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School academic performance of children hospitalised with a chronic condition

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.


Supplementary
-----a Maternal postcode-level residential socioeconomic disadvantage was measured using the Index of Relative Socioeconomic Disadvantage (IRSD) score. b Maternal postcode-level residential remoteness was determined using the Accessibility/Remoteness Index of Australia (ARIA) classification. c Parental highest educational attainment was measured at the time of the child's NAPLAN Grade 5 test.
--Numbers from 1 to 5 are suppressed from presentation to protect individual confidentiality.

Supplementary
--0 (0) a Maternal postcode-level residential socioeconomic disadvantage was measured using the Index of Relative Socioeconomic Disadvantage (IRSD) score. b Maternal postcode-level residential remoteness was determined using the Accessibility/Remoteness Index of Australia (ARIA) classification. c Parental highest educational attainment was measured at the time of the child's NAPLAN Grade 7 test. --Numbers from 1 to 5 are suppressed from presentation to protect individual confidentiality.   (1.14, 1.37) a The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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, child's year of birth, as well as the total length of duration of hospitalisations (due to any health conditions).
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aOR) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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.  The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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.  The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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.  The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)  (1.84, 3.11) a The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)  (1.78, 3.11) a The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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. c Metabolic/endocrine/digestive/renal/genitourinary conditions BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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. c Metabolic/endocrine/digestive/renal/genitourinary conditions BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)  (1.73, 3.13) a The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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. c Metabolic/endocrine/digestive/renal/genitourinary conditions BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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. c Metabolic/endocrine/digestive/renal/genitourinary conditions BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) The denominators used to calculate the percentages (%) were the number of children who sat in the NAPLAN test (i.e., excluding children who were absent, exempt, or withdrawn from the test). b The adjusted odds ratios (aORs) were derived from the multivariable logistic regression analyses controlling for school-level clustering effect and all the groups of confounders including child's sex, child's perinatal factors (gestational age, birthweight by gestation, plurality, 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. c Metabolic/endocrine/digestive/renal/genitourinary conditions BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)