背景:英国出生的千名儿童中有9名患有先天性心脏病,25万成年人生活在这种情况下。这项研究旨在调查苏格兰学龄儿童先天性心脏病与教育结果之间的关系。
方法:将常规健康和教育数据库链接起来,以产生所有在苏格兰出生并参加地方当局小学的单胎儿童的队列,次要,或苏格兰的特殊学校在2009年至2013年之间的某个时候。将该队列中患有先天性心脏病的儿童与未受先天性疾病影响的儿童进行比较。调查的结果是特殊教育需要(SEN),旷工,排除,学术成就,和失业。所有分析均针对社会人口统计学和产妇混杂因素进行了调整。缺勤被认为是与成就和失业相关的中介因素。
结果:在715,850名儿童中,6,295(0.9%)患有先天性心脏病,4,412(6.1%)患有孤立性先天性心脏病。先天性心脏病和孤立性先天性心脏病均与随后的特殊教育需要显着相关(分别为OR3.45,95%CI3.26-3.65,p<0.001和OR1.98,95%CI1.84-2.13,p<0.001),旷工(IRR1.13,95%CI1.10-1.16,p<0.001和IRR1.10,95%CI1.06-1.13,p<0.001),和低学业成绩(分别为OR1.69,95%CI1.39-2.07,p<0.001和OR1.35,95%CI1.07-1.69,p=0.011)。先天性心脏病和孤立的先天性心脏病均与学校排斥无关。只有先天性心脏病(OR1.21,95%CI1.03-1.42,p=0.022),而不是孤立的先天性心脏病与失业有关。当缺席天数包括在调查达标和失业的分析中时,结论没有改变。
结论:患有先天性心脏病的儿童有更大的特殊教育需要,入学率较低,与同龄人相比,考试成绩较低,失业率较高。除了医疗保健支持,受影响的儿童需要教育支持,以避免对他们的长期福祉产生额外影响。
BACKGROUND: Nine in every thousand
children born in the United Kingdom have congenital heart disease, and 250,000 adults are living with the condition. This study aims to investigate the associations between congenital heart disease and educational outcomes among school-aged children in Scotland.
METHODS: Routine health and education databases were linked to produce a cohort of all singleton
children born in Scotland and attending a local authority run primary, secondary, or special school in Scotland at some point between 2009 and 2013.
Children with congenital heart disease within this cohort were compared with
children unaffected by congenital conditions. Outcomes investigated were special educational need (SEN), absenteeism, exclusion, academic attainment, and unemployment. All analyses were adjusted for sociodemographic and maternity confounders. Absenteeism was investigated as a mediating factor in the associations with attainment and unemployment.
RESULTS: Of the 715,850
children, 6,295 (0.9%) had congenital heart disease and 4,412 (6.1%) had isolated congenital heart disease. Congenital heart disease and isolated congenital heart disease were both significantly associated with subsequent special educational need (OR 3.45, 95% CI 3.26-3.65, p < 0.001 and OR 1.98, 95% CI 1.84-2.13, p < 0.001 respectively), absenteeism (IRR 1.13, 95% CI 1.10-1.16, p < 0.001 and IRR 1.10, 95% CI 1.06-1.13, p < 0.001 respectively), and low academic attainment (OR 1.69, 95% CI 1.39-2.07, p < 0.001 and OR 1.35, 95% CI 1.07-1.69, p = 0.011 respectively). Neither congenital heart disease nor isolated congenital heart disease were associated with school exclusion. Only congenital heart disease (OR 1.21, 95% CI 1.03-1.42, p = 0.022) but not isolated congenital heart disease was associated with unemployment. When days absent were included in the analyses investigating attainment and unemployment, the conclusions were not altered.
CONCLUSIONS: Children with congenital heart disease have greater special educational need, lower school attendance, attain lower examination grades and have greater unemployment compared to peers. In addition to healthcare support, affected children need educational support to avoid additional impact on their long-term wellbeing.