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Here, we study education in neurofibromatosis 1 (NF1) that is associated with multifaceted medical, social and cognitive consequences. Educational attainment in the Finnish population\u2010based cohort of 1408 individuals with verified NF1 was compared with matched controls using Cox proportional hazards model with delayed entry and competing risk for death. Moreover, models accounting for the effects of cancer at age 15\u201330\u2009years, parental NF1 and developmental disorders were constructed. Overall, the attainment of secondary education was reduced in individuals with NF1 compared to controls (hazard ratio 0.83, 95%CI 0.74\u20130.92). History of cancer and developmental disorders were major predictors of lack of secondary education. Individuals with NF1 obtained vocational secondary education more often than general upper secondary education. Consequently, NF1 decreased the attainment of Bachelor's and Master's degrees by 46%\u201349% and 64%\u201374%, respectively. Surprisingly, the non\u2010NF1 siblings of individuals with NF1 also had lower educational attainment than controls, irrespective of parental NF1. In conclusion, NF1 is associated with reduced educational attainment and tendency for affected individuals to obtain vocational instead of academic education. Individuals living with NF1, especially those with cancer, developmental disorders or familial NF1, need effective student counseling and learning assistance.<\/jats:p>","DOI":"10.1111\/cge.13907","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T03:38:16Z","timestamp":1609126696000},"page":"529-539","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["A rare disease and education: Neurofibromatosis type 1 decreases educational attainment"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-907X","authenticated-orcid":false,"given":"Edvard","family":"Johansson","sequence":"first","affiliation":[{"name":"Faculty of Social Sciences, Business, and Economics \u00c5bo Akademi University Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-2980","authenticated-orcid":false,"given":"Roope A.","family":"Kallionp\u00e4\u00e4","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine University of Turku Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petri","family":"B\u00f6ckerman","sequence":"additional","affiliation":[{"name":"Jyv\u00e4skyl\u00e4 University School of Business and Economics Jyv\u00e4skyl\u00e4 Finland"},{"name":"Labour Institute for Economic Research Helsinki Finland"},{"name":"IZA Institute of Labor Economics Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5732-4167","authenticated-orcid":false,"given":"Juha","family":"Peltonen","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine University of Turku Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0990-1430","authenticated-orcid":false,"given":"Sirkku","family":"Peltonen","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology University of Turku Turku Finland"},{"name":"Department of Dermatology Turku University Hospital Turku Finland"},{"name":"Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"},{"name":"Department of Dermatology and Venereology, Region V\u00e4stra G\u00f6taland Sahlgrenska University Hospital Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2006.tb01268.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41431-019-0359-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehb.2009.01.002"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/daq059"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2014.465"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2017.215"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1215\/15228517-2008-011"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32187"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.37123"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.65.3576"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2018.28"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13526"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073808316366"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41436-020-0752-2"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.b.32414"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.33178"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1087054712450749"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(96)00022-6"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.2012.01648.x"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rssm.2019.100455"},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression models and life\u2010tables","volume":"34","author":"Cox D","year":"1972","journal-title":"JR Stat Soc B"},{"key":"e_1_2_9_23_1","unstructured":"Statistics Finland \u2010 Education \u2010 Educational structure of population. 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