Relationship between anemia and learning performance in Chinese primary school students: evidence from a large national survey

Abstract

Abstract This study explored the association between anemia and learning performance, and the possible factors mediating this association among Chinese adolescents. Data of 17695 Grade 4 students from China Education Panel Survey were analyzed. Anemia was diagnosed according to the World Health Organization’s reference. Test scores for Chinese, mathematics and English were gathered from the final examination of previous semester. An ordinary least squares regression and mediation effect analysis were conducted. Our findings found the prevalence of anemia was 6.52% among Chinese Grade 4 students. Students without anemia had a higher average test score for three academic subjects than students with anemia (P = 0.000); their test scores for Chinese, mathematics, and English were also higher (P < 0.05). Multivariate regression analysis showed a negative association between anemia and average test scores as well as individual test scores for the three subjects. Mediation analysis found that anemia affected learning performance directly (P < 0.05), and indirectly by decreasing the cognition score (P < 0.05). The indirect effect was 19.9% of the total effect. Findings highlighted anemia affected learning performance both directly and indirectly. Nutrition-related interventions should be implemented to prevent a decrease in learning performance among students with anemia.