Associations of major congenital anomalies, long-term health conditions, and socioeconomic deprivation with educational attainment in Wales: A population-based data linkage study
5 affiliations
- 1Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom.
- 2Congenital Anomaly Registers & Information Service for Wales (CARIS), Public Health Knowledge & Research, Public Health Wales, Swansea, United Kingdom.
- 3Data Solutions Division, Mathematica Policy Research, Princeton, New Jersey, United States of America.
- 4Faculty of Life & Health Sciences, Ulster University, Belfast, United Kingdom.
- 5School of Health and Medical Sciences, City St George's, University of London, London, United Kingdom.
Abstract
Background
Education outcomes are associated with life chances. However, deprivation, ill-health and disability are barriers to achievement. We aimed to investigate educational attainment of children with and without major congenital anomalies in state-funded mainstream schools at ages 11 and 16 (key stages [KS] 2 and 4), accounting for maternal and child socioeconomic deprivation, demographic factors, comorbidities, and special education needs (SEN) provision.Methods and findings
We conducted a retrospective population-based cohort study using the Secure Anonymised Information Linkage (SAIL) Databank to link routinely collected electronic health and education records of children born in Wales between January 1st, 1998 and December 31st, 2007, who were followed up until December 31st, 2019. Education outcomes were explored using logistic regression, adjusting for: major congenital anomalies, maternal and child socioeconomic deprivation, medicated co-morbidities, hospitalisation, gestation length, child sex, year of birth, and SEN provision. Children with major congenital anomalies were less likely to achieve national academic standards, including those required for some professional courses: however, attainment was more strongly associated with socioeconomic deprivation. At age 11, 81.9% (7167/8754) with and 93.8% (232,450/247,814) without major congenital anomalies attained established standards (odds ratio [OR] 0.30; 95% confidence intervals [CI] [0.28,0.32]). At age 16, 46.8% (2070/4427) with and 56.1% (69,732/124,300) without major congenital anomalies achieved 5 General Certificates of Secondary Education (GCSEs) at grades C-A*, including English/Welsh, Maths and Science (EWMS) (OR 0.69; 95% CI [0.65,0.73]). Discrepancies narrowed in adjusted analyses, particularly when SEN provision was accounted: aOR 0.72; 95% CI [0.66,0.78] at KS2, age 11, and aOR 0.93; 95% CI [0.87,1.00] for 5 GCSEs C-A* with EWMS. These GCSEs were achieved by 29.7% (307/1034) children with major congenital anomalies and 38.4% (10,875/28,305) of unaffected children in the most deprived quintile (using maternal Welsh Index of Multiple Deprivation: in the least deprived quintile, figures were 67.6% (547/810) and 75.0% (16,978/22,644), respectively. Children with major congenital anomalies, receiving maximum SEN support, and eligible for Free School Meals (FSM) were the least likely to achieve national academic standards: 5/192 (2.6%) obtained 5 GCSEs C-A* with EWMS, as did 37/354 (10.4%) ineligible for FSM. The strongest associations with 5 GCSEs C-A* with EWMS, were SEN statements (aOR 0.07; 95% CI [0.06,0.07]), FSM eligibility (aOR 0.39; 95% CI [0.37,0.41]), and epilepsy (aOR 0.60; 95% CI [0.45,0.80]). Study limitations included absence of data for 15%-18% of children, mainly those educated outside mainstream schools, and for some comorbidities; generalisation of findings to other settings or other countries is uncertain.Conclusions
Many children with major congenital anomalies from least deprived quintiles attained national academic standards, including 5 GCSEs C-A* with EWMS. The children living in the most deprived quintiles or eligible for FSM and with ill-health from major congenital anomalies and/or epilepsy were two to four times less likely to attain these standards. SEN provision mitigated the associations with disadvantage, but children from socioeconomically deprived quintiles with major congenital anomalies were unlikely to achieve 5 GCSEs C-A* with EWMS.
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BibTeX
@article{scanlon2026associations,
title = {{Associations of major congenital anomalies, long-term health conditions, and socioeconomic deprivation with educational attainment in Wales: A population-based data linkage study}},
author = {Ieuan Scanlon and Anna Rawlings and David Tucker and Daniel S Thayer and Hywel T Evans and Joanne Given and Sam Jones and Maria Loane and Chloe Morgan and Joan K Morris and Sue Jordan},
journal = {PLOS Medicine},
year = {2026},
month = oct,
doi = {10.1371/journal.pmed.1005050},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050},
note = {CC BY},
}
RIS
TY - JOUR
TI - Associations of major congenital anomalies, long-term health conditions, and socioeconomic deprivation with educational attainment in Wales: A population-based data linkage study
AU - Ieuan Scanlon
AU - Anna Rawlings
AU - David Tucker
AU - Daniel S Thayer
AU - Hywel T Evans
AU - Joanne Given
AU - Sam Jones
AU - Maria Loane
AU - Chloe Morgan
AU - Joan K Morris
AU - Sue Jordan
PY - 2026
DA - 2026/10/16
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1005050
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050
AB - Background Education outcomes are associated with life chances. However, deprivation, ill-health and disability are barriers to achievement. We aimed to investigate educational attainment of children with and without major congenital anomalies in state-funded mainstream schools at ages 11 and 16 (key stages [KS] 2 and 4), accounting for maternal and child socioeconomic deprivation, demographic factors, comorbidities, and special education needs (SEN) provision.Methods and findings We conducted a retrospective population-based cohort study using the Secure Anonymised Information Linkage (SAIL) Databank to link routinely collected electronic health and education records of children born in Wales between January 1st, 1998 and December 31st, 2007, who were followed up until December 31st, 2019. Education outcomes were explored using logistic regression, adjusting for: major congenital anomalies, maternal and child socioeconomic deprivation, medicated co-morbidities, hospitalisation, gestation length, child sex, year of birth, and SEN provision. Children with major congenital anomalies were less likely to achieve national academic standards, including those required for some professional courses: however, attainment was more strongly associated with socioeconomic deprivation. At age 11, 81.9% (7167/8754) with and 93.8% (232,450/247,814) without major congenital anomalies attained established standards (odds ratio [OR] 0.30; 95% confidence intervals [CI] [0.28,0.32]). At age 16, 46.8% (2070/4427) with and 56.1% (69,732/124,300) without major congenital anomalies achieved 5 General Certificates of Secondary Education (GCSEs) at grades C-A*, including English/Welsh, Maths and Science (EWMS) (OR 0.69; 95% CI [0.65,0.73]). Discrepancies narrowed in adjusted analyses, particularly when SEN provision was accounted: aOR 0.72; 95% CI [0.66,0.78] at KS2, age 11, and aOR 0.93; 95% CI [0.87,1.00] for 5 GCSEs C-A* with EWMS. These GCSEs were achieved by 29.7% (307/1034) children with major congenital anomalies and 38.4% (10,875/28,305) of unaffected children in the most deprived quintile (using maternal Welsh Index of Multiple Deprivation: in the least deprived quintile, figures were 67.6% (547/810) and 75.0% (16,978/22,644), respectively. Children with major congenital anomalies, receiving maximum SEN support, and eligible for Free School Meals (FSM) were the least likely to achieve national academic standards: 5/192 (2.6%) obtained 5 GCSEs C-A* with EWMS, as did 37/354 (10.4%) ineligible for FSM. The strongest associations with 5 GCSEs C-A* with EWMS, were SEN statements (aOR 0.07; 95% CI [0.06,0.07]), FSM eligibility (aOR 0.39; 95% CI [0.37,0.41]), and epilepsy (aOR 0.60; 95% CI [0.45,0.80]). Study limitations included absence of data for 15%-18% of children, mainly those educated outside mainstream schools, and for some comorbidities; generalisation of findings to other settings or other countries is uncertain.Conclusions Many children with major congenital anomalies from least deprived quintiles attained national academic standards, including 5 GCSEs C-A* with EWMS. The children living in the most deprived quintiles or eligible for FSM and with ill-health from major congenital anomalies and/or epilepsy were two to four times less likely to attain these standards. SEN provision mitigated the associations with disadvantage, but children from socioeconomically deprived quintiles with major congenital anomalies were unlikely to achieve 5 GCSEs C-A* with EWMS.
SN - 1549-1676
SN - 1549-1277
ER -