Early Predictors of School Absenteeism in First-Grade Children: A Multidimensional Longitudinal Study in Japan

<b>Background</b>: Continuous schooling and healthy learning are essential during childhood. Therefore, we investigated the risk factors of absenteeism in supporting at-risk students. The aim of this study examined the longitudinal relationships between absenteeism and body mass index (BMI), lifestyle, physical fitness, academic performance, and frequency of school health room use during the first grade of elementary school. <b>Methods</b>: A total of 453 first-grade students in elementary school were included in the analysis. These students were enrolled in the target elementary schools between 2014 and 2021. The analysis used data obtained from the students' schoolwork. We performed a Cox regression analysis to assess the characteristics associated with absenteeism for 10 days or more, excluding absences due to relatives' funerals and suspension of attendance. The independent variables were BMI, sleep duration, sleep quality, frequency of physical activity, screen time, physical fitness, grade points, and frequency of health room use during the first grade of elementary school. <b>Results</b>: The grade point average (girls: hazard ratio [HR] = 0.013; boys: HR = 0.115) and frequency of use of school health rooms due to illness (girls: HR = 1.252; boys: HR = 1.261) were common among girls and boys in the adjusted model. Additionally, three or more days of physical activity per week and six or more days of sound sleep were additional predictors for girls. <b>Conclusions</b>: Our results suggest that careful monitoring of children with minimal physical activity, poor sleep quality, low grade point average, and frequent school health room usage in the first grade of elementary school and providing them with support in dealing with school difficulties may reduce absenteeism.