Expectancy and Achievement Gaps in Educational Attainment and Subsequent Adverse Health Effects Among Adolescents With and Without Chronic Medical Conditions

Abstract

Purpose While education-based disparities in health are common, the extent to which chronic conditions contribute to education gaps and to consequent health disparities is not fully understood. As such, we sought to investigate educational aspirations, expectations, and attainment among youth with and without chronic conditions, and to determine if these relationships mediated subsequent disparities in health and wellbeing. Methods Longitudinal data on 3518 youth are from the 1997–2013 Panel Study of Income Dynamics (PSID), a population-based survey. Multivariate regression was used to assess disparities in educational aspirations, expectations, and attainment by chronic conditions and the subsequent effects on health and wellbeing, adjusting for important potential confounders. Results Youth with chronic medical conditions (YCMC) did not report significantly lower educational aspirations than their healthy peers; however, YCMC reported lower expectations for their educational attainment and fewer YCMC had earned their desired degree by the end of follow-up (e.g., ≥bachelor’s degree: 19.9% for YCMC vs 26.0% for peers, p<0.05). YCMC reported significantly worse general health, lower life satisfaction, and lower psychological wellbeing in young adulthood than did their healthy peers. These disparities persisted after adjustment for confounders; the association between chronic disease and health was partially, but significantly, mediated by actual educational attainment. Conclusions Findings suggest an important risk mechanism through which YCMC may acquire socioeconomic disadvantage as they develop and progress through educational settings. Disproportionate lags in education, from expectation to attainment, may in turn increase YCMC’s susceptibility to poor health and wellbeing in the future.

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