Spencer Nicholas James, Ludvigsson Johnny, You Yueyue, Francis Kate, Abu Awad Yara, Markham Wolfgang, Faresjö Tomas, Goldhaber-Fiebert Jeremy, Andersson White Pär, Raat Hein, Mensah Fiona, Gauvin Lise, McGrath Jennifer J
Health Sciences, University of Warwick Warwick Medical School, Coventry, UK
Department of Clinical and Experimental Medicine, Department of Psychology, Division of Pediatrics, Linköping University, S-581 85 Linköping, Sweden & Department of Behavioural Sciences and Learning, Linkoping, Sweden.
J Epidemiol Community Health. 2022 Jul 21. doi: 10.1136/jech-2022-219228.
We examined absolute and relative relationships between household income and maternal education during early childhood (<5 years) with activity-limiting chronic health conditions (ALCHC) during later childhood in six longitudinal, prospective cohorts from high-income countries (UK, Australia, Canada, Sweden, Netherlands, USA).
Relative inequality (risk ratios, RR) and absolute inequality (Slope Index of Inequality) were estimated for ALCHC during later childhood by maternal education categories and household income quintiles in early childhood. Estimates were adjusted for mother ethnicity, maternal age at birth, child sex and multiple births, and were pooled using meta-regression.
Pooled estimates, with over 42 000 children, demonstrated social gradients in ALCHC for high maternal education versus low (RR 1.54, 95% CI 1.28 to 1.85) and middle education (RR 1.24, 95% CI 1.11 to 1.38); as well as for high household income versus lowest (RR 1.90, 95% CI 1.66 to 2.18) and middle quintiles (RR 1.34, 95% CI 1.17 to 1.54). Absolute inequality showed decreasing ALCHC in all cohorts from low to high education (range: -2.85% Sweden, -13.36% Canada) and income (range: -1.8% Sweden, -19.35% Netherlands).
We found graded relative risk of ALCHC during later childhood by maternal education and household income during early childhood in all cohorts. Absolute differences in ALCHC were consistently observed between the highest and lowest maternal education and household income levels across cohort populations. Our results support a potential role for generous, universal financial and childcare policies for families during early childhood in reducing the prevalence of activity limiting chronic conditions in later childhood.
我们在来自高收入国家（英国、澳大利亚、加拿大、瑞典、荷兰、美国）的六个纵向前瞻性队列中，研究了幼儿期（<5岁）家庭收入与母亲教育程度和儿童期后期的活动受限慢性健康状况（ALCHC）之间的绝对和相对关系。
根据幼儿期母亲教育程度类别和家庭收入五分位数，估计儿童期后期ALCHC的相对不平等（风险比，RR）和绝对不平等（不平等斜率指数）。估计值针对母亲种族、生育时的母亲年龄、孩子性别和多胞胎进行了调整，并使用元回归进行汇总。
对超过42000名儿童的汇总估计显示，在ALCHC方面，高母亲教育程度与低教育程度（RR 1.54，95%CI 1.28至1.85）和中等教育程度（RR 1.24，95%CI 1.11至1.38）之间存在社会梯度；高家庭收入与最低收入（RR 1.90，95%CI 1.66至2.18）和中等五分位数（RR 1.34，95%CI 1.17至1.54）之间也存在社会梯度。绝对不平等显示，在所有队列中，从低到高教育程度（范围：瑞典为-2.85%，加拿大为-13.36%）和收入水平（范围：瑞典为-1.8%，荷兰为-19.35%），ALCHC均呈下降趋势。
我们发现，在所有队列中，儿童期后期的ALCHC相对风险因幼儿期母亲教育程度和家庭收入而异。在队列人群中，最高和最低母亲教育程度及家庭收入水平之间始终观察到ALCHC的绝对差异。我们的研究结果支持在幼儿期为家庭提供慷慨、普遍的财政和儿童保育政策，以降低儿童期后期活动受限慢性病患病率的潜在作用。
