Health-Related School Absenteeism Among US School-Age Children With Chronic Health and Social Needs

In the 2022-2023 school year, more than 1 in 4 children in the US were chronically absent from school, doubling prepandemic rates. As a potential signal of underlying health and social challenges and a predictor of long-term health, this surge in absenteeism presents a pressing public health concern.

To examine associations between chronic health needs, health-related social needs, and health-related school absenteeism among US school-aged children.

This cross-sectional study was conducted using the 2022-2023 National Survey of Children's Health among US children aged 6 to 17 years with available data on school absenteeism. Data were analyzed from April to December 2025.

Chronic health needs, including children with special health care needs status or 1 of 27 chronic health conditions, and household-level health-related social needs (HRSNs), including housing instability, food insecurity, parent health needs, or exposure to adverse childhood experiences. Covariates included age, sex, race and ethnicity, and income.

The primary outcome was elevated health-related school absenteeism, defined as missing 11 days or more due to illness or injury in the past year. Survey weights were used to generate national estimates.

The weighted sample represented 49.3 million children (mean age, 11.6 years; 24 100 000 female children [48.9%]; 30 700 000 [62.2%] at ≥201% of the federal poverty level). More than half of the sample (35 012 of 66 752 [52.5%]) reported having combined chronic health need(s) and HRSN(s), representing an estimated 25.9 million children. Prevalence of elevated health-related school absenteeism in the study sample was 6.8% (n = 5117), representing an estimated 3.4 million children. Compared to children with neither chronic health needs nor HRSNs (1.8%; 95% CI, 1.3%-2.2%), the estimated probability of elevated health-related school absenteeism was higher among those with either chronic health needs (4.4%; 95% CI, 3.6%-5.3%) or HRSNs (3.7%; 95% CI, 3.0%-4.4%) and was highest among those with both (9.4%; 95% CI, 8.8%-9.9%).

In this cross-sectional study, children with chronic health needs and HRSNs were more likely to experience elevated health-related school absenteeism compared to children without these needs; these associations were greatest among children with both chronic health needs and HRSNs. These findings highlight potential opportunities to improve health and educational outcomes through targeted interventions focused on these groups.