Socioeconomic factors and risk of hospitalization with infectious diseases in 0- to 2-year-old Danish children

Abstract

Although the association between low socioeconomic status and illness in childhood is well known, the impact of socioeconomic factors on risk and frequency of hospitalizations for infectious diseases, the most frequent disease category, during the first 2 years of life has scarcely been studied. Through linkage of records drawn from public administrative and health registries, we conducted a population-based cohort study of 5024 Danish children born in 1997 to examine the frequency of hospitalization for infectious diseases in very young children. The main exposure variables, adjusted for potential confounding factors, were mother's education level, household income, and cohabitation status. The outcome was number of hospital admissions (0, 1-2, or 3+) for infectious diseases. A total of 737 children (14.7%) were admitted to hospital 1-2 times, and 83 (1.6%) were admitted 3-10 times. The risk of hospitalization was increased in children of mothers with a low level of education compared with vocational education (1-2 admissions: adjusted odds ratio (OR) 1.3 (95% confidence interval [CI]: 1.1-1.6). Children from low-income families had an increased risk of 3 or more admissions (low cf middle income: adjusted OR 2.0 [95% CI: 0.6-6.0]). Children of single mothers had an increased risk of hospitalization (1-2 admissions: adjusted OR 1.7 [95% CI: 1.1-2.6]. We found the highest risk of hospitalization for infectious diseases in children of mothers with only basic schooling, and particularly among those coming from single parent homes with a low income.

Childhood disadvantage and emergency admission rates for common presentations in London: an exploratory analysis

“…These findings may suggest that parents are increasingly unwilling to manage self-limiting childhood complaints at home with the support of primary care services. Parental confidence in managing such conditions may contribute to the association between admissions and maternal age and education,28 29 but these maternal factors are not visible in our data because they do not contribute directly to either the IMD or CWI.…”

“…It is possible that admissions practice at different hospitals and the implementation of new advice such as the NICE fever guidelines in 2007,33 could also affect admission rates. Lower maternal education and single parenthood were associated with hospitalisation for infectious disease in a Danish study28 and the risk of repeated admissions was also increased in children from low-income families 28. Maternal factors, including lower levels of education, younger age and single parenthood, were also associated with hospitalisation for rotavirus acute gastroenteritis in the USA, along with insurance status, low birth weight and not being breast fed 29.…”

Infectious Disease Hospitalizations Among Infants in the United States

“…The increased proportion of hospitalizations with lower reported income and with Medicaid as the primary payer among infants hospitalized with IDs presumably reflect disadvantaged social status. 26 ID hospitalizations represented a major source of health care expenditures (both subsidized and private) among US infants, with Ͼ1 million total hospital days and more than $3 billion in total hospital charges for 2003. Limited access to preventive care resources such as vaccination might have influenced ID hospitalization rates and contributed to the higher rates among certain groups of infants.…”

Stressful life events in childhood and risk of infectious disease hospitalization

“…Several biological parents do live together without being married and a separation will, without doubt, be perceived as very stressful by the child. We did observe an increased risk of infectious diseases among children belonging to the group of non-married parents, which could be due to separation between non-married but also to the well-known higher morbidity among children living with single parents [46,49].…”

“…Children suffering from an SID would normally require hospital treatment, whereas the likelihood of LSID hospitalization could be influenced by other factors such as the health and socioeconomic position of the parents but also by the admitting physician's judgement of parent's capability to take care of a sick child and how worried and frightened the parents are by the sickness of the child [46]. Information on SID (sepsis, meningitis, pyelonephritis, osteomyelitis, ethmoiditis) [6,33,47] and LSID (pneumonia, upper respiratory infections, gastroenteritis, cystitis, bronchitis, conjunctivitis, influenza) [39] (diseases and diagnostic codes are listed in the "Appendix") was obtained from the Danish Hospital Discharge Register which contains information on all hospitalizations (excluding psychiatric hospitalizations) in Denmark since January 1977, including outpatient treatments since 1995.…”