Effects of Childhood-onset Inflammatory Bowel Disease on School Performance: A Nationwide Population-based Cohort Study Using Swedish Health and Educational Registers

Abstract

ABSTRACT Background Childhood-onset inflammatory bowel disease (IBD) might negatively impact academic school performance. We conducted a nationwide study to examine the association between childhood-onset IBD and school results. Methods Our study population was selected from Swedish health registers. In the National Patient Register (1990 to 2013), we identified 2827 children with IBD: Crohn’s disease (CD), n = 1207, and ulcerative colitis (UC), n = 1370. Patients were matched with 10 reference individuals by age, sex, birth year, and place of residence (n = 28,235). Final compulsory school grades (0 to 320 grade points) and qualification for high school (yes or no) were obtained through the National School Register. Regression models controlling for socioeconomic factors were used to analyze the association of IBD with school performance. Results Children with IBD had a lower final grade point average (adjusted mean grade difference [AMGD] −4.9, 95% confidence interval [CI] −7.1 to −2.6) but not a significantly higher risk to not qualify for high school (odds ratio [OR] 1.14, CI 0.99–1.31). The results were similar in children with UC (AMGD −5.5, CI −8.7 to −2.3) and CD (AMGD −4.7, CI −8.2 to −1.2). Underperformance was more common in subsets of IBD children characterized by markers associated with long-standing active disease (eg, >30 inpatient days [AMGD−18.1, CI −25.8 to −10.4]). Conclusion Most children with IBD achieve comparable results in the final year of compulsory school as their healthy peers. Care should be improved for the subgroup of children for which IBD has a stronger negative impact on school performance.