Excessive Absenteeism Due to Asthma in California Elementary Schoolchildren

OBJECTIVE: Previous studies of asthma-related school absenteeism have reported absenteeism dichotomously (ie, any school days missed vs none). However, schools use higher thresholds to identify and intervene for students at risk of chronic absenteeism (18 days or >= 10% schoolyear missed), which is associated with negative health and educational outcomes. We sought to identify factors associated with excessive absenteeism (EA) due to asthma (>= 9 days missed), a threshold based on a convention defined by Attendance Works for absenteeism risk, and is linked to decreased academic performance and increased risk of chronic absenteeism. METHODS: We examined responses for asthma-related absenteeism from the 2011 to 2014 California Health Interview Survey for children ages 5-11. Multivariate logistic regression modeled odds ratios of EA for demographic, healthcare utilization, and asthma-related factors. Sensitivity analysis was performed modeling a >= 1 threshold (any absenteeism). RESULTS: 715 respondents represent an estimated 314,200 California schoolchildren with asthma. 50.3% of students missed >= 1 day, and 11.7% missed >= 9 days of school due to asthma. Odds of EA were significantly higher for younger children, lower-income families, and rural students, but not significant for any absenteeism. Indicators of greater asthma severity and poorer control were significantly associated with both EA and any absenteeism. CONCLUSIONS: This study identified factors significantly associated with EA that were not significant for lower absence thresholds. This may help direct school-based asthma interventions for which limited resources must target students at higher risk of chronic absenteeism.