Social disadvantage predicts growth outcomes in preadolescent children with cystic fibrosis

Abstract

Socioeconomic status (SES) is a multi-dimensional construct that is used as anindicator of environmental influences on health and well-being [1–7]. A sociological approach to understanding the importance of SES for health outcomes may be informative. The idea of capital, broadly defined as resources and assets that affectwell-being on anindividual orgroup level, is derived from conventional measures of SES but incorporates the critical dimension of social relationships. Specifically, access to material resources (financial capital), non-material resources (human capital) and social relationships (social capital) may converge to influence health and well-being, but represent distinct resources [8–9]. Although it is preferable to measure multiple dimensions of SES, investigators often use a single measure, such as income. Braverman and others [10–12] have maintained that although SES measures are moderately correlated, they are neither interchangeable nor robust independent proxies for SES. Bauman et al. [1] examined the impact of social disadvantage on child health. Social disadvantage was defined by four risk factors that are commonly used as SES measures: race/ethnicity, income, parental education, family structure. While each factor was independently related to overall risk of poor health, only income, parental education and family structure were related to other health outcomes, namely the presence of a chronic medical condition, and to the presence of limited activity. Cystic fibrosis (CF) is the most common genetic disease in children of European descent in the US, with variable effects on pulmonary function and growth. Using data from the US CF Registry, two studies have investigated the impact of income on health outcomes in children with CF [13–14]. Investigators reported a significantly higher risk of death, growth faltering and reduced pulmonary function in children from lower versus higher income families. The effects of other dimensions of SES were not examined. The aim of this study was to explore the impact of SES on children with CF using a sociological approach. We examined the relationship between financial, human and social capital and growth and pulmonary status in preadolescent children with CF and pancreatic insufficiency (PI) over 24 months. For the purpose of this study, financial capital was defined as household income,humancapital asprimarycaregivereducationandsocial capital as family structure, specifically the number of caregivers in the household.