In Wales, poverty tracked school results more strongly than congenital anomalies

A large study in Wales suggests that the social conditions around a child’s education can be closely linked to exam results, alongside long-term health and disability. In the study, income deprivation and eligibility for free school meals were more strongly associated with GCSE attainment than having a major congenital anomaly.

The peer-reviewed paper, published in PLOS Medicine, reports a retrospective population-based cohort study. Researchers linked routinely collected health and education records for children born in Wales between 1998 and 2007. They examined school attainment at ages 11 and 16 among pupils in state-funded mainstream schools, comparing children with and without major congenital anomalies. The age-16 cohort included 128,727 children; 4,427 had a major congenital anomaly.

At age 16, 46.8% of children with a major congenital anomaly achieved five GCSEs at grades C to A*, including English or Welsh, mathematics and science. Among children without a major anomaly, 56.1% met that standard. These qualifications are relevant to entry to some higher education and professional courses, though they are not the only route into further study or work.

The gap changed when researchers accounted for factors including deprivation, health conditions, hospital stays and special educational needs provision. For this GCSE outcome, the adjusted association between major congenital anomalies and attainment was described by the authors as statistically nonsignificant. That does not show that health has no bearing on learning; it means the study’s adjusted estimate did not establish a clear association for this particular outcome.

The social gradient was pronounced. In the most income-deprived quintile, 29.7% of children with major congenital anomalies and 38.4% of children without them achieved the GCSE standard. In the least deprived quintile, the corresponding proportions were 67.6% and 75.0%. Across the analyses, the differences associated with deprivation were larger than those associated with congenital anomalies. Eligibility for free school meals, an indicator of household disadvantage used in the study, was also strongly associated with lower attainment.

Special educational needs provision was associated with narrower attainment gaps between children with and without major congenital anomalies. But this was an observational analysis of existing records, not a trial assigning support. It cannot show that a particular form of support caused improved results, or establish which services would work best for different pupils. The researchers also found that the least favourable outcomes often occurred when health-related needs and socioeconomic disadvantage coincided.

The findings need to be read within the study’s boundaries. Its results describe pupils in mainstream state-funded schools in Wales, not all children with disabilities or health conditions. Education records were unavailable for many pupils outside mainstream schooling, including those in special schools, and the authors report missing data for 15% to 18% of children, mainly those educated outside mainstream settings. The analysis also lacked information on some potentially relevant factors, including school attendance and behavioural issues.

Because this is a study of linked records, it can reveal patterns but cannot establish that deprivation or congenital anomalies caused a particular result. The authors caution that findings may not apply to other countries or to cohorts educated after pandemic-related disruption. The paper is marked as an uncorrected proof, so some internal inconsistencies in its text and figures also warrant care when reporting exact details.

The study’s central contribution is a comparison of health, educational support and socioeconomic circumstances in a large Welsh cohort. It shows that educational outcomes varied substantially across deprivation levels, while the relationship with congenital anomalies depended on what other factors were considered. It leaves open which changes to education, health or social services could improve outcomes, and for whom.