Is the onset of disabling chronic conditions in later childhood associated with exposure to social disadvantage in earlier childhood? a prospective cohort study using the ONS Longitudinal Study for England and Wales

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.

Socioeconomic disadvantage and onset of childhood chronic disabling conditions: a cohort study

“…The present study based on the Growing Up in Australia: Longitudinal Study of Australian Children (LSAC) aims to replicate and extend the findings of Blackburn et al 11 in a different country setting. We first test if socioeconomic disadvantage, assessed by household income, precedes childhood CDC.…”

“…This paper extends the method used by Blackburn et al 11 by further considering if caring for a child with CDC subsequently eroded family finances.…”

“…To replicate the findings of Blackburn et al ,11 we selected similar potential confounding variables: child's sex and age in months at 6/7; indigenous status; and lone parenthood at child age 6/7 with addition of maternal CDC at 6/7. Selected potential confounding variables have a known association with childhood CDC7 16 and were significantly associated at 10% level with CDC onset in bivariate analysis (table 2), a recognised statistical cut-off for inclusion in multivariate models 17…”

“…Logistic regression was undertaken in the SPSS V.20 Complex Samples facility (IBM Inc). Models were fitted on the dependent variable with the independent variable of interested first followed by potential confounders in the same sequence as that used by Blackburn et al 11 with the addition of maternal CDC: Model 1—household income quintile at 6/7 years only Model 2—child's sex and age added Model 3—indigenous status added Model 4—lone parenthood added Model 5—maternal CDC. …”

“…Longitudinal studies exploring the temporal relationship of social disadvantage with disability are rare 10. The study by Blackburn et al 11 is an exception, finding increased odds of CDC onset in later childhood among children socioeconomically disadvantaged in early childhood. However, they did not examine socioeconomic disadvantage arising as a consequence of CDC.…”