Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies

Abstract

ObjectiveTo determine the association of socioeconomic disadvantage with the prevalence of childhood disabling chronic conditions in high-income countries.Study designSystematic review and meta-analyses.Data sources6 electronic databases, relevant websites, reference lists and experts in the field.Study selection160 observational studies conducted in high-income countries with data on socioeconomic status and disabling chronic conditions in childhood, published between 1 January 1991 and 31 December 2013.Data extraction and synthesisAbstracts were reviewed, full papers obtained, and papers identified for inclusion by 2 independent reviewers. Inclusion decisions were checked by a third reviewer. Where reported, ORs were extracted for low versus high socioeconomic status. For studies reporting raw data but not ORs, ORs were calculated. Narrative analysis was undertaken for studies without data suitable for meta-analysis.Results126 studies had data suitable for meta-analysis. ORs for risk estimates were: all-cause disabling chronic conditions 1.72 (95% CI 1.48 to 2.01); psychological disorders 1.88 (95% CI 1.68 to 2.10); intellectual disability 2.41 (95% CI 2.03 to 2.86); activity-limiting asthma 2.20 (95% CI 1.87 to 2.85); cerebral palsy 1.42 (95% CI 1.26 to 1.61); congenital abnormalities 1.41 (95% CI 1.24 to 1.61); epilepsy 1.38 (95% CI 1.20 to 1.59); sensory impairment 1.70 (95% CI 1.39 to 2.07). Heterogeneity was high across most estimates (I2>75%). Of the 34 studies without data suitable for meta-analysis, 26 reported results consistent with increased risk associated with low socioeconomic status.ConclusionsThe findings indicate that, in high-income countries, childhood disabling chronic conditions are associated with social disadvantage. Although evidence of an association is consistent across different countries, the review provides limited evidence to explain the association; future research, using longitudinal data, will be required to distinguish low socioeconomic status as the cause or consequence of childhood disabling chronic conditions and the aetiological pathways and mechanisms.

A Study of Comparative Clinical and Socio-Economic Characteristics of School-Age Children Screened for ADHD: Implications for Development of ADHD Clinical Care Pathway

“…There is currently limited evidence to explain the causality of the observed consistent association across different countries [4]. This study confirms a relatively high prevalence of children at high risk of developing ADHD and other behavioural or developmental co-morbidities living in the least affluent areas of the community.…”

“…Socio-economic factors are known to influence the prevalence of chronic childhood disabling conditions including emotional and behavioural disorders like ADHD [4].…”

Predictive Validity of the Modified Checklist for Autism in Toddlers (M-CHAT) Born Very Preterm

“…Furthermore, factors such as sensorimotor or cognitive impairments that were found to affect the validity of the M-CHAT may be more prominent among children with lower socioeconomic backgrounds. 27 In fact, we found higher severity or prevalence of sensory, motor and cognitive impairments as well as dysregulation profiles among children with lower socioeconomic background in our sample (Table V; available at www.jpeds.com). …”

Poor versus rich children with epilepsy have the same clinical course and remission rates but a less favorable social outcome: A population‐based study with 25 years of follow‐up

“…There was also no consistent association between family income or parental income on the rates of comorbid intellectual disability or neurologic deficit. 11 In a helpful meta-analysis, Spencer et al 12 found 126 population-based studies that addressed the prevalence of chronic disease in children compared with their socioeconomic status in developed countries. There were some associations found with stepwise logistic regression that may be spurious and possibly the result of the permissive level of statistical significance that is traditionally used with this technique.…”