Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study

Amanda Hughes; Kaitlin H. Wade; Matt Dickson; Frances Rice; Alisha R Davies; Neil M Davies; Laura D Howe

doi:10.1038/s41539-020-00080-6

Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study

Amanda Hughes, Kaitlin H. Wade, Matt Dickson, Frances Rice, Alisha R Davies, Neil M Davies, Laura D Howe

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Abstract

Good health is positively related to children’s educational outcomes, but relationships may not be causal. Demonstrating a causal influence would strongly support childhood and adolescent health as important for education policy.
We applied genetic causal inference methods to assess the causal relationship of common health conditions at age 10 (primary/elementary school) and 13 (mid-secondary/mid-high school) with educational attainment at 16 and school absence at 14-16. Participants were 6113 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Exposures were symptoms of Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), depression, asthma, migraines and BMI. Genetic liability for these conditions and BMI was indexed by polygenic scores.
In non-genetic, multivariate-adjusted models, all health conditions except asthma and migraines were associated with poorer attainment and greater school absence. School absence substantially mediated effects of BMI (39.9% for BMI at 13) and migraines (72.0% at 10), on attainment with more modest mediation for emotional and neurodevelopmental conditions. In genetic models, a unit increase in standardized BMI at 10 predicted a 0.19 S.D. decrease (95%CI: 0.11, 0.28) in attainment at 16, equivalent to around a 1/3 grade lower in all subjects, and 8.7% more school absence (95%CI:1.8%,16.1%). Associations were similar at 13. Genetic liability for ADHD predicted lower attainment but not more absence.
Triangulation across multiple approaches supports a causal, negative influence on educational outcomes of BMI and ADHD, but not of ASD, depression, asthma or migraine. Higher BMI in childhood and adolescence may causally impair educational outcomes.

Original language	English
Article number	1
Journal	Nature Partner Journal - Science of Learning
Volume	6
DOIs	https://doi.org/10.1038/s41539-020-00080-6
Publication status	Published - 4 Jan 2021

Funding

We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The UK Medical Research Council and Wellcome (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. GWAS data was generated by Sample Logistics and Genotyping Facilities at Wellcome Sanger Institute and LabCorp (Laboratory Corporation of America) using support from 23andMe. This publication is the work of the authors, who will serve as guarantors for the contents of this paper. A comprehensive list of grants funding is available on the ALSPAC website (http://www. bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). This research was specifically funded by the Health Foundation. The Medical Research Council (MRC) and the University of Bristol support the MRC Integrative Epidemiology Unit [MC_UU_12013/1, MC_UU_12013/9, MC_UU_00011/1]. The Economics and Social Research Council (ESRC) support NMD via a Future Research Leaders grant [ES/ N000757/1] and a Norwegian Research Council Grant number 295989. L.D.H. is supported by a Career Development Award from the UK Medical Research Council (MR/M020894/1). K.H.W. is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund [204813/Z/16/Z]. This work is part of a project entitled ‘Social and economic consequences of health: causal inference methods and longitudinal, intergenerational data’, which is part of the Health Foundation’s Efficiency Research Programme (Award number 807293). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Keywords

Education attainment
GCSEs
ALSPAC
Mendelian randomization
school absence
absenteeism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Manuscript_15_October.docxAccepted author manuscript, 86.1 KB
Supplementary material_Dickson_et_al.pdfAccepted author manuscript, 2.68 MB
Manuscript_15_October.PDFAccepted author manuscript, 334 KB

Matt Dickson
- M.Dicksonbath.acuk
- Institute for Policy Research (IPR) - Professor
- Centre for the Analysis of Social Policy and Society (CASPS)
Person: Research & Teaching, Core staff, Researcher

Cite this

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title = "Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study",

abstract = "Good health is positively related to children{\textquoteright}s educational outcomes, but relationships may not be causal. Demonstrating a causal influence would strongly support childhood and adolescent health as important for education policy. We applied genetic causal inference methods to assess the causal relationship of common health conditions at age 10 (primary/elementary school) and 13 (mid-secondary/mid-high school) with educational attainment at 16 and school absence at 14-16. Participants were 6113 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Exposures were symptoms of Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), depression, asthma, migraines and BMI. Genetic liability for these conditions and BMI was indexed by polygenic scores. In non-genetic, multivariate-adjusted models, all health conditions except asthma and migraines were associated with poorer attainment and greater school absence. School absence substantially mediated effects of BMI (39.9% for BMI at 13) and migraines (72.0% at 10), on attainment with more modest mediation for emotional and neurodevelopmental conditions. In genetic models, a unit increase in standardized BMI at 10 predicted a 0.19 S.D. decrease (95%CI: 0.11, 0.28) in attainment at 16, equivalent to around a 1/3 grade lower in all subjects, and 8.7% more school absence (95%CI:1.8%,16.1%). Associations were similar at 13. Genetic liability for ADHD predicted lower attainment but not more absence. Triangulation across multiple approaches supports a causal, negative influence on educational outcomes of BMI and ADHD, but not of ASD, depression, asthma or migraine. Higher BMI in childhood and adolescence may causally impair educational outcomes.",

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KW - GCSEs

KW - ALSPAC

KW - Mendelian randomization

KW - school absence

KW - absenteeism

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JF - Nature Partner Journal - Science of Learning

M1 - 1

ER -

Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study

Abstract

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