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

Annelise Brochier; Emily Messmer; Mikayla Gordon Wexler; Stephen Rogers; Erika Cottrell; Yorghos Tripodis; Arvin Garg

doi:10.1186/s12887-023-03894-6

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

BMC Pediatr. 2023 Mar 8;23(1):115. doi: 10.1186/s12887-023-03894-6.

Authors

Annelise Brochier¹, Emily Messmer², Mikayla Gordon Wexler³, Stephen Rogers⁴, Erika Cottrell^{5

6}, Yorghos Tripodis⁷, Arvin Garg⁸

Affiliations

¹ Department of Pediatrics, Boston Medical Center, 801 Albany St. Floor 2N, Boston, MA, 02119, USA. Annelise.Brochier@bmc.org.
² Quality and Patient Experience, Mass General Brigham, 399 Revolution Dr., Somerville, MA, 02145, USA.
³ Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., New York, NY, 10029, USA.
⁴ Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 9104, USA.
⁵ OCHIN, Inc., PO Box 5426, Portland, OR, 97228, USA.
⁶ Oregon Clinical & Translational Research Institute, Oregon Health & Science University, 3250 Southwest Sam Jackson Park Rd., Portland, OR, 97329, USA.
⁷ Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave., 3rd Floor, Boston, MA, 02118, USA.
⁸ Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, 55 N Lake Ave., Worcester, MA, 01655, USA.

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.

Keywords: Asthma; Attention deficit hyperactivity disorder; Autism spectrum disorder; Obesity; Social determinants of health; Social risks.

MeSH terms

Asthma* / complications
Asthma* / epidemiology
Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / etiology
Autism Spectrum Disorder* / complications
Autism Spectrum Disorder* / etiology
Child
Cross-Sectional Studies
Humans
Overweight / complications
Pediatric Obesity* / complications
Pediatric Obesity* / epidemiology
Prevalence