Educational achievement and economic self-sufficiency in adults after childhood bacterial meningitis

Abstract

Importance To our knowledge, no previous study has examined functioning in adult life among persons who had bacterial meningitis in childhood.

Objective To study educational achievement and economic self-sufficiency in adults diagnosed as having bacterial meningitis in childhood.

Design, Setting, and Participants Nationwide population-based cohort study using national registries of Danish-born children diagnosed as having meningococcal, pneumococcal, or Haemophilus influenzae meningitis in the period 1977-2007 (n=2784 patients). Comparison cohorts from the same population individually matched on age and sex were identified, as were siblings of all study participants. End of study period was 2010.

Main Outcomes and Measures Cumulative incidences of completed vocational education, high school education, higher education, time to first full year of economic self-sufficiency, and receipt of disability pension and differences in these outcomes at age 35 years among meningitis patients, comparison cohorts, and siblings.

Results By age 35 years, among persons who had a history of childhood meningococcal (n=1338), pneumococcal (n=455), and H influenzae (n=991) meningitis, an estimated 11.0% (41.5% vs 52.5%; 95% CI, 7.3%-14.7%), 10.2% (42.6% vs 52.8%; 95% CI, 3.8%-16.6%), and 5.5% (47.7% vs 53.2%; 95% CI, 1.9%-9.1%) fewer persons, respectively, had completed high school and 7.9% (29.3% vs 37.2%; 95% CI, 1.6%-14.2%), 8.9% (28.1% vs 37.0%; 95% CI, 0.6%-17.2%), and 6.5% (33.5% vs 40.0%; 95% CI, 1.4%-11.6%) fewer had attained a higher education compared with individuals from the comparison cohort. Siblings of meningococcal meningitis patients also had lower educational achievements, while educational achievements of siblings of pneumococcal and H influenzae meningitis patients did not differ substantially from those in the general population. At end of follow-up, 3.8% (90.3% vs 94.1%; 95% CI, 1.1%-6.5%), 10.6% (84.0% vs 94.6%; 95% CI, 5.1%-16.1%), and 4.3% (90.6% vs 94.9%; 95% CI, 2.0%-6.6%) fewer meningococcal, pneumococcal, and H influenzae meningitis patients were economically self-sufficient and 1.5% (3.7% vs 2.3%; 95% CI, ?0.2% to 3.2%), 8.7% (10.0% vs 1.3%; 95% CI, 5.0%-12.4%), and 3.7% (6.2% vs 2.5%; 95% CI, 1.6%-5.8%) more received disability pension compared with individuals from the comparison cohort.

Conclusions and Relevance In a Danish population, bacterial meningitis in childhood was associated with lower educational achievement and economic self-sufficiency in adult life. This association may apply particularly to pneumococcal and H influenzae meningitis, whereas for meningococcal meningitis the lower educational achievement may be family-related.

Short- and long-term mortality in children diagnosed as having bacterial meningitis have been well described.1- 4 The infection may lead to brain damage due to inflammation, infarction, or seizures causing neuronal necrosis,5 and survivors of childhood bacterial meningitis are at particular risk of hearing loss, seizure disorders, motor deficits, and cognitive impairment.6 Learning disabilities are well documented as sequelae of the disease,7 with implications for educational achievement in adolescence.8

To our knowledge, no previous study has examined functioning in adult life among persons diagnosed as having bacterial meningitis in childhood. We therefore aimed to estimate educational achievement and economic self-sufficiency among children surviving bacterial meningitis on a population-based, nationwide scale compared with the general population. To elucidate the potential association with family-related factors, we compared the outcomes of the patients with that of their siblings and further estimated the educational achievement of the parents of members of the patient and comparison cohorts.