---
title: "Congenital anomalies, deprivation, and long-term health conditions linked to lower school attainme"
id: "plos-medicine-0-associations-of-major-congenital-anomalies-long-term-health-conditions-and"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-0-associations-of-major-congenital-anomalies-long-term-health-conditions-and"
content_type: "clinical_feed_article"
specialty: "Pediatrics"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050"
published_at: "2026-10-16T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Congenital anomalies, deprivation, and long-term health conditions linked to lower school attainme
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-0-associations-of-major-congenital-anomalies-long-term-health-conditions-and
- **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050)
- **Published At:** 2026-10-16T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Population-based linkage of Welsh health and education records followed children born 1998–2007 through 2019 to assess school attainment at ages 11 (KS2) and 16 (KS4). - Investigators compared children with and without major **congenital anomalies**, adjusting for maternal and child socioeconomic deprivation, medicated comorbidities, hospitalisation, gestation, sex, birth year, and special education needs (SEN) provision. - Raw attainment at age 11: 81.9% of children with major congenital anomalies versus 93.8% without met KS2 standards (OR 0.30; 95% CI 0.28–0.32). - Raw attainment at age 16 for 5 **GCSEs** C–A*, including English/Welsh, Maths and Science (EWMS): 46.8% with anomalies vs 56.1% without (OR 0.69; 95% CI 0.65–0.73). - Adjusted models narrowed disparities; accounting for SEN provision produced aORs of 0.72 (KS2) and 0.93 (KS4 for 5 GCSEs C–A* with EWMS), authors reported. - Socioeconomic deprivation showed a stronger association with low attainment than anomaly status in many comparisons; largest gaps seen in the most deprived quintile and among children eligible for Free School Meals (FSM). - Children with anomalies who received maximum SEN support and were FSM-eligible had the lowest attainment: 2.6% achieved 5 GCSEs C–A* with EWMS (5/192), versus 10.4% (37/354) of those not FSM-eligible within the same SEN level. - Strongest adjusted negative associations with 5 GCSEs C–A* with EWMS included SEN statements (aOR 0.07), FSM eligibility (aOR 0.39), and epilepsy (aOR 0.60); these values are reported with 95% CIs in the source. - Study limitations reported by authors: missing education data for 15%–18% (mainly children outside mainstream schools), incomplete comorbidity data, absence of measures such as school attendance and behavioral issues, and uncertain generalisability to other settings. - Data were derived from the SAIL Databank; coding followed EUROCAT and publicly available phenotype libraries, and all aggregated results were reported in the manuscript and supplementary tables.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1005050) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#citedHeader) * 19 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050#discussedHeader) Open Access Peer-reviewed Research Article # Associations of major congenital anomalies, long-term health conditions, and socioeconomic deprivation with educational attainment in Wales: A population-based data linkage study * Ieuan Scanlon, Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Visualization, Writing – review & editing Affiliation Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-7479-5497 ](https://orcid.org/0000-0002-7479-5497 "ORCID Registry") ⨯ * Anna Rawlings, Roles Data curation, Formal analysis, Investigation, Methodology, Software, Visualization, Writing – review & editing Affiliation Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-3929-474X ](https://orcid.org/0000-0003-3929-474X "ORCID Registry") ⨯ * David Tucker, Roles Conceptualization, Data curation, Funding acquisition, Investigation, Resources, Supervision, Writing – review & editing Affiliation Congenital Anomaly Registers & Information Service for Wales (CARIS), Public Health Knowledge & Research, Public Health Wales, Swansea, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-3077-5918 ](https://orcid.org/0000-0003-3077-5918 "ORCID Registry") ⨯ * Daniel S. Thayer, Roles Funding acquisition, Investigation, Resources, Supervision, Writing – review & editing Affiliation Mathematica Policy Research, Princeton, New Jersey, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-1847-4362 ](https://orcid.org/0000-0003-1847-4362 "ORCID Registry") ⨯ * Hywel T. Evans, Roles Data curation, Investigation, Project administration, Software, Writing – review & editing Affiliation Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-6745-4187 ](https://orcid.org/0000-0001-6745-4187 "ORCID Registry") ⨯ * Joanne Given, Roles Methodology, Project administration, Software, Writing – review & editing Affiliation Faculty of Life & Health Sciences, Ulster University, Belfast, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-4921-1944 ](https://orcid.org/0000-0003-4921-1944 "ORCID Registry") ⨯ * Sam Jones, Roles Methodology, Project administration, Writing – review & editing Affiliation Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-1583-1985 ](https://orcid.org/0000-0003-1583-1985 "ORCID Registry") ⨯ * Maria Loane, Roles Data curation, Funding acquisition, Project administration, Software, Supervision, Validation, Writing – review & editing Affiliation Faculty of Life & Health Sciences, Ulster University, Belfast, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-1206-3637 ](https://orcid.org/0000-0002-1206-3637 "ORCID Registry") ⨯ * Chloe Morgan, Roles Validation, Writing – review & editing Affiliation Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom ⨯ * Joan K. Morris, Roles Funding acquisition, Methodology, Project administration, Resources, Supervision, Writing – review & editing Affiliation School of Health and Medical Sciences, City St George’s, University of London, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-7164-612X ](https://orcid.org/0000-0002-7164-612X "ORCID Registry") ⨯ * Sue Jordan Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Validation, Writing – original draft * E-mail: s.e.jordan@swansea.ac.uk Affiliation Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-5691-2987 ](https://orcid.org/0000-0002-5691-2987 "ORCID Registry") ⨯ # Associations of major congenital anomalies, long-term health conditions, and socioeconomic deprivation with educational attainment in Wales: A population-based data linkage study * Ieuan Scanlon, * Anna Rawlings, * David Tucker, * Daniel S. Thayer, * Hywel T. Evans, * Joanne Given, * Sam Jones, * Maria Loane, * Chloe Morgan, … * Joan K. Morris ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: October 16, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1005050) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005050) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005050) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1005050) * [Peer Review](https://journals.plos.org/plosmedicine/article/peerReview?id=10.1371/journal.pmed.1005050) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#abstract1) * [Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#sec004) * [Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#sec005) * [Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#sec013) * [Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#sec020) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#sec021) * [Acknowledgments](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#ack) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005050) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005050) ![Accessible Data Icon](https://journals.plos.org/resource/img/accessible_data.svg)Accessible Data [ See the data ![Link Icon](https://journals.plos.org/resource/img/data_link_icon.svg) ](https://doi.org/10.5281/zenodo.22750662) This article includes the Accessible Data icon, an experimental feature to encourage data sharing and reuse. [Find out how research articles qualify for this feature.](https://theplosblog.plos.org/2023/07/accessible-data/) [?](https://journals.plos.org/plosmedicine/s/accepted-manuscripts#loc-early-version) ## This is an uncorrected proof. ## Abstract ### Background Education outcomes are associated with life chances. However, deprivation, ill-health and disability are barriers to achievement. We aimed to investigate educational attainment of children with and without major congenital anomalies in state-funded mainstream schools at ages 11 and 16 (key stages [KS] 2 and 4), accounting for maternal and child socioeconomic deprivation, demographic factors, comorbidities, and special education needs (SEN) provision. ### Methods and findings We conducted a retrospective population-based cohort study using the Secure Anonymised Information Linkage (SAIL) Databank to link routinely collected electronic health and education records of children born in Wales between January 1st, 1998 and December 31st, 2007, who were followed up until December 31st, 2019. Education outcomes were explored using logistic regression, adjusting for: major congenital anomalies, maternal and child socioeconomic deprivation, medicated co-morbidities, hospitalisation, gestation length, child sex, year of birth, and SEN provision. Children with major congenital anomalies were less likely to achieve national academic standards, including those required for some professional courses: however, attainment was more strongly associated with socioeconomic deprivation. At age 11, 81.9% (7167/8754) with and 93.8% (232,450/247,814) without major congenital anomalies attained established standards (odds ratio [OR] 0.30; 95% confidence intervals [CI] [0.28,0.32]). At age 16, 46.8% (2070/4427) with and 56.1% (69,732/124,300) without major congenital anomalies achieved 5 General Certificates of Secondary Education (GCSEs) at grades C–A*, including English/Welsh, Maths and Science (EWMS) (OR 0.69; 95% CI [0.65,0.73]). Discrepancies narrowed in adjusted analyses, particularly when SEN provision was accounted: aOR 0.72; 95% CI [0.66,0.78] at KS2, age 11, and aOR 0.93; 95% CI [0.87,1.00] for 5 GCSEs C–A* with EWMS. These GCSEs were achieved by 29.7% (307/1034) children with major congenital anomalies and 38.4% (10,875/28,305) of unaffected children in the most deprived quintile (using maternal Welsh Index of Multiple Deprivation at birth): in the least deprived quintile, figures were 67.6% (547/810) and 75.0% (16,978/22,644), respectively. Children with major congenital anomalies, receiving maximum SEN support, and eligible for Free School Meals (FSM) were the least likely to achieve national academic standards: 5/192 (2.6%) obtained 5 GCSEs C–A* with EWMS, as did 37/354 (10.4%) ineligible for FSM. The strongest associations with 5 GCSEs C–A* with EWMS, were SEN statements (aOR 0.07; 95% CI [0.06,0.07]), FSM eligibility (aOR 0.39; 95% CI [0.37,0.41]), and epilepsy (aOR 0.60; 95% CI [0.45,0.80]). Study limitations included absence of data for 15%–18% of children, mainly those educated outside mainstream schools, and for some comorbidities; generalisation of findings to other settings or other countries is uncertain. ### Conclusions Many children with major congenital anomalies from least deprived quintiles attained national academic standards, including 5 GCSEs C–A* with EWMS. The children living in the most deprived quintiles or eligible for FSM and with ill-health from major congenital anomalies and/or epilepsy were two to four times less likely to attain these standards. SEN provision mitigated the associations with disadvantage, but children from socioeconomically deprived quintiles with major congenital anomalies were unlikely to achieve 5 GCSEs C–A* with EWMS. ## Author summary ### Why was this study done? * Major congenital anomalies affect around 267 of every 10,000 births in Europe. In Wales, 319 in 10,000 are affected. * Most (~96%) children born with major congenital anomalies survive infancy and over 80% are educated in mainstream schools. * Few national whole population cohorts have followed these children to ages 11 and 16 to explore educational attainment, including national qualifications. ### What did the researchers do and find? * Our cohort included 256,568 children aged 11, and 128,727 aged 16, born between 1988 and 2007. We built explanatory models to report any associations between educational attainment and major congenital anomalies, deprivation, epilepsy, asthma, diabetes, hospitalisation, preterm birth, demographics, and special education needs (SEN) provision. * Differences in educational attainment between children eligible and ineligible for free school meals were greater than differences between children with and without major congenital anomalies, when measured at each level of SEN provision. * At age 16, 67.8% of children with major congenital anomalies in the least deprived households attained 5 general certificates of secondary education (GCSEs), including English/Welsh plus maths and science, at grades C–A*, which are the entry qualifications for many professional courses. In the most deprived households, only 38.4% of children without and 29.7% of children with major congenital anomalies achieved this standard. * SEN provision narrowed the gap between children with and without major congenital anomalies, but did not close it. ### What do these findings mean? * In Wales, a profoundly disadvantaged group of children living with disability and deprivation need greater health, education, and social support to obtain the entry qualifications for professional courses. * Our study is limited by the inability to account for some potentially important factors, including school attendance and behavioural issues. Our findings may not apply to children educated outside mainstream education or to other countries. ## Figures ![Fig 6](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g006) ![Table 11](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t011) ![Table 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t001) ![Table 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t002) ![Fig 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g001) ![Table 3](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t003) ![Fig 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g002) ![Fig 3](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g003) ![Table 4](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t004) ![Table 5](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t005) ![Table 6](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t006) ![Table 7](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t007) ![Table 8](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t008) ![Table 9](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t009) ![Fig 4](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g004) ![Fig 5](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g005) ![Table 10](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t010) ![Fig 6](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g006) ![Table 11](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t011) ![Table 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t001) ![Table 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.t002) ![Fig 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005050.g001) **Citation:** Scanlon I, Rawlings A, Tucker D, Thayer DS, Evans HT, Given J, et al. (2026) Associations of major congenital anomalies, long-term health conditions, and socioeconomic deprivation with educational attainment in Wales: A population-based data linkage study. PLoS Med 23(10): e1005050. https://doi.org/10.1371/journal.pmed.1005050 **Academic Editor:** Lars Åke Persson, London School of Hygiene and Tropical Medicine, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND **Received:** March 13, 2026; **Accepted:** September 25, 2026; **Published:** October 16, 2026 **Copyright:** © 2026 Scanlon et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** The linked anonymised person-level data used in this study are available from the Secure Anonymised Information Linkage (SAIL) Databank at Swansea University, Wales, UK. The raw individual-level data cannot be exported from the SAIL Databank Trusted Research Environment and can only be accessed within SAIL, because it contains person-based information that is protected by strict governance controls. Applications to access SAIL data can be made via . All proposals to use SAIL data must comply with information governance policies and are subject to review and approval by the independent Information Governance Review Panel (IGRP). When approved, access is then provided through the SAIL Trusted Research Environment, a privacy-protecting safe-haven and a secure remote access system. We did not receive any special access privileges to the data. We have reported all the safe aggregated results. All relevant data are contained within the manuscript or supplementary tables. The metadata for the data used in this study are listed in Table 1. Codes used in this study: Congenital Anomalies were coded according to EUROCAT’s ICD10 coding published as cited: EUROCAT. Chapter 3.3: EUROCAT Subgroups of Congenital Anomalies (version 23.09.2016). EUROCAT Guide 14: . Coding of medicines used in this study is available in the public domain, in the phenotype library: . The databases below are unique to Wales and confidential. Data extraction algorithms can be sent on reque
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