Statewide Academic Performance of High School Students With Sickle Cell Disease

Purpose: Among patients with sickle cell disease (SCD), poor academic attainment in adolescence is associated with a greater frequency of acute care visits and a poorer health-related quality of life in adulthood. We compared the academic performance of high school students with SCD to students without SCD after controlling for race and sex. Methods: This retrospective cohort study was constructed based on the Tennessee Medicaid program claims data and Tennessee Department of Education Race to the Top educational data from October 1, 2007 to September 30, 2019. For every ninth grade student with SCD identified, eight students without SCD were identified. Academic achievement was measured using rates of proficiency on end-of-course assessments. The number of days absent per school year, grade retention, and school withdrawal were used as measures of academic attainment. Results: The analysis included 498 students with SCD and 3188 students without SCD. After race and sex were adjusted for, students with SCD had English proficiency odds of 0.8 times (95% confidence interval [CI]: 0.7–0.9; p < 0.001) those of students without SCD. Students with SCD were 1.2 times (95% CI: 1.0–1.5; p = 0.045) more likely to be retained in the ninth grade. The effect of SCD on grade retention was mediated by days absent from school (odds ratio for indirect effect, 1.18 (95% CI: 1.1–1.26; p < 0.0001). Discussion: SCD negatively affects academic performance partly through frequent school absence.