The impact of low birth weight, perinatal conditions, and sociodemographicfactors on educational outcome in kindergarten

Objective. To assess the relative effects and the impact of perinatal and s ociodemographic risk factors on long-term morbidity within a total birth po pulation in Florida. Methods. School records for 339 171 children entering kindergarten in Flori da public schools in the 1992-1993, 1993-1994, or 1994-1995 academic years were matched with Florida birth records from 1985 to 1990. Effects on long- term morbidity were assessed through a multivariate analysis of an educatio nal outcome variable, defined as placement into 9 mutually exclusive catego ries in kindergarten. Of those categories, 7 were special education (SE) cl assifications determined by statewide standardized eligibility criteria, 1 was academic problems, and the reference category was regular classroom. Ge neralized logistic regression was used to simultaneously estimate the odds of placement in SE and academic problems. The impact of all risk factors wa s assessed via estimated attributable excess/deficit numbers, based on the multivariate analysis. Results. Educational outcome was significantly influenced by both perinatal and sociodemographic factors. Perinatal factors had greater adverse effect s on the most severe SE types, with birth weight <1000 g having the greates t effect. Sociodemographic predictors had greater effects on the mild educa tional disabilities. Because of their greater prevalence, the impact attrib utable to each of the factors (poverty, male gender, low maternal education , or non-white race) was between 5 and 10 times greater than that of low bi rth weight and >10 times greater than that of very low birth weight, presen ce of a congenital anomaly, or prenatal care. Conclusions. Results are consistent with the hypothesis that adverse perina tal conditions result in severe educational disabilities, whereas less seve re outcomes are influenced by sociodemographic factors. Overall, sociodemog raphic factors have a greater total impact on adverse educational outcomes than perinatal factors.