Socioeconomic inequalities in children under 15 with medical complexity: A population-based study

Abstract

Background Health inequalities from the first stages of life onwards have consequences for children’s health status and for their future development. Children’s health is profoundly affected by the socioeconomic position (SEP) of their parents. The situation is even more disruptive in children with medically complex (CMC) conditions. The aim of this study is to describe the characteristics and related pathologies of CMC in Catalonia, and to assess the presence of socioeconomic inequalities.Methods Cross-sectional study and cluster analysis of the diseases in the CMC population under the age of 15 in Catalonia in 2016 using administrative data. Each pathology cluster obtained was described and its association with socioeconomic position (SEP) determined. The Adjusted Morbidity Groups (Catalan acronym GMA) classification system was used to identify the CMC. Main outcome measures: SEP, GMA score, sex, and age distribution were recorded in both populations (CMC and non-CMC) and in each of the clusters identified.Results 71% of the CMC population have at least one parent with no employment or an annual income of less than €18,000. Four comorbidity clusters were identified in CMC: respiratory (47%), neurodevelopmental (18%), hemato-oncological (12%), and perinatal disorders (23%). CMC experience higher levels of poverty and social disadvantage in all clusters. SES-cluster association results were: in the respiratory OR, 2.1 in boys and 2.1 in girls; in the neurodevelopmental disease, OR 2.0 in boys and 1.8 in girls; in the hemato-oncology OR, 1.7 in boys and 1.8 in girls; and in the perinatal OR, 1.7 in boys and 1.8 in girls.Conclusions There are socioeconomic health inequalities in childhood across a broad spectrum of health outcomes. Children with lower SEP are more likely to have CMC conditions. All clusters showed SEP inequalities and respiratory and neurodevelopment clusters are the most prevalent.