School attendance is an indicator of child well-being and function across health, education, and social domains. In the 2022–23 school year, 28% of US children were chronically absent from school, contributing to national declines in academic performance. The objective of this study was to characterize health-related and social reasons for chronic absenteeism in an urban public school district.

We conducted a cross-sectional mixed-methods study in collaboration with a northeastern US urban school district, utilizing a community-based participatory research (CBPR) approach. We analyzed secondary data from surveys administered by school district representatives to caregivers of chronically absent students. Visits were conducted between December 2022 and June 2023. We analyzed quantitative data using descriptive statistics and applied qualitative summative content analysis to transcribed responses to open-ended questions.

The sample included 5223 first-time survey records, each representing one student. A majority of home visit records (71%) selected “Health” and 18% selected “Social” as the primary reason for school absences. Nearly 10% of families reported having both health and social barriers to attendance. Qualitative analysis further described health-related barriers to attendance as acute illness, chronic disease, and mental/behavioral health needs. Social barriers included family-related challenges, transportation difficulties, and housing or financial instability.

Health-related and social barriers were commonly reported reasons for chronic absenteeism in an urban school district. Our findings present a call to action for pediatricians and pediatric health systems to recognize the interrelatedness of school attendance and health, positioning them as key players in addressing chronic absenteeism.