R KHALID1,2, A VAN ZWIETEN1,2, M DIDSBURY1,2, K CHEN2, L JAMES1,2, A FRANCIS1,2,3, S KIM1,2, S MCTAGGART3, A WALKER4, F MACKIE5,12, T KARA6, C PRESTIDGE6, A TEIXEIRA-PINTO1,2, B BARTON7, J LORENZO8, S LAH9, K HOWARD2, N NASSAR10, E AU1,2, A TONG1,2, K BLAZEK1,2, J CRAIG1,13, G WONG1,2,11
1Centre for Kidney Research, The Children’s Hospital at Westmead, 2Sydney School of Public Health, The University of Sydney, 3Child & Adolescent Renal Service, Queensland Children’s Hospital, 4Department of Nephrology, The Royal Children’s Hospital, 5Department of Nephrology, Sydney Children’s Hospital at Randwick, 6Department of Nephrology, Starship Children’s Hospital, 7Children’s Hospital Education Research Institute, The Children’s Hospital at Westmead, 8Kids Neuroscience Centre, The Children’s Hospital at Westmead, 9School of Psychology, The University of Sydney, 10Child Population and Translational Health Research, Children’s Hospital at Westmead Clinical School, 11Centre for Transplant and Renal Research, Westmead Hospital, 12School of Women’s and Child Health, University of New South Wales, 13College of Medicine and Public Health, Flinders University
Aim: To examine the relationship between socioeconomic status (SES) and academic performance in children and adolescents with chronic kidney disease (CKD).
Background: Lower SES is linked to lower academic achievement, but this relationship is understudied in children with CKD.
Methods: 377 participants (aged 6-18 years) with CKD stages 1-5 (n=199), on dialysis (n=43) or with a kidney transplant (n=135) were recruited from (5/13) paediatric hospitals in Australia and New Zealand. Five SES measures and a global SES index were examined for associations with parent-rated high/low performance in numeracy and literacy using multivariable logistic regression.
Results: Participants’ median age was 12.6 years [IQR 8.9-15.5]. Adjusted odds ratios (OR) (95%CI) for better performance in literacy and numeracy respectively were 0.75 (0.47-1.21) and 0.70 (0.44-1.11) for children whose caregivers had lower educational attainment, 0.53 (0.32-0.88) and 0.48 (0.29-0.80) for lower household income, 0.45 (0.27-0.73) and 0.51 (0.32-0.83) for caregivers who were unemployed, 0.56 (0.34-0.92) and 0.65 (0.41-1.05) for caregivers with poor self-rated financial status, 0.84 (0.50-1.40) and 0.78 (0.47-1.29) for caregivers who did not own their own home. With reference to the highest SES index quartile, adjusted ORs for better performance by SES quartile in descending order were 0.84 (0.40-1.77), 0.76 (0.36-1.59) and 0.35 (0.17-0.73) for literacy and 1.22 (0.60-2.48), 0.81 (0.40-1.62) and 0.44 (0.22-0.91) for numeracy. Lower global SES index was associated with poorer performance in literacy among children with CKD stages 1-5 (p=0.01), but the effects diminished in children on kidney replacement therapy. Performance in numeracy was not moderated by CKD stage.
Conclusions: Children with CKD from lower SES families were less likely to perform well in literacy and numeracy than those from higher SES households.
Rabia Khalid is a Research Assistant at the Sydney School of Public Health, The University of Sydney, Australia. She is involved in numerous clinical trials focusing on disparities in children and young adults with chronic kidney disease.