Chronic health conditions and school absence, exclusions, and non-enrolment: a cohort study using the Education and Child Health Insights from Linked Data database

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Approaches to improve school attendance should consider needs of children with CHCs, ensuring adequate support.