Abstract
IntroductionIn adults, multimorbidity is associated with social position. Socially disadvantaged adults typically experience more chronic illness at a younger age than comparable individuals who are more advantaged. The relation between social position and multimorbidity amongst children and adolescents has not been as widely studied and is less clear.MethodsThe NHS Information Centre (NHS IC) linked participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) to the General Practice Research Database (GPRD). Multimorbidity was measured in three different ways: using a count of the number of drugs prescribed, a count of chronic diseases, and a person’s predicted resource use score; the latter two measures were derived using the Johns Hopkins ACG system. A number of different socio-economic position variables measured as part of ALSPAC during pregnancy and early childhood were considered. Ordered logistic and negative binomial regression models were used to investigate associations between socio-economic variables and multimorbidity.ResultsAfter mutually adjusting for the different markers of socio-economic position, there was evidence, albeit weak, that chronic condition counts among children aged from 0 to 9 years were higher among those whose mothers were less well educated (OR = 0.44; 95% confidence interval 0.18-1.10; p = 0.08). Conversely, children whose mothers were better educated had higher rates of chronic illness between 10 and 18 years (OR = 1.94; 95% CI 1.14-3.30). However, living in a more deprived area, as indicated by the Townsend score, was associated with a higher odds of chronic illness between 10 and 18 years (OR for each increasing decile of Townsend score = 1.09; 95% CI 1.00-1.19; p = 0.06).ConclusionsWe have found some evidence that, in younger children, multimorbidity may be higher amongst children whose parents are less well educated. In older children and adolescents this association is less clear. We have also demonstrated that linkage between prospective observational studies and electronic patient records can provide an effective way of obtaining objectively measured outcome variables.
Highlights
In adults, multimorbidity is associated with social position
In this study, carried out as part of a larger project being conducted to explore the potential value of linkage between large observational cohort studies and administrative and healthcare data, we have investigated whether there is an association between socio-economic position measured during pregnancy and multimorbidity during childhood and adolescence
Apart from the Townsend score, which was available for all whom a record of contact was made during 1990–92, the socio-economic variables were only available for individuals who had enrolled in Avon Longitudinal Study of Parents and Children (ALSPAC); in addition, numbers with a non-missing or valid response varied according to when the information was collected
Summary
Multimorbidity is associated with social position. Socially disadvantaged adults typically experience more chronic illness at a younger age than comparable individuals who are more advantaged. Multimorbidity, the co-occurrence of two or more chronic medical conditions, is increasingly common [1,2] and has a large impact on a number of different outcomes, including treatment complications, disability, mortality and quality of life [3,4]. Few studies have examined the impact of socioeconomic position in childhood on multimorbidity. One study carried out in the USA examined the impact of childhood economic hardship on multimorbidity among people aged 50 or over and found that, on average, those who experienced hardship during childhood had a greater number of chronic conditions [9]. Other studies have shown social class inequalities in rates of common childhood conditions, such as injury, asthma, respiratory infections, and general morbidity [11,12]
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