During the period from 2010 to 2016, parents of children from low-income households were more likely to report recent childhood gastrointestinal (GI) and respiratory illnesses than were parents with a higher income. Further, parents of children from low-income households were less likely to report missing any school, but when they did the tended to miss more days on average. These results were published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

Gastrointestinal and respiratory infections are considered among the most important illnesses that affect school-aged children in the United States; schools are often the primary setting for transmission. Therefore, National Health Interview Survey (NHIS) data on school absenteeism and GI and respiratory illnesses were analyzed to examine associations of these phenomena with income. Data on school absenteeism in the last year, including number of days, were pulled from the NHIS database, and the investigators conducted an interview with parents to obtain reports of GI or respiratory illness in the 2 weeks before the interview. Researchers also used NHIS income files to create income brackets to allow for stratification of survey results.

Results showed that of the 61,482 households included and interviewed, 69% of children missed >1 day of school; further, 5% and 13% of children were reported to experience a GI or respiratory infection in the past 2 weeks, respectively. Children of the lowest-income households (earning <$35,000) had a 65% likelihood of missing school in the past year and a prevalence of 6% and 14% of GI or respiratory illness, respectively; this is compared with a 67%-73% likelihood for children in households of higher-income household and a prevalence of 4%-5% and 12%-13% for the aforementioned respective illnesses.

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Children of households living below the poverty line were 9% less likely to miss school but 23% more likely to have had a GI or respiratory infection during the past year.

The investigators noted at least 2 limitations of their study. First, NHIS collects health and school absence data generalizable to the civilian noninstitutional­ized United States population, but the reasons for absences are not collected. Second, both health and school absence data are reported by parents; therefore, the data are subject to recall bias and are not consistent in their respective recall timelines, the preceding 2 weeks vs the preceding year. It was, however, noted that, “recall of self-reported illness and school absenteeism is likely to be more accurate for the recent past; thus, the association between reporting of recent illness and school absenteeism is likely to be strengthened.”

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Although it is not possible to ascertain the reasons for absenteeism from this analysis and further studies are needed to explore what factors underlie these associations with income, investigators believe the data emphasizes the importance for accessible, affordable resources to aid in the prevention of infections in children. It also highlights the opportunity for both homes and schools to act as “important points for implementation of public health preventive measures, including improved hand hygiene practices.”


Berendes D, Andujar A, Barrios LC, Hill V. Associations among school absenteeism, gastrointestinal and respiratory illness, and income — United States, 2010-2016. MMWR. 2020;68:1201-1205.