Prevalence and impact of disabling chronic conditions in childhood.
01 Apr 1998-American Journal of Public Health (American Public Health Association)-Vol. 88, Iss: 4, pp 610-617
TL;DR: A current national profile of the prevalence and impact of chronic conditions causing childhood disability is provided, which has profound impacts on children, the education system, and the health care system.
Abstract: OBJECTIVES: This study provides a current national profile of the prevalence and impact of chronic conditions causing childhood disability. Disability is defined as a long-term reduction in ability to conduct social role activities, such as school or play, because of a chronic physical or mental condition. METHODS: A cross-sectional descriptive analysis was performed on data from 99513 children younger than 18 years who were included in the 1992-1994 National Health Interview Survey. The response rate exceeded 93% during each year. RESULTS: A significant proportion of children, estimated at 6.5% of all US children, experienced some degree of disability. The most common causes of childhood disability were respiratory diseases and mental impairments. Prevalence of disability was higher for older children, boys, and children from low-income and single-parent families. Childhood disability is estimated to result in 66 million restricted activity days annually, including 24 million days lost from school. Furth...
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TL;DR: In this paper, the authors explored the link between parental socioeconomic status (as measured by education, income, occupation, or in some cases area of residence) and child health, and between child health and adult education or income.
Abstract: There are many possible pathways between parental education, income, and health, and between child health and education, but only some of them have been explored in the literature. This essay focuses on links between parental socioeconomic status (as measured by education, income, occupation, or in some cases area of residence) and child health, and between child health and adult education or income. Specifically, I ask two questions: What is the evidence regarding whether parental socioeconomic status affects child health? And, what is the evidence relating child health to future educational and labor market outcomes? I show that there is now strong evidence of both links, suggesting that health could play a role in the intergenerational transmission of economic status.
1,417 citations
TL;DR: Results of this study indicate that the CSHCN Screener requires minimal time to administer, is acceptable for use as both an interview-based and self-administered survey, and that rates of children positively identified vary according to child demographic, health, and health care-need characteristics.
659 citations
TL;DR: The proportion of pediatric inpatient use that is attributable to patients with a diagnosis of one or more complex chronic condition (CCC) has increased over time and the degree to which CCC hospitalizations are associated with attributes that are consistent with heightened medical complexity is assessed.
Abstract: Children with special health care needs (CSHCN), defined as children who have or at risk for a chronic physical, developmental, behavioral, or emotional condition and require health and related services of a type or an amount beyond that required by children generally, constitute 18% (~12.6 million) of US children.1 The Institute of Medicine has identified CSHCN as a priority population,2 in part because of their use of health resources. A small proportion of children account for the bulk of health care expenditures in the United States: 20% of children who use medical services account for ~80% of all children's health care expenditures.3
Chronic illness accounts for the majority of children's hospital days and dollars.4 A smaller set of CSHCN, termed medically complex children, are perceived to use a disproportionate amount of resources, particularly in the inpatient and tertiary care settings.5 Consistent and complete identification criteria of this subpopulation for administrative, clinical, and research purposes, however, remains elusive.5–7 A prototypical medically complex child has a diversity of conditions and multisystem disease; may be technology-dependent; has frequent inpatient admissions; and requires multiple medications, multiple subspecialists, and optimal care coordination across inpatient and outpatient settings.5 Previous work describing the 6.5% of children with disabilities,8,9 the nearly 5% of children with multiple chronic conditions,10 or children with technology dependence5 likely described sets of children with some degree of medical complexity.
For accurate attribution of health care use of medically complex children, an operational definition is needed for use in administrative data sets. One potential method to study medically complex children is to group International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes so as to specify a set of complex chronic conditions (CCCs). Developed initially for the purpose of identifying children who are at risk for death,11–15 the working definition for a CCC was “any medical condition that can be reasonably expected to last at least 12 months (unless death intervenes) and to involve either several different organ systems or 1 system severely enough to require specialty pediatric care and probably some period of hospitalization in a tertiary care center.”11 Although CCCs likely do not capture all medically complex children, the definition and implementation of the CCC scheme incorporates 3 hallmarks of medical complexity: chronic medical conditions, often existing in comorbid combinations, and associated with intensive inpatient use. In this study, we sought to determine whether the proportion of pediatric inpatient use for CCCs increased over time from 1997 to 2006 and to assess the degree to which hospitalizations of patients with CCCs were associated with use of inpatient health care resources and outcomes consistent with heightened medical complexity.
609 citations
TL;DR: An epidemiologic profile of children with special health care needs is presented using a new definition of the population developed by the federal Maternal and Child Health Bureau using the recently released 1994 National Health Interview Survey on Disability.
Abstract: Objective. To present an epidemiologic profile of children with special health care needs using a new definition of the population developed by the federal Maternal and Child Health Bureau. Methods. We operationalized the new definition using the recently released 1994 National Health Interview Survey on Disability. Estimates are based on 30 032 completed interviews for children Results. Eighteen percent of US children Conclusions. A substantial minority of US children were identified as having an existing special health care need using national survey data. Children with existing special health care needs are disproportionately poor and socially disadvantaged. Moreover, many of these children face significant barriers to health care.
586 citations
TL;DR: A conceptual model of 11 environmental, family, and child factors that are thought to influence children's participation in recreation and leisure activities is presented, outlining the existing evidence for the influence of these factors on one another and on children'sparticipation.
Abstract: Participation in everyday activities is considered to be a vital part of children's development, which is related to their quality of life and future life outcomes. Research studies indicate that children with disabilities are at risk for lower participation in ordinary activities at home and in the community. This article presents a conceptual model of 11 environmental, family, and child factors that are thought to influence children's participation in recreation and leisure activities. The article outlines the existing evidence for the influence of these factors on one another and on children's participation. The review encompasses four bodies of literature: the participation of children or adults with disabilities, the risk and resilience of children facing adversity, the determinants of leisure and recreation activities, and the factors influencing physical activity and exercise. The proposed model is expected to be a useful tool for guiding future research studies and for developing policies and programs for children with disabilities and their families.
554 citations
Cites methods from "Prevalence and impact of disabling ..."
...Using the 1992-1994 National Health Interview Survey, Newacheck and Halfon (1998) estimated that childhood disability results in 66 million restricted activity days annually, including 24 mil- lion days absent from school....
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...Using the 1992-1994 National Health Interview Survey, Newacheck and Halfon (1998) estimated that childhood disability results in 66 million restricted activity days annually, including 24 milPerspectives 67...
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TL;DR: National estimates of the prevalence and impact of childhood chronic conditions using data from the 1988 National Health Interview Survey are presented, showing highly variable impacts on children's activities and use of health care.
Abstract: BACKGROUND. Using data from the 1988 National Health Interview Survey, this article presents national estimates of the prevalence and impact of childhood chronic conditions. METHODS. Proxy responses to a checklist of child health conditions administered for 17,110 children under 18 years of age were used. Conditions were classified as chronic if they were first noticed more than 3 months prior to the interview or if they were the type that would ordinarily be of extended duration, such as arthritis. RESULTS. An estimated 31% of children were affected by chronic conditions. Among these children, highly prevalent conditions included respiratory allergies 9.7 per 100, repeated ear infections 8.3 per 100 and asthma 4.3 per 100. These children can be divided into three groups: 66% with mild conditions that result in little or no bother or activity limitation; 29% with conditions of moderate severity that result in some bother or limitation of activity, but not both; and 5% with severe conditions that cause fre...
666 citations
TL;DR: The development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended, which might reflect the child's functional status or ongoing use of medical services over a specified time period.
Abstract: The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.
348 citations
TL;DR: When compared with pediatricians' records, parent reports are generally acceptable for most research purposes and may be a better source for some health events such as accidents.
Abstract: Objectives: To determine the range of accuracy of parent recall for many different events when compared with pediatrician's records and to establish whether good recall is associated with the nature of the event, period of recall, or demographic characteristics. Research Design: A nonconcurrent, descriptive survey of previous events. Setting: Two pediatric group practices in Montreal, Quebec. Participants: Two hundred eighty-eight parents of children aged 1 to 13 years. Interventions: None. Measurements/Main Results: Parents' responses to a self-administered questionnaire were compared with information extracted from pediatricians' records. The health events studied included asthma, bronchitis, otitis media, accidents, hospitalizations, office visits, and birth weight. Most parents (73%) were able to recall birth weight within 50 g, and 85% reported a frequency of hospitalizations that agreed exactly with the record. For asthma, bronchitis, and otitis in the last year, the percentages with good agreement were 91%, 85%, and 51%, respectively, while for the same disorders during the child's lifetime, the corresponding figures were 87%, 74%, and 53%, respectively. Each parent's responses were classified according to overall quality of agreement; associations between agreement and respondent characteristics were investigated. Mothers responded more accurately than fathers, and parents of younger children also showed better recall. Other factors, eg, education and occupation, were not significantly correlated with recall. Conclusions: When compared with pediatricians' records, parent reports are generally acceptable for most research purposes and may be a better source for some health events such as accidents. (Arch Pediatr Adolesc Med. 1995;149:553-558)
256 citations
TL;DR: Testing the usefulness of diagnostic groupings in examining correlates of illness suggests the need for a major reorientation of the research paradigm when examining the psychological, social, rehabilitative and preventive issues raised by chronic illness in children and families.
199 citations
TL;DR: The negative impact of these mental health problems on the child was more severe when a chronic illness was also present, but referrals for mental health services did not reflect his association.
Abstract: The prevalence of chronic physical illnesses and their association with mental disorders was assessed using data collected by primary care pediatricians. A chronic illness was diagnosed in 1573 (15.6%) of 10,058 children aged 4 to 16 years, 945 (9.4%) of whom had a "serious" disorder, 535 (5.3%) had a minor disorder (hay fever or dermatitis), and 121 (1.2%) had a speech or language disorder. Behavioral problems were identified more often among patients with "serious" disorders than among those without chronic illnesses (2.4% vs 1.7%), as were emotional problems (5.0% vs 3.1%). Among those with "serious" conditions involving the central nervous system, the prevalence of behavioral (5.2%) and emotional (10.4%) disorders was still higher. Although children with "serious" disorders not involving the central nervous system also showed elevated prevalence rates of behavioral (2.1%) and emotional (4.5%) disturbances, this increase did not reach statistical significance. No association with "minor" chronic disorders was found. The negative impact of these mental health problems on the child was more severe when a chronic illness was also present, but referrals for mental health services did not reflect his association.
65 citations