Socio‐economic status and quality of life in children with chronic disease: A systematic review

Abstract

Reduced quality of life (QoL) is a known consequence of chronic disease in children, and this association may be more evident in those who are socio-economically disadvantaged. The aims of this systematic review were to assess the association between socio-economic disadvantage and QoL among children with chronic disease, and to identify the specific socio-economic factors that are most influential. MEDLINE, Embase and PsycINFO were searched to March 2015. Observational studies that reported the association between at least one measure of social disadvantage in caregivers and at least one QoL measure in children and young people (age 2-21 years) with a debilitating non-communicable childhood disease (asthma, chronic kidney disease, type 1 diabetes mellitus and epilepsy) were eligible. A total of 30 studies involving 6957 patients were included (asthma (six studies, n = 576), chronic kidney disease (four studies, n = 796), epilepsy (14 studies, n = 2121), type 1 diabetes mellitus (six studies, n = 3464)). A total of 22 (73%) studies reported a statistically significant association between at least one socio-economic determinant and QoL. Parental education, occupation, marital status, income and health insurance coverage were associated with reduced QoL in children with chronic disease. The quality of the included studies varied widely and there was a high risk of reporting bias. Children with chronic disease from lower socio-economic backgrounds experience reduced QoL compared with their wealthier counterparts. Initiatives to improve access to and usage of medical and psychological services by children and their families who are socio-economically disadvantaged may help to mitigate the disparities and improve outcomes in children with chronic illnesses.

The relationship between household income and patient‐reported symptom distress and quality of life in children with advanced cancer: A report from the PediQUEST study

“…To the best of our knowledge, the impact of toxic stress in pediatric patients with cancer is largely unexplored and future studies might examine how toxic stress–induced pathways link income and child PROs. With regard to our observed differences in HRQOL, although prior data from children with advanced cancer are limited, these results are consistent with well‐documented sociodemographic differences in HRQOL in a variety of other pediatric chronic conditions . Low‐income status has been shown to negatively impact HRQOL in children with asthma, sickle cell disease, and cardiac disease .…”

Relationship between quality of life and behavioural disorders in children with persistent asthma: a Multiple Indicators Multiple Causes (MIMIC) model

“…About asthma control, some studies show that uncontrolled status negatively affected only QoL 24,25 , whereas no study has investigated the effect on SDQ. Some authors show that socioeconomic status of parents was significantly associated with QoL scores in asthmatic children 26,27 , but no study has ever investigated the effect of socioeconomic status on behavioural problems in asthmatic children.…”

Socioeconomic Status and Health Services Utilization for Children With Complex Chronic Conditions Liable to Receive Nurse‐Led Services: A Cross‐Sectional Study

“…In addition, they are more likely to receive delayed care and to experience unmet care and coordination needs (Nageswaran, Silver, & Stein, ). Furthermore, there may be socioeconomic disparities in the provision of health care for children with complex healthcare needs, which has an immediate impact on their quality of life (Didsbury et al., ; Johnston et al., ).…”