Missing Care, Missing Class—Analyzing the Overlooked Relationship Between Unmet Healthcare Needs and Absenteeism

• In Event: Unpacking The Role of Student Health Challenges in Chronic Absenteeism

Abstract

Researchers have tied chronic absenteeism—or missing 10% or more school days—to lower levels of school readiness, lower test scores, and graduation rates (Gershenson et al., 2017; Gottfried, 2010; Kirksey, 2019). Moreover, chronic absenteeism can negatively impact peer performance (Gottfried, 2014, 2019; Gottfried & Ansari, 2022) and teacher satisfaction (Gottfried et al., 2024, 2025). Before the COVID-19 pandemic, about 15% of students in the United States missed 10% or more days of school (United States Department of Education, 2024). Chronic absenteeism spiked during the pandemic, and while there has been some recovery, it remains substantially higher than pre-pandemic levels (Dee, 2024; Malkus, 2024). As such, policymakers and practitioners are paying increasing attention to student attendance and chronic absenteeism as obstacles to improving student achievement and attainment. 
Yet, chronic absenteeism is a complex problem—the consequence of several individual, school, family, neighborhood, and macro-level conditions, many of which are beyond schools’ immediate control (Childs & Lofton, 2021; Singer et al., 2021). One example is student health. Acute illnesses (e.g., colds, the flu, stomach bugs) are the most common reasons for students to miss school, and students often miss more school if they have a chronic illness (e.g., asthma, sickle cell anemia) (Allison et al., 2019). Finally, students may miss additional days of school if they do not have reliable access to healthcare. This can include a lack of healthcare coverage, transportation resources to get to and from the doctor easily, or scheduling issues that require students to miss school for a doctor’s appointment (Carrillo et al., 2011). In some cases, families fail to access healthcare at all when their children need it.

In this paper, we explore how failing to access healthcare is associated with students' health-related absences and whether the relationship between healthcare access and health-related absences has changed over time. We analyze the National Survey of Children’s Health (NSCH) to do so. We present a nationally representative cross-sectional analysis of the years 2017-2023, excluding 2016 because it did not have any relevant data for our study. Our study has a sample size of over 160,000 students harmonized across all years.

Ordinary Least Squares shows us that when students did not receive one type of healthcare they needed, they were absent 1.13 days (P <.001), but the interaction with post-COVID years was not significant. When looking at the specific types of healthcare not received, mental and dental health were the most frequently selected, with around 40% of parents choosing this option for not receiving care when needed. When parents were asked why they were not receiving health care, the most cited reasons were getting an appointment and the cost. 

These results underscore the necessity of policy interventions to improve healthcare, specifically dental and mental health access, as a strategic measure to reduce absenteeism and improve learning. We conclude with recommendations for coordinated action by schools, healthcare systems, and policymakers to increase access to healthcare and more broadly provide healthy conditions for students and their families. 

Authors

• Wendy Castillo, Montclair State University
  Presenting Author

• Jeremy Singer, Wayne State University
  Non-Presenting Co-Author