Educational attainment in patients with congenital heart disease: A comprehensive systematic review and meta-analysis

Background: Our aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs obtaining/completing) in adults.
Method: Studies were eligible if they reported the rate, odds, or proportion of level of educational attainment in adults by whether or not they had a CHD.
Result: Out of 1537 articles screened, we identified 11 (N = 104585 participants, 10487 with CHD), 10 (N = 167470 participants, 11820 with CHD), and 8 (N = 150813 participants, 9817 with CHD) studies reporting information on university education, secondary education, and vocational training, respectively in both CHD and non-CHD participants. Compared to their non-CHD peers, CHD patients were more likely not to obtain a university degree (OR=1.38, 95% CI [1.16, 1.65]), complete secondary education (OR=1.33, 95 % CI [1.09, 1.61]) or vocational training (OR= 1.11, 95%CI [0.98, 1.26]). For all three outcomes there was evidence of between study heterogeneity, with geographical area contributing to this heterogeneity.
Conclusion: This systematic review identified all available published data on educational attainment in CHD patients. Despite broad inclusion criteria we identified relatively few studies that included a comparison group from the same population, and amongst those that did, few adjusted for key confounders. Pooled analyses suggest evidence of lower levels of educational attainment in patients with CHD when compared to non-CHD peers. The extent to which this may be explained by confounding factors, such as parental education, or mediated by treatments is not possible to discern from the current research literature.