Impact of air pollution and asthma on school attendance and educational attainment: a scoping review.

BACKGROUND: Asthma morbidity is high among young people, and studies have shown associations between asthma and school attendance and educational attainment. However, findings are unclear concerning associations between air pollution and these educational outcomes, and whether asthma might mediate any associations. OBJECTIVE: This review aimed to summarise, and find gaps in, the research on outdoor air pollution, asthma and educational outcomes. To our knowledge, this is the first review to consider the impact of air pollution or asthma, individually or in combination, on the school attendance and educational attainment of children and young people. DESIGN: This scoping review, using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews method, reports on searches for English language studies of air pollution, asthma and school attendance and educational attainment in eight databases with tabulation and synthesis of the extracted data. RESULTS: Association between air pollution and school absence was found to be weaker than for active asthma with this outcome. Uncontrolled asthma was associated with lower educational attainment, but findings on air pollution exposure were mixed. Two studies found associations for air pollution with poorer educational outcomes for young people with asthma. Long-term exposure to air pollution, and an increase in the frequency of peaks of air pollution, were associated with worse educational outcomes. Inequalities in access to healthcare and education were associated with uncontrolled asthma and lower educational outcomes. Only one study used linked health, environmental and educational data. CONCLUSIONS: Linked administrative data will be important to enable longitudinal studies of exceptionally large populations to explore asthma exacerbation, baseline and spikes of air pollution and risk factors. Analyses should control for type of educational assessment and specific particulate exposure. Studies should examine temporal changes and a variety of geographical settings to identify even weak associations to inform approaches to address inequalities of public health and education.