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.
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.
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DOI：
10.1186/1471-2431-13-101
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发表时间：
2013-06-26
期刊：
影响因子：
2.4
通讯作者：
Read JM
中科院分区：
文献类型：
--
作者：
Blackburn CM;Spencer NJ;Read JM
高收入国家儿童期致残性慢性疾病的病因尚未完全了解，特别是与社会经济地位（SES）的关系。很少有研究使用纵向数据集来研究儿童早期暴露于社会劣势是否会增加儿童后期患慢性病的风险。在这里，我们研究了这种关联，其时间顺序，与发病的所有原因致残慢性童年后期的儿童报告为免费的残疾在幼儿期。该研究包括一项前瞻性队列研究，使用英格兰和威尔士国家统计局纵向研究（ONSLS）的数据。研究样本包括1981-1991年出生的52，839名儿童，这些儿童在1991年没有致残的慢性疾病。指数病例是2001年记录的残疾儿童。1991年的比较案例是没有残疾记录的儿童。根据社会阶层、住房保有权和小汽车/货车使用情况的数据，编制了一个社会经济不利因素指数。通过逻辑回归模型对潜在的混杂因素（年龄、性别、种族和单亲）进行顺序控制，探讨了相关性。到2001年，2 049人（4%）至少有一种残疾。社会经济劣势，年龄，性别和单亲家庭，但不是种族显着相关的致残慢性疾病的发病。SDI与指数组中致残性慢性疾病的发生存在精细分级的相关性（最不利OR 2.11 [CI 1.76至2.53];两个领域不利OR 1.45 [CI 1.20至1.75];在一个领域中处于不利地位的OR为1.14 [CI为0.93至1.39]，不受年龄、性别和种族的影响，并因单亲而略有减弱。据我们所知，这是第一项研究，以确定社会经济不利的早期儿童发病的诱发因素，所有原因的残疾慢性疾病在儿童后期。时间顺序和等级的反应表明，社会经济劣势可能发挥因果作用。这表明，有针对性地开展预防工作，减少幼儿期的社会经济劣势，可能是减少儿童后期和成年早期健康不平等的一项重要公共卫生战略。
The 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. The 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. By 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. To 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.
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影响因子：
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作者：
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