School of Public Health, The University of Adelaide, Adelaide, Australia.
Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
JAMA Netw Open. 2022 Aug 1;5(8):e2226203. doi: 10.1001/jamanetworkopen.2022.26203.
Intergenerational welfare contact is a policy issue because of the personal and social costs of entrenched disadvantage; yet, few studies have quantified the burden associated with intergenerational welfare contact for health.
To examine the proportion of individuals who experienced intergenerational welfare contact and other welfare contact types and to estimate their cause-specific hospital burden.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a whole-of-population linked administrative dataset of individuals followed from birth to age 20 years using deidentified data from the Better Evidence Better Outcomes Linked Data platform (Australian Government Centrelink [welfare payments], birth registration, perinatal birth records, and inpatient hospitalizations). Participants included individuals born in South Australia from 1991 to 1995 and their parents. Analysis was undertaken from January 2020 to June 2022.
Using Australian Government Centrelink data, welfare contact was defined as 1 or more parents receiving a means-tested welfare payment (low-income, unemployment, disability, or caring) when children were aged 11 to 15 years, or youth receiving payment at ages 16 to 20 years. Intergenerational welfare contact was defined as welfare contact occurring in both parent and offspring generations. Offspring were classified as: no welfare contact, parent-only welfare contact, offspring-only welfare contact, or intergenerational welfare contact.
Hospitalization rates and cumulative incidence were estimated by age, hospitalization cause, and welfare contact group.
A total of 94 358 offspring (48 589 [51.5%] male) and 143 814 parents were included in analyses. The study population included 32 969 offspring (34.9%) who experienced intergenerational welfare contact. These individuals were more socioeconomically disadvantaged at birth and had the highest hospitalization rate (133.5 hospitalizations per 1000 person-years) compared with individuals with no welfare contact (46.1 hospitalizations per 1000 person-years), individuals with parent-only welfare contact (75.0 hospitalizations per 1000 person-years), and individuals with offspring-only welfare contact (87.6 hospitalizations per 1000 person-years). Hospitalizations were frequently related to injury, mental health, and pregnancy. For example, the proportion of individuals with intergenerational welfare contact who had experienced at least 1 hospitalization at ages 16 to 20 years was highest for injury (9.0% [95% CI, 8.7%-9.3%]).
In this population-based cohort study, individuals who experienced intergenerational welfare contact represented one-third of the population aged 11 to 20 years. Compared with individuals with parent-only welfare contact, individuals with intergenerational welfare contact were more disadvantaged at birth and had 78% higher hospitalization rates from age 11 to 20 years, accounting for more than half of all hospitalizations. Frequent hospitalization causes were injuries, mental health, and pregnancy. This study provides the policy-relevant estimate for what it could mean to break cycles of disadvantage for reducing hospital burden.
代际福利接触是一个政策问题，因为根深蒂固的劣势会带来个人和社会成本；然而，很少有研究定量评估代际福利接触对健康的相关负担。
研究经历代际福利接触和其他福利接触类型的个体比例，并估计他们特定病因的住院负担。
设计、设置和参与者：这项队列研究使用了整个人口的基于行政的数据集，通过从出生到 20 岁的个体进行了随访，使用了 Better Evidence Better Outcomes 链接数据平台（澳大利亚政府中央信贷局[福利支付]、出生登记、围产期出生记录和住院治疗）的匿名数据。参与者包括 1991 年至 1995 年在南澳大利亚出生的个人及其父母。分析于 2020 年 1 月至 2022 年 6 月进行。
使用澳大利亚政府中央信贷局的数据，福利接触被定义为当孩子 11 至 15 岁时，1 个或多个父母领取收入测试型福利金（低收入、失业、残疾或护理），或年轻人在 16 至 20 岁时领取福利金。代际福利接触被定义为父母和子女两代都发生的福利接触。后代被分为：无福利接触、父母一方福利接触、子女一方福利接触或代际福利接触。
按年龄、住院原因和福利接触组估计了住院率和累积发病率。
共有 94358 名后代（48589[51.5%]为男性）和 143814 名父母纳入了分析。研究人群包括 32969 名经历代际福利接触的后代（34.9%）。与无福利接触的个体（46.1 例/1000人年）、父母一方福利接触的个体（75.0 例/1000人年）和子女一方福利接触的个体（87.6 例/1000 人年）相比，这些个体在出生时处于更不利的社会经济地位，住院率最高（133.5 例/1000 人年）。住院通常与伤害、心理健康和怀孕有关。例如，在 16 至 20 岁时经历至少 1 次住院治疗的代际福利接触个体中，因伤害而住院的比例最高（9.0%[95%CI，8.7%-9.3%]）。
在这项基于人群的队列研究中，经历代际福利接触的个体占 11 至 20 岁人群的三分之一。与父母一方福利接触的个体相比，经历代际福利接触的个体在出生时处于更不利的地位，11 至 20 岁期间的住院率高出 78%，占所有住院治疗的一半以上。常见的住院病因是伤害、心理健康和怀孕。本研究提供了打破劣势循环以减少住院负担的相关政策估计。
