Rethinking what is important: biologic versus social predictors of childhood health and educational outcomes.
BACKGROUND
Social risk factors are often less vigorously pursued in clinical assessments of infant risk than are biologic risk factors. We examined the relative importance of early social and biologic risk factors in predicting poor health and educational outcomes in children.


METHODS
The study was composed of all infants born in Winnipeg, Canada, during April-December 1984, who were followed up until age 19 years (n = 4667). Predictors were 3 routinely assessed biologic risks (birth weight, gestational age, and Apgar score) and 3 prominent social factors (mother's age, parent marital status, and socioeconomic status). Outcomes were childhood hospitalization and passage of a required high school examination. Analyses included logistic regression, measures of accuracy, and population attributable risk percent (PAR%).


RESULTS
Biologic and social risk factors were associated with similarly steep poor outcomes gradients. Social risk factors had similar, and in some cases stronger, measures of association and accuracy. Using biologic risk criteria alone misclassified as low-risk 65% of cohort children who had high rates of later hospitalization and examination failure. PAR% associated with social risk factors exceeded biologic risk factors in most cases (eg, hospitalization PAR% = 4.4 for offspring of teen mothers vs. 1.7 for low birth weight).


CONCLUSIONS
In a population-based sample of infants followed-up through adolescence, early social risk factors were as threatening as, and more common than, routinely documented biologic risks-frequently identifying otherwise-unrecognized at-risk children. These findings together suggest that rigorous evaluation of social factors should be made a routine part of clinical assessment to more comprehensively and accurately identify infants at risk for later serious health problems and academic failure.
Jutte
Douglas P
DP
School of Public Health, Division of Community Health & Human Development, University of California, Berkeley, CA 94720-1190, USA. dpjutte@berkeley.edu
Brownell
Marni
M
Roos
Noralou P
NP
Schippers
Christine
C
Boyce
W Thomas
WT
Syme
S Leonard
SL
D000293:Adolescent; D001034:Apgar Score; D001724:Birth Weight / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008350:Manitoba; D017533:Marital Status; D009035:Mothers; D012307:Risk Factors; D012923:Social Class; D055815:Young Adult