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儿童早期多病共存与社会经济劣势:来自新西兰大型儿童队列的研究结果。

Multimorbidity in Early Childhood and Socioeconomic Disadvantage: Findings From a Large New Zealand Child Cohort.

机构信息

Centre for Longitudinal Research-He Ara Ki Mua, University of Auckland (J Russell and SMB Morton), Auckland, New Zealand.

School of Medicine, University of Auckland (CC Grant), Auckland, New Zealand.

出版信息

Acad Pediatr. 2020 Jul;20(5):619-627. doi: 10.1016/j.acap.2019.09.007. Epub 2019 Sep 28.

Abstract

OBJECTIVE

In contrast with multimorbidity during adulthood, the relationship of childhood multimorbidity with socioeconomic position (SEP) is poorly understood. We aimed to describe early childhood multimorbidity and investigate the relationship of this with SEP.

METHODS

Within a diverse prospective child cohort study, we determined associations of SEP with multimorbidity (defined as the presence of 2 or more chronic conditions) at age 2 years. Maternal SEP was ranked into 5 categories using an index constructed from variables collected antenatally describing maternal education, employment, financial stress, beneficiary status, housing tenure, overcrowding, and residential mobility. Missing values were handled using multiple imputation with chained equations. Independent associations of SEP with multimorbidity were described using adjusted odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Of the 6822 women and 6853 children who were enrolled into the cohort study, 5737 (84%) mother-child dyads had complete antenatal data and were interviewed at age 2 years. Of these 5737, for 3826 (67%) dyads, there were complete data for all variables. Multimorbidity was present in 374/3838 (9.7%) of the cohort children. After multiple imputation and adjustment for maternal ethnicity, smoking, poor health, depressive symptoms, and child gender, the odds of multimorbidity being present were increased for children of mothers in the most (OR 1.74, 95% CI 1.16-2.59) and second most (OR 1.43, 95% CI 1.00-2.04) versus the least disadvantaged group.

CONCLUSION

The odds of multimorbidity are increased for children whose mothers have lower SEP. Cumulative socioeconomic disadvantage increases the potential for a chronic illness trajectory to develop in early childhood.

摘要

目的

与成年期的多种疾病不同,儿童时期的多种疾病与社会经济地位(SEP)的关系尚未得到充分理解。本研究旨在描述儿童早期的多种疾病,并研究其与 SEP 的关系。

方法

在一个多样化的前瞻性儿童队列研究中,我们确定了 SEP 与 2 岁时的多种疾病(定义为存在 2 种或更多种慢性疾病)之间的关联。使用从产前收集的描述母亲教育、就业、经济压力、受益状况、住房所有权、过度拥挤和居住流动性的变量构建的指数,将母亲的 SEP 分为 5 类。使用链式方程进行多重插补处理缺失值。使用调整后的优势比(OR)和 95%置信区间(CI)描述 SEP 与多种疾病之间的独立关联。

结果

在纳入队列研究的 6822 名妇女和 6853 名儿童中,5737 对(84%)母子对具有完整的产前数据并在 2 岁时接受了访谈。在这 5737 对母子中,有 3826 对(67%)具有所有变量的完整数据。在队列儿童中,有 374 名(9.7%)存在多种疾病。经过多重插补和对母亲的种族、吸烟状况、健康状况不佳、抑郁症状和儿童性别进行调整后,母亲处于最不利(OR 1.74,95%CI 1.16-2.59)和第二不利(OR 1.43,95%CI 1.00-2.04)组的儿童出现多种疾病的可能性更高。

结论

母亲 SEP 较低的儿童患多种疾病的可能性更高。累积社会经济劣势增加了儿童在早期发展为慢性疾病轨迹的可能性。

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