A cross-sectional study of relationships between social risks and prevalence and severity of pediatric chronic conditions

Abstract

Background To examine the differential relationships between seven social risk factors (individually and cumulatively) with the prevalence and severity of asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and overweight/obesity in children. Methods Using the 2017–2018 National Survey of Children's Health, we examined associations between social risk factors (caregiver education, caregiver underemployment, discrimination, food insecurity, insurance coverage, neighborhood support, and neighborhood safety) and the prevalence and severity of asthma, ADHD, ASD, and overweight/obesity. We used multivariable logistic regression to assess the relationship between individual and cumulative risk factors with each pediatric chronic condition, controlling for child sex and age. Results Although each social risk factor was significantly associated with increased prevalence and/or severity of at least one of the pediatric chronic conditions we investigated, food insecurity was significantly associated with higher disease prevalence and severity for all four conditions. Caregiver underemployment, low social support, and discrimination were significantly associated with higher disease prevalence across all conditions. For each additional social risk factor a child was exposed to, their odds of having each condition increased: overweight/obesity (aOR: 1.2, 95% CI: [1.2, 1.3]), asthma (aOR: 1.3, 95% CI: [1.2, 1.3], ADHD (aOR: 1.2, 95% CI: [1.2, 1.3]), and ASD (aOR: 1.4, 95% CI: [1.3, 1.5]). Conclusions This study elucidates differential relationships between several social risk factors and the prevalence and severity of common pediatric chronic conditions. While more research is needed, our results suggest that social risks, particularly food insecurity, are potential factors in the development of pediatric chronic conditions.

The potential role of social care in reducing childhood obesity

“…Most clinical research on social factors and childhood obesity has focused on social risks. In a large, cross-sectional study from the 2017–2018 National Survey of Children's Health, researchers examined associations of seven social risks with four chronic conditions: asthma, attention deficit disorder (ADHD), autism spectrum disorder (ASD), and overweight/obesity (BMI ≥ 85th percentile for age and sex) among children [16 ▪ ]. Among children ages 10–17 years, food insecurity was associated with higher likelihood and greater severity of overweight/obesity [16 ▪ ].…”

“…In a large, cross-sectional study from the 2017–2018 National Survey of Children's Health, researchers examined associations of seven social risks with four chronic conditions: asthma, attention deficit disorder (ADHD), autism spectrum disorder (ASD), and overweight/obesity (BMI ≥ 85th percentile for age and sex) among children [16 ▪ ]. Among children ages 10–17 years, food insecurity was associated with higher likelihood and greater severity of overweight/obesity [16 ▪ ]. This is one of a few recent studies that has examined associations between multiple social risks and multiple pediatric chronic conditions, but prior research has shown relationships between increasing cumulative social risk and obesity early in childhood [17].…”

Narrative review: food as medicine across the pediatric age continuum

“…In 2022, rates of food insecurity were significantly higher than the previous year, at 12.8% of United States (US) households and 17.3% of households with children [ 1 ]. In children, food insecurity is associated with poor diet quality [ 6 ], poor health [ 7 ], excess healthcare utilization [ 8 , 9 ], and lower cognitive performance [ 10 ]. Also, households experiencing food insecurity have approximately $2400 greater annual healthcare expenditures versus households experiencing food security [ 11 ▪ ].…”

Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health

“…There is a wealth of literature describing the relationship between selected SDOH factors and childhood obesity using cross-sectional analyses. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] However, these cross-sectional studies assume that all children with obesity are a homogeneous group with similar growth patterns, but the obesity growth pattern of children while developing obesity could have different implications for intervention. 35 For example, children who have obesity from birth may have genetic and epigenetic risk factors and intervention may need to occur in the perinatal period, whereas children born with normal weight but then develop obesity during early childhood may benefit from interventions that can impact their environment and lifestyle.…”