## Abstract

Background: Among students with sickle cell anemia (SCA), cerebral infarcts are an established risk factor for poor cognition and academic achievement. We tested the hypothesis that in children with SCA, lower socioeconomic status (SES) is associated with grade failure.

Methods: We evaluated the association between the SES as measured by annual income per person in household per year, age of student, gender, medical history and grade failure in children with SCA in 24 sites participating in the Silent Cerebral Infarct Multi-Center Clinical Trial.

Results: A total of 404 students were evaluable. The mean age was 9.2 years (range 6–13), 37% had a silent infarct, 15% failed a grade, and 18% had an Individualized Education Plan. SES was divided in tertiles based on annual income/person in the household/year < $5000,$5000–$9999, >$10,000. After adjustment for covariates, the risk of grade failure was 1.4 (95% CI 1.2, 1.6) for each increasing year of age, and 1.9 (95% CI 1.03, 3.5) for male gender. Children from households of the lowest tertile were 4 times more likely to fail a grade than children from the top tertile. A silent cerebral infarct was not associated with grade failure 1.4 (95% CI 0.8, 2.6). No student with a history of grade failure was hospitalized > 3 times per year over the past three years.

Conclusion: Among students with SCA, poverty is the greatest risk factor for grade failure; whereas the presence of silent cerebral infarct is not. Targeted strategies to improve educational attainment in students with SCA are needed.

## Author notes

Disclosure:Research Funding: NIH-NINDS, NIH-NHLBI, and the Doris Duke Charitable Foundation.