Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies.
Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies.
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DOI：
10.1136/bmjopen-2014-007062
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发表时间：
2015-09-03
期刊：
影响因子：
2.9
通讯作者：
Read JM
中科院分区：
文献类型：
--
作者：
Spencer NJ;Blackburn CM;Read JM
确定高收入国家社会经济不利因素与儿童致残性慢性病患病率之间的关系。系统综述和荟萃分析。6个电子数据库、相关网站、参考文献清单和该领域的专家。在高收入国家进行的160项观察性研究，其中包括1991年1月1日至2013年12月31日期间发表的关于儿童社会经济状况和致残性慢性病的数据。对摘要进行了审查，获得了全文，并由2名独立评审员确定了纳入的论文。由第三名审查员检查入选决定。如果报告，则提取低与高社会经济地位的OR。对于报告原始数据但未报告OR的研究，计算OR。对于没有适合荟萃分析的数据的研究进行叙述分析。126项研究的数据适合进行荟萃分析。风险估计的OR为：所有原因的致残性慢性病1.72（95% CI 1.48 - 2.01）;心理障碍1.88（95% CI 1.68 - 2.10）;智力残疾2.41（95% CI 2.03 - 2.86）;活动限制性哮喘2.20（95% CI 1.87 - 2.85）;脑瘫1.42（95% CI 1.26 - 1.61）;先天性异常1.41（95% CI 1.24 - 1.61）;癫痫1.38（95% CI 1.20 - 1.59）;感觉障碍1.70（95% CI 1.39 - 2.07）。在大多数估计值中，异源性很高（I2>75%）。在34项没有适合荟萃分析的数据的研究中，26项报告的结果与低社会经济地位相关的风险增加一致。研究结果表明，在高收入国家，儿童致残性慢性病与社会劣势有关。虽然不同国家之间的关联证据是一致的，但该综述提供的解释该关联的证据有限;未来的研究，使用纵向数据，将需要区分低社会经济地位作为儿童致残慢性疾病的原因或后果以及病因学途径和机制。
To determine the association of socioeconomic disadvantage with the prevalence of childhood disabling chronic conditions in high-income countries. Systematic review and meta-analyses. 6 electronic databases, relevant websites, reference lists and experts in the field. 160 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. Abstracts 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. 126 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. The 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.