Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies.
OBJECTIVE
To determine the association of socioeconomic disadvantage with the prevalence of childhood disabling chronic conditions in high-income countries.


METHODS
Systematic review and meta-analyses.


METHODS
6 electronic databases, relevant websites, reference lists and experts in the field.


METHODS
160 observational studies conducted in high-income countries with data on socioeconomic status and disabling chronic conditions in childhood, published between 1 January 1991 and 31 December 2013.


METHODS
Abstracts were reviewed, full papers obtained, and papers identified for inclusion by 2 independent reviewers. Inclusion decisions were checked by a third reviewer. Where reported, ORs were extracted for low versus high socioeconomic status. For studies reporting raw data but not ORs, ORs were calculated. Narrative analysis was undertaken for studies without data suitable for meta-analysis.


RESULTS
126 studies had data suitable for meta-analysis. ORs for risk estimates were: all-cause disabling chronic conditions 1.72 (95% CI 1.48 to 2.01); psychological disorders 1.88 (95% CI 1.68 to 2.10); intellectual disability 2.41 (95% CI 2.03 to 2.86); activity-limiting asthma 2.20 (95% CI 1.87 to 2.85); cerebral palsy 1.42 (95% CI 1.26 to 1.61); congenital abnormalities 1.41 (95% CI 1.24 to 1.61); epilepsy 1.38 (95% CI 1.20 to 1.59); sensory impairment 1.70 (95% CI 1.39 to 2.07). Heterogeneity was high across most estimates (I(2)>75%). Of the 34 studies without data suitable for meta-analysis, 26 reported results consistent with increased risk associated with low socioeconomic status.


CONCLUSIONS
The findings indicate that, in high-income countries, childhood disabling chronic conditions are associated with social disadvantage. Although evidence of an association is consistent across different countries, the review provides limited evidence to explain the association; future research, using longitudinal data, will be required to distinguish low socioeconomic status as the cause or consequence of childhood disabling chronic conditions and the aetiological pathways and mechanisms.
Warwick Medical School, University of Warwick, Coventry, UK.
Nicholas J
NJ
Spencer
Warwick Medical School, University of Warwick, Coventry, UK.
Clare M
http://orcid.org/0000-0002-6326-640X
CM
Blackburn
Warwick Medical School, University of Warwick, Coventry, UK.
Janet M
JM
Read
D002648:Child; D002908:Chronic Disease / Q000191:economics; D019049:Developed Countries; D019988:Children with Disabilities; D054624:Health Status Disparities; D006801:Humans; D015233:Models, Statistical; D064887:Observational Studies as Topic; D016017:Odds Ratio; D011203:Poverty; D012923:Social Class
SOCIAL MEDICINE