title: Silent cerebral infarction, income, and grade retention among students with sickle cell anemia.
abstract: Children with sickle cell anemia have a higher-than-expected prevalence of poor educational attainment. We test two key hypotheses about educational attainment among students with sickle cell anemia, as measured by grade retention and use of special education services: (1) lower household per capita income is associated with lower educational attainment; (2) the presence of a silent cerebral infarct is associated with lower educational attainment. We conducted a multicenter, cross-sectional study of cases from 22 U.S. sites included in the Silent Infarct Transfusion Trial. During screening, parents completed a questionnaire that included sociodemographic information and details of their child's academic status. Of 835 students, 670 were evaluable; 536 had data on all covariates and were used for analysis. The students' mean age was 9.4 years (range: 5-15) with 52.2% male; 17.5% of students were retained one grade level and 18.3% received special education services. A multiple variable logistic regression model identified that lower household per capita income (odds ratio [OR] of quartile 1 = 6.36, OR of quartile 2 = 4.7, OR of quartile 3 = 3.87; P = 0.001 for linear trend), age (OR = 1.3; P < 0.001), and male gender (OR, 2.2; P = 0.001) were associated with grade retention; silent cerebral infarct (P = 0.31) and painful episodes (P = 0.60) were not. Among students with sickle cell anemia, household per capita income is associated with grade retention, whereas the presence of a silent cerebral infarct is not. Future educational interventions will need to address both the medical and socioeconomic issues that affect students with sickle cell anemia.
authors.affiliation: Program in Occupational Therapy and Department of Pediatrics, Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Allison A
authors.initials: AA
authors.lastname: King
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rodeghier
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Panepinto
authors.forename: John J
authors.initials: JJ
authors.lastname: Strouse
authors.forename: James F
authors.initials: JF
authors.lastname: Casella
authors.forename: Charles T
authors.initials: CT
authors.lastname: Quinn
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dowling
authors.forename: Sharada A
authors.initials: SA
authors.lastname: Sarnaik
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Thompson
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Woods
authors.forename: Caterina P
authors.initials: CP
authors.lastname: Minniti
authors.forename: Rupa C
authors.initials: RC
authors.lastname: Redding-Lallinger
authors.forename: Melanie
authors.initials: M
authors.lastname: Kirby-Allen
authors.forename: Fenella J
authors.initials: FJ
authors.lastname: Kirkham
authors.forename: Robert
authors.initials: R
authors.lastname: McKinstry
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Noetzel
authors.forename: Desiree A
authors.initials: DA
authors.lastname: White
authors.forename: Janet K
authors.initials: JK
authors.lastname: Kwiatkowski
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Howard
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kalinyak
authors.forename: Baba
authors.initials: B
authors.lastname: Inusa
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Rhodes
authors.forename: Mark E
authors.initials: ME
authors.lastname: Heiny
authors.forename: Ben
authors.initials: B
authors.lastname: Fuh
authors.forename: Jason M
authors.initials: JM
authors.lastname: Fixler
authors.forename: Mae O
authors.initials: MO
authors.lastname: Gordon
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000453:epidemiology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D006801:Humans; D008297:Male; D008954:Models, Biological; D014481:United States / Q000453:epidemiology