# Association between chronic diseases in childhood and subsequent educational achievement: a Danish register-based cohort study

## TL;DR

Children with severe chronic diseases in childhood are less likely to complete school and achieve lower grades compared to their healthy peers, even in countries with universal healthcare and education.

## Contribution

This study provides population-level evidence of educational disparities linked to childhood severe chronic diseases in a universal healthcare setting.

## Key findings

- Children with severe chronic disease had lower odds of completing 9th grade compared to those without.
- Grade point averages were significantly lower for children with severe chronic disease.
- Neurological and perinatal conditions were associated with the worst educational outcomes.

## Abstract

Severe chronic disease (SCD) in childhood may hinder not only physical health but also academic performance. In this population-based cohort study, we investigated educational outcomes among 20,979 Danish children with SCD (54.7% male) and 423,814 without SCD (51.1% male). We assessed completion of lower secondary school and grade point averages (GPAs). Completion and GPAs with 95% confidence intervals (95% CI) were estimated using logistic and linear regression models adjusted for sex, country of origin, and maternal education. Children with SCD had lower probability of completing 9th grade (male: 0.53 [95% CI 0.52\documentclass[12pt]{minimal}
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\begin{document}$$-$$\end{document}0.64]) than their peers without SCD (male: 0.70 [0.70\documentclass[12pt]{minimal}
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\begin{document}$$-$$\end{document}7.91]). The sex disparity persisted across all groups. Children of mothers with lower education experienced larger performance gaps. Neurological and perinatal conditions showed the poorest outcomes. Our findings demonstrate persistent educational inequalities among children with SCD, even in settings with universal healthcare and education, underscoring the need for targeted, cross-sectoral support.