479 - Factors Associated with Chronic School Absenteeism Among Medicaid-Insured Children with Asthma

Publication Number: 479.4711

Sarah D. Ronis, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Marie Masotya, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Meagan Ray-Novak, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Stephen R. Steh, Case Western Reserve University, Cleveland, OH, United States; Robert L. Fischer, Case Western Reserve University, Cleveland, OH, United States

Background: Chronic absenteeism from school (missing >=10% eligible school days) is an important marker of asthma control and is associated with adverse academic developmental and health outcomes. The factors contributing to chronic absenteeism by children with asthma have historically been difficult to quantify, relying primarily on self-report measures.

Objective: To describe factors associated with chronic school absenteeism in a cohort of Medicaid-insured children residing in Northeast Ohio.

Design/Methods: Retrospective analysis of Medicaid claims, social services and public school records from July 2018 through June 2022 of children residing in Cuyahoga County Ohio aged 6-12 years with at least one encounter with University Hospitals Health System and enrollment in 1+ participating school districts. Children with asthma had at least one encounter for with diagnosis code ICD-10 J45 and prescription for a beta-agonist +/- inhaled corticosteroid during the study period. The Andersen and Aday Framework was used to identify variables included in multivariable logistic regression models exploring modifiable factors associated with chronic absenteeism in 2 or more academic years ("persistent chronic absenteeism").

Results: In total, 25,058 children met inclusion criteria, of whom 4970 (19.8%) had asthma. Chronic absenteeism in the study cohort exceeded State-level estimates in all academic years (from 33 vs 17% in AY2018-19 to 64% vs 30% in AY2021-22). Among study children with asthma, 67.5% were ever chronically absent and 25.3% were persistently chronically absent. Accounting for demographics (age, sex & race), risks for persistent chronic absenteeism included: poorer indoor air quality (as measured by prenatal tobacco exposure, aOR 1.48, 95%CI 1.07-2.04, p=0.017) and comorbid ADHD anxiety and/or depression (aOR 1.34, 95%CI 1.01-1.81, p=0.048). Protective factors in the model included: residence in a census tract with greater opportunity for Health & Education (as measured by the metro-normed Health & Education subscale of the Child Opportunity Index, aOR 0.66, 95%CI 0.49-0.89, p=0.006) and achieving an Asthma Medication Ratio >50% (aOR 0.77, 95%CI 0.59-1.00, p=0.052).

Conclusion(s): Chronic absenteeism is common among Medicaid-insured children obtaining care in our health system, and influences on attendance are not limited to asthma alone. Opportunities for clinicians to optimize outcomes for this population include: inquiring about school attendance, absenteeism and reasons for absenteeism, increasing Asthma Medication Ratios, and screening for and treating comorbid mental and behavioral health conditions.