Abstract
BackgroundOur aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs. obtaining/completing) in adults.MethodStudies were eligible if they reported the rate, odds, or proportion of level of educational attainment in adults by whether or not they had a CHD.ResultOut of 1537 articles screened, we identified 11 (N = 104,585 participants, 10,487 with CHD), 10 (N = 167,470 participants, 11,820 with CHD), and 8 (N = 150,813 participants, 9817 with CHD) studies reporting information on university education, secondary education, and vocational training, respectively in both CHD and non-CHD participants. Compared to their non-CHD peers, CHD patients were more likely not to obtain a university degree (OR = 1.38, 95% CI [1.16, 1.65]), complete secondary education (OR = 1.33, 95% CI [1.09, 1.61]) or vocational training (OR = 1.11, 95% CI [0.98, 1.26]). For all three outcomes there was evidence of between study heterogeneity, with geographical area contributing to this heterogeneity.ConclusionThis systematic review identified all available published data on educational attainment in CHD patients. Despite broad inclusion criteria we identified relatively few studies that included a comparison group from the same population, and amongst those that did, few adjusted for key confounders. Pooled analyses suggest evidence of lower levels of educational attainment in patients with CHD when compared to non-CHD peers. The extent to which this may be explained by confounding factors, such as parental education, or mediated by treatments is not possible to discern from the current research literature.
Highlights
Our aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment in adults
In order to provide comprehensive information for patients, education, and health service providers we included all studies in our review in which the rates, odds, or proportion of any of the three educational outcomes could be obtained in adult CHD patients, irrespective of whether the main aim of the study was to look at the association of having a CHD with educational attainment or not
Cohort1: Age No and sex Cohort 2: sibling. These are the studies included in our main meta-analyses. aWe included any study that provided data of the proportion, odds or risk, of patients with one or more of the educational outcomes in CHD patients, irrespective of whether the aim of the study was concerned with educational attainment in CHD patients or not: Yes means the aim at least in part was concerned with educational attainment in CHD patients; No that the aim was not concerned with educational attainment in CHD patients
Summary
Our aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs. obtaining/completing) in adults. An area of particular interest is whether those with CHD have similar educational attainment to their contemporaries without CHD [5]. The different conclusions from individual studies of the relationship between CHD and educational attainment may reflect differences in disease severity between studies as it is plausible that more severe CHD would have a greater impact on educational attainment [9]. As both treatments for CHD, and educational systems and policies, vary across time and between geographic regions it is plausible that associations might vary by these factors
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