title: Poverty and Trends in Three Common Chronic Disorders.
abstract: OBJECTIVE
  For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions.
  
  
  METHODS
  Secondary analyses of the National Survey of Children's Health for years 2003, 2007, and 2011-2012 were conducted to identify trends in parent reported lifetime prevalence and comorbidity among children with asthma, ADHD, and ASD and examine variation by sociodemographic characteristics, poverty status, and insurance coverage. Using 2011-2012 data, multivariable regression was used to examine whether poverty status predicted higher than average comorbid conditions after adjusting for other sociodemographic characteristics.
  
  
  RESULTS
  Parent-reported lifetime prevalence of asthma and ADHD rose 18% and 44%, respectively, whereas the lifetime prevalence of ASD rose almost 400% (from 0.5% to 2%). For asthma, the rise was most prominent among the poor at 25.8%. For ADHD, the percent change by poverty status was similar (<100% federal poverty level [FPL]: 43.20%, 100% to 199% FPL: 52.38%, 200% to 399% FPL: 43.67%), although rise in ASD was associated with being nonpoor (200% to 399% FPL: 43.6%, ≥400% FPL: 36.0%). Publicly insured children with asthma, ADHD, and ASD also had significantly higher odds (1.9×, 1.6×, 3.0×, respectively) of having higher than average comorbidities.
  
  
  CONCLUSIONS
  Poverty status differentially influenced parent-reported lifetime prevalence and comorbidities of these target disorders. Future research is needed to examine parent and system-level characteristics that may further explain poverty's variable impact.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Pulcini
authors.affiliation: UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.affiliation: Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio; and.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; houtrow@upmc.edu.|Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Houtrow
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology; D001249:Asthma / Q000453:epidemiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D000067877:Autism Spectrum Disorder / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D019955:Conduct Disorder / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D002658:Developmental Disabilities / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007806:Language Disorders / Q000453:epidemiology; D007859:Learning Disabilities / Q000453:epidemiology; D008297:Male; D008484:Medicaid; D011203:Poverty; D015995:Prevalence; D013064:Speech Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology