Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study

Abstract

Background Socioeconomic position (SEP) powerfully affects health status in the childhood population. However, the knowledge of which diseases are more affected by SEP and whose outcomes could be improved by having a more equitable society remains uncertain on a population basis. Methods We measured socioeconomic and gender inequalities in the pre-COVID-19 era for 29 diseases in the entire childhood population in Catalonia to identify which diseases are most impacted by inequalities. This population-based study included 1,449,816 children under 15 years old from 2014 to 2017 (48.52% girls) and each of their registered diagnoses within the Catalonia National Health System. We calculated frequency measures by SEP and their sex ratios for each disease. We estimated four regression-based inequality measures: slope index of inequality, relative index of inequality (RII), absolute population-attributable fraction, and population-attributable fraction. Results Twenty-five of the 29 diseases examined showed SEP inequalities. The diseases with the greatest inequalities in both sexes were tuberculosis, obesity, adjustment and anxiety disorders, essential hypertension, poisoning, short gestation, low birth weight, foetal growth retardation and intrauterine hypoxia and birth asphyxia and trauma (RII ≥ 2.0); only food allergy showed the opposite pattern (RII < 1.0). Overall, 80,188 (7.80%) of the disease events in boys and 74,921 (8.88%) in girls would be avoided if all children had the same disease rate as those in the medium-high SEP group, with tuberculosis, intrauterine hypoxia and birth asphyxia and trauma, obesity, and short gestation, low birth weight, foetal growth retardation being those that could be reduced the most in relative terms, and dermatitis, injuries, acute bronquitis, and being overweight those that could be reduced the most in absolute terms. Girls present higher RII than boys for respiratory allergy, asthma, dermatitis, being overweight, and obesity (p < 0.05). In contrast, boys showed higher RII compared to girls only in congenital anomalies (p < 0.05). Conclusions Socioeconomic and gender inequalities are widely present in childhood health. This indicates that SEP plays a common role in their development although it varies in magnitude according to each disease. It is also a phenomenon that comprises all SEP groups in society. Action needs to be taken to ensure a fairer start in life in terms of health.

Inequality and child health: dynamic population health interventions

“…Children living in disadvantaged or marginalized circumstances have worse physical and mental health than their more advantaged peers [1 ▪▪ ,2–4]. This relationship holds true for conditions ranging from obesity to anxiety, infectious diseases to low birthweight [5]. There is an established social gradient in health from the bottom to the top of the socio-economic spectrum making this a societal issue [6].…”

Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study

“…Definitions have been proposed to group children with medically complex or chronic conditions [ 29 – 31 ], with a prevalence estimated to be between 13 and 18% and who also show healthcare inequities [ 31 , 32 ]. Several studies have provided data on specific chronic diseases or not are more affected by socioeconomic positions based on and other diseases [ 4 ].…”

Association between Socioeconomic Status and Healthcare Utilization for Children with Allergic Diseases: Korean National Health and Nutritional Examination Survey (2015–2019)

“…As a result, the socioeconomic status of an individual, which affects their burden of spending on such care services, was identified as a specific factor contributing to the poor utilization of healthcare services. Numerous studies have reported that SES is associated with healthcare utilization according to parental education and household income [9,12,17,18,24,27]. Another study reported that the burden of medical expenses for preschool children is lower than in other nations due to universal medical insurance and regional government subsidies for children's medical expenses [28].…”

“…Reportedly, hospital utilization is higher in urban than rural areas, and hospitals in rural areas typically have less resources than the facilities in urban areas. Furthermore, since the health disparities related to the association between gender and age have already been studied in children [11][12][13][14][15][16][17][18], there is a need for research on the health disparities related to the association between SES and healthcare utilization. This study assumed that healthcare utilization might vary depending on SES categories.…”