Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

Association of asthma severity and educational attainment at age 6-7 years in a birth cohort: population-based record-linkage study

Evans, Annette ORCID:, Farewell, Daniel ORCID:, Demmler, Joanne, Bandyopadhyay, Amrita, Powell, Colin Victor Eric and Paranjothy, Shantini ORCID: 2021. Association of asthma severity and educational attainment at age 6-7 years in a birth cohort: population-based record-linkage study. Thorax 76 (2) 10.1136/thoraxjnl-2020-215422

[thumbnail of thoraxjnl-2020-215422.full.pdf] PDF - Published Version
Available under License Creative Commons Attribution.

Download (549kB)


Background There is conflicting research about the association between asthma and poor educational attainment that may be due to asthma definitions. Our study creates seven categories of current chronic and acute asthma to investigate if there is an association for poorer educational attainment at age 6–7 years, and the role of respiratory infections and school absence. Methods This study used a population- based electronic cross- sectional birth cohort 1998–2005, in Wales, UK, using health and education administrative datasets. Current asthma or wheeze categories were developed using clinical management guidelines in general practice (GP) data, acute asthma was inpatient hospital admissions and respiratory infections were the count of GP visits, from birth to age 6–7 years. We used multilevel logistic regression grouped by schools to ascertain if asthma or wheeze was associated with not attaining the expected level in teacher assessment at Key Stage 1 (KS1) adjusting for sociodemographics, perinatal, other respiratory illness and school characteristics. We tested if absence from school was a mediator in this relationship using the difference method. Results There were 85 906 children in this population representative cohort with 7- year follow- up. In adjusted multilevel logistic regression, only asthma inpatient hospital admission was associated with increased risk for not attaining the expected level at KS1 (adjusted OR 1.14 95% CI (1.02 to 1.27)). Lower respiratory tract infection (LRTI) GP contacts remained an independent predictor for not attaining the expected level of education. Absence from school was a potential mediator of the association between hospital admission and educational attainment. Conclusions Clinicians and educators need to be aware that children who have inpatient hospital admissions for asthma or wheeze, or repeated LRTI, may require additional educational support for their educational outcomes.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:
Publisher: BMJ Publishing Group
ISSN: 0040-6376
Funders: Wellcome Trust
Date of First Compliant Deposit: 7 December 2020
Date of Acceptance: 9 October 2020
Last Modified: 26 Nov 2023 16:18

Citation Data

Cited 4 times in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item Edit Item


Downloads per month over past year

View more statistics