Abstract
Very little high quality evidence exists on the causal relationship between income poverty and childhood health. We provide a comprehensive overview of the association between household income poverty and hospitalisations for children. We used New Zealand's Integrated Data Infrastructure (IDI) to link income poverty data from the Survey of Family, Income and Employment (SoFIE; n = 21,759 households) and the 2013 New Zealand Census (n = 523,302 households) to publicly funded hospital records of children aged 0-17 (SoFIE: n = 39,459; Census, n = 986,901). Poverty was defined as equivalised household income below 60% of the median income, calculated both before and after housing costs, and using both self-reported and tax-recorded income. Correlations for the association between income poverty and hospitalisation were small (ranging from 0.02 to 0.05) and risk ratios were less than 1.35 for all but the rarest outcome-oral health hospitalisation. Weak or absent associations were apparent across age groups, waves of data collection, cumulative effects, and for estimates generated from fixed effects models and random effect models adjusted for age and ethnicity. Alternative measures of deprivation (area-level deprivation and material deprivation) showed stronger associations with hospitalisations (risk ratios ranged from 1.27-2.55) than income-based poverty measures. Income poverty is at best weakly associated with hospitalisation in childhood. Measures of deprivation may have a stronger association. Income measures alone may not be sufficient to capture the diversity of household economic circumstances when assessing the poverty-health relationship.
Highlights
Childhood poverty is increasing in many OECD countries [1,2,3,4]
These non-income measures of deprivation were more strongly associated with hospitalisation outcomes, typically in a dose-response fashion, and associations were stronger than associations found using measures of income poverty
While the literature clearly demonstrates that poverty is important for child health, our study findings suggest that income measures alone may not be sufficient to capture the diversity of household economic circumstances
Summary
Childhood poverty is increasing in many OECD countries [1,2,3,4]. In New Zealand, children have 1.6 times the poverty rate of the overall population—a concentration higher than for any European country [3]. The systemic cycle of poverty perpetuates social and economic differences between ethnic groups, and traps families in poverty across generations To break this cycle, policy makers need evidence on the most effective means of reducing the impact of poverty on a range of outcomes, including the health of children in families experiencing poverty. Children living in poverty in New Zealand have a 40% higher risk of dying during childhood [6], are sick three times as often [7], are more than twice as likely to be admitted to hospital for an acute infectious disease [8], miss out on more days of school due to ill health [9], and are more likely to have poor health outcomes in adulthood, including cardiovascular disease, dental decay, lowered longevity and mental illness [5]. We provide a comprehensive overview of the association between household income poverty and hospitalisations for children
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