De Neve Jan-Walter, Karlsson Omar, Rai Rajesh Kumar, Kumar Santosh, Vollmer Sebastian
Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany.
Department of Economic History, Lund University, Lund, Sweden.
Commun Med (Lond). 2024 Jun 12;4(1):112. doi: 10.1038/s43856-024-00533-8.
Anemia has been suggested to be related with schooling outcomes in India. Less is known, however, about whether the observed relationship persists after accounting for all household-level factors which may confound the association between anemia and schooling.
Nationally representative data on adolescents aged 15-18 years with data on measured hemoglobin level and school attendance were extracted from India's National Family Health Surveys conducted between 2005 and 2021. We compared school attendance between adolescents living in the same household but with varying levels of hemoglobin concentration, while controlling for age and period effects. We assessed heterogeneity in the relationship between anemia and school attendance across anemia severity groups and socio-demographic characteristics.
The proportion of adolescents with any anemia is 55.2% (95% CI: 55.0-55.5) among young women and 31.0% (95% CI: 30.6-31.5) among young men. In conventional (between-household) regression models, having any anemia is associated with a 2.5 percentage point reduction (95% CI: 2.1-2.8) in school attendance; however, in household fixed-effects models, anemia has qualitatively small and non-significant effects on school attendance. Our results are consistent using alternative model specifications as well as across anemia severity groups, genders, types of relationship to the household head, household wealth quintiles, and states and union territories in India.
This within-household analysis finds little evidence that anemia is associated with school attendance among adolescents in India. Observational studies likely overstate the connection between anemia and school attendance due to household factors that have not been accounted for.
在印度，贫血被认为与学业成绩有关。然而，在考虑了所有可能混淆贫血与学业之间关联的家庭层面因素之后，这种观察到的关系是否仍然存在，人们了解得较少。
从2005年至2021年期间进行的印度全国家庭健康调查中提取了关于15 - 18岁青少年的全国代表性数据，这些数据包含测量的血红蛋白水平和上学出勤情况。我们比较了居住在同一家庭但血红蛋白浓度水平不同的青少年的上学出勤情况，同时控制年龄和时期效应。我们评估了贫血严重程度组和社会人口学特征之间贫血与上学出勤关系的异质性。
年轻女性中患有任何贫血的青少年比例为55.2%（95%置信区间：55.0 - 55.5），年轻男性中为31.0%（95%置信区间：30.6 - 31.5）。在传统的（家庭间）回归模型中，患有任何贫血与上学出勤率降低2.5个百分点（95%置信区间：2.1 - 2.8）相关；然而，在家庭固定效应模型中，贫血对上学出勤率的影响在性质上较小且不显著。使用替代模型规格以及在贫血严重程度组、性别、与户主的关系类型、家庭财富五分位数以及印度各邦和联邦属地之间，我们的结果是一致的。
这种家庭内部分析几乎没有发现证据表明贫血与印度青少年的上学出勤率有关。由于未考虑家庭因素，观察性研究可能高估了贫血与上学出勤率之间的联系。
