Abstract
BackgroundThe aetiology of disabling chronic conditions in childhood in high income countries is not fully understood, particularly the association with socio-economic status (SES). Very few studies have used longitudinal datasets to examine whether exposure to social disadvantage in early childhood increases the risk of developing chronic conditions in later childhood. Here we examine this association, and its temporal ordering, with onset of all-cause disabling chronic later childhood in children reported as free from disability in early childhood.MethodsThe study comprised a prospective cohort study, using data from the Office for National Statistics Longitudinal Study (ONSLS) for England and Wales. The study sample included 52,839 children with complete data born between 1981–1991 with no disabling chronic condition/s in 1991. Index cases were children with disability recorded in 2001. Comparison cases were children with no recorded disability in 1991. A socio-economic disadvantage index (SDI) was constructed from data on social class, housing tenure and car/van access. Associations were explored with logistic regression modelling controlling sequentially for potentially confounding factors; age, gender, ethnicity and lone parenthood.ResultsBy 2001, 2049 (4%) had at least one disability. Socio-economic disadvantage, age, gender and lone parenthood but not ethnicity were significantly associated with onset of disabling chronic conditions. The SDI showed a finely graded association with onset of disabling chronic conditions in the index group (most disadvantaged OR 2·11 [CI 1·76 to 2·53]; disadvantaged in two domains OR 1·45 [CI 1·20 to 1·75]; disadvantaged in one domain OR 1·14 [CI 0·93 to 1·39] that was unaffected by age, gender and ethnicity and slightly attenuated by lone parenthood.ConclusionTo our knowledge, this is the first study to identify socio-economic disadvantage in earlier childhood as a predisposing factor for onset of all-cause disabling chronic conditions in later childhood. Temporal ordering and gradation of the response indicate socio-economic disadvantage may play a causal role. This suggests that targeting preventative efforts to reduce socio-economic disadvantage in early childhood is likely to be an important public health strategy to decease health inequalities in later childhood and early adulthood.
Highlights
The aetiology of disabling chronic conditions in childhood in high income countries is not fully understood, the association with socio-economic status (SES)
Using data from the United Kingdom (UK) Office of National Statistics Longitudinal Study (ONSLS) we report on children who were identified as being free from disabling chronic conditions in early childhood (0–10 years) and examine whether exposure to socio-economic disadvantage during this period increased their risk of developing a disabling chronic condition in later childhood and early adulthood (10–20 years)
Our analysis of a representative sample of children in England and Wales, showed that children who lived in socio-economically disadvantaged households when they were aged 0–10 years and who were reported as not having any disabling chronic condition at this time point were at greater risk of developing disabling chronic conditions in later childhood than children who lived in more advantaged households in earlier childhood
Summary
The aetiology of disabling chronic conditions in childhood in high income countries is not fully understood, the association with socio-economic status (SES). Very few studies have used longitudinal datasets to examine whether exposure to social disadvantage in early childhood increases the risk of developing chronic conditions in later childhood. We examine this association, and its temporal ordering, with onset of all-cause disabling chronic later childhood in children reported as free from disability in early childhood. Many cross-sectional studies have documented the association of low SES with disabling chronic conditions, [5,6,7,8] but studies of this design cannot answer questions about causality or temporal sequencing [9]. Studies that have used longitudinal designs to explore pathways from early childhood socioeconomic disadvantage to disabling chronic conditions and poor health in later childhood
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