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

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 0.52-0.54], female: 0.63 [0.62-0.64]) than their peers without SCD (male: 0.70 [0.70-0.70], female: 0.82 [0.81-0.82]). Similarly, GPA was lower for children with SCD (male: 6.61 [6.55-6.66], female: 7.51 [7.45-7.56]) compared to those without (male: 6.86 [6.85-6.87], female: 7.90 [7.89-7.91]). 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.