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Updated: Sep 13, 2025

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Statewide Academic Performance of High School Students With Sickle Cell Disease
Andrew M Heitzer1, Meredith Ray2, Andrew Wiese3
1Department of Psychology & Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Sickle cell disease (SCD) negatively impacts academic performance in high school students, leading to lower English proficiency and increased grade retention, partly due to frequent school absences.
Area of Science:
- Pediatric Health
- Educational Psychology
- Public Health
Background:
- Adolescent academic underachievement in sickle cell disease (SCD) correlates with increased healthcare utilization and diminished adult quality of life.
- Understanding the academic impact of SCD is crucial for developing targeted support interventions.
Purpose of the Study:
- To compare the academic performance of high school students with SCD to their peers without SCD.
- To identify specific academic outcomes affected by SCD, controlling for race and sex.
Main Methods:
- Retrospective cohort study utilizing Tennessee Medicaid claims and educational data (2007-2019).
- Matched analysis comparing students with SCD to a control group (1:8 ratio).
- Academic achievement assessed via end-of-course proficiency, grade retention, school withdrawal, and days absent.
Main Results:
- Students with SCD demonstrated lower odds of English proficiency (OR 0.8; P < 0.001).
- Students with SCD were more likely to be retained in ninth grade (OR 1.2; P = 0.045).
- School absence significantly mediated the effect of SCD on grade retention (indirect effect OR 1.18; P < 0.0001).
Conclusions:
- Sickle cell disease adversely affects academic performance in adolescents.
- Frequent school absences emerge as a key factor mediating the negative impact of SCD on academic attainment.
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