth and SEN provision.
At age 11, 81.9% (7167/8754) of children with major congenital anomalies and 93.8% (232,450/247,814) of those without attained the established standard (OR 0.30; 95% CI 0.28–0.32). At age 16, 46.8% (2070/4427) with anomalies and 56.1% (69,732/124,300) without achieved five GCSEs at grades C–A*, including English/Welsh, maths and science (OR 0.69; 95% CI 0.65–0.73) doi.org
PLoS Medicinedoi.orgOpen source ↗. After adjustment, and especially after accounting for SEN provision, the differences narrowed: aOR 0.72 (0.66–0.78) at age 11 and 0.93 (0.87–1.00) at age 16
doi.org
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Deprivation and support
In the most deprived quintile of maternal deprivation, 29.7% (307/1034) of children with anomalies and 38.4% (10,875/28,305) of unaffected children achieved the five-GCSE standard. In the least deprived quintile the figures were 67.6% (547/810) and 75.0% (16,978/22,644) doi.org
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Children with anomalies who received maximum SEN support and were eligible for FSM were least likely to meet the standard: 5 of 192 (2.6%), versus 37 of 354 (10.4%) among those not eligible. The strongest associations with the five-GCSE outcome were SEN statements (aOR 0.07), FSM eligibility (aOR 0.39) and epilepsy (aOR 0.60) doi.org
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The authors state that children in the most deprived quintiles or eligible for FSM, with ill-health from anomalies or epilepsy, were two to four times less likely to attain these standards. Limitations include missing data for 15–18% of children, mainly those educated outside mainstream schools, and for some comorbidities; applicability to other settings or countries is uncertain doi.org
PLoS Medicinedoi.orgOpen source ↗.
