Jay Matthew A, Zylbersztejn Ania, Herlitz Lauren, Deighton Jessica, Gilbert Ruth, Blackburn Ruth
University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
Social Research Institute, UCL Institute of Education - University College London's Faculty of Education and Society, 55-59 Gordon Square, London WC1H 0NU, UK.
J Public Health (Oxf). 2025 Aug 29;47(3):414-422. doi: 10.1093/pubmed/fdaf064.
Policies to reduce school absence can place a burden on children with chronic health conditions (CHCs). Although estimates suggest > 25% of children in England have a CHC before age 16, there is limited evidence on extent of absence, exclusion, and non-enrolment from school among children with CHCs.
We used all-of-England inpatient data (Hospital Episode Statistics) to identify groups of adolescents with CHCs from age 5 to 15. Cohorts were born in 2000/01 to 2002/03. Data were linked to England's National Pupil Database for secondary school (age 11 to 16) persistent absence (>1 month missed/year), exclusion, and non-enrolment to examine rates of each outcome by CHC groups.
Of 1 456 361 children, 12.5% had a CHC from age 5 to 11, and 18.9% to age 16. Rates of persistent absence were higher among children with CHCs than unexposed peers (e.g. 25.9% compared to 14.7% aged 15/16), especially among those with mental health presentations (32.1%). Increased rates were found for exclusion and non-enrolment for children with CHCs. The percentage of absence recorded as health-related was lowest among children with externalizing presentations.
Approaches to improve school attendance should consider needs of children with CHCs, ensuring adequate support.
减少学校缺勤的政策可能会给患有慢性健康状况（CHC）的儿童带来负担。尽管估计显示，在英国超过25%的儿童在16岁之前患有慢性健康状况，但关于患有慢性健康状况的儿童的缺勤、被开除和未入学程度的证据有限。
我们使用了全英格兰的住院数据（医院事件统计）来识别5至15岁患有慢性健康状况的青少年群体。队列出生于2000/01年至2002/03年。数据与英格兰中学（11至16岁）国家学生数据库相链接，以获取持续缺勤（每年缺课超过1个月）、被开除和未入学情况，从而按慢性健康状况组检查每种结果的发生率。
在1456361名儿童中，12.5%的儿童在5至11岁时患有慢性健康状况，18.9%的儿童在16岁时患有慢性健康状况。患有慢性健康状况的儿童的持续缺勤率高于未受影响的同龄人（例如，15/16岁的儿童中，这一比例为25.9%，而未受影响的同龄人为14.7%），尤其是那些有心理健康问题的儿童（32.1%）。患有慢性健康状况的儿童被开除和未入学的发生率也有所增加。在有外化表现的儿童中，记录为与健康相关的缺勤百分比最低。
提高学校出勤率的方法应考虑患有慢性健康状况的儿童的需求，确保提供足够的支持。
