Excessive school absence is a major educational and social problem in the United States which is most pronounced in urban school systems. A case control study of excessively absent inner-city middle-school students and regular attenders failed to demonstrate any differences between groups in terms of health status, health-related behaviors, or utilization of health services. These results contrast dramatically with the findings of a previous study which identified a number of educational and demographic characteristics which clearly distinguish excessively absent students from regular attenders. It is concluded that educational and demographic factors are far more important in influencing excessive absence behavior than are health-related factors. The implications of these findings for the pediatrician are discussed.