Increase in chronic disease among children
chronic disease among children
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Note: In 1998 it was reported that A
significant proportion of children, estimated at 6.5% of all US children,
experienced some degree of disability. In 1986 it was reported that:
According to data from the National Health Interview Survey (NHIS) over two
million children under 17 years (3.8%) are afflicted by chronic conditions that
cause some limitation of activity.And
that in1986 it was reported that: Data from the National Health Interview
Survey indicate that the prevalence of activity-limiting chronic conditions
among children under age 17 years doubled between 1960 and 1981, from 1.8 to
3.8 per cent.So between 1960
and 1998, it would appear that the prevalence of chronic conditions, among all
children, resulting in disability, rose from 1.8% to 6.5%,
although a certain portion of the earlier rise may be attributable to
changes in perception and other factors not indicative of real changes in
Prevalence, impact, and trends in childhood disability due to
Newacheck PW, Halfon N.
Institute for Health Policy Studies and the Department of Pediatrics, School of
Medicine, University of California, San Francisco 94118, USA.
BACKGROUND: Although not widely recognized as such, asthma is the single most
prevalent cause of childhood disability and has contributed to a substantial
rise in the overall prevalence of disability among children during the past 25
years. OBJECTIVE: To provide a national profile of the prevalence, impact, and
trends in childhood disability due to asthma. (Disability is a long-term
reduction in the ability to participate in children's usual activities, such as
attending school or engaging in play, due to a chronic condition.) METHODS: We
derived our primary findings from a cross-sectional, descriptive analysis of
62171 children younger than 18 years who were included in the 1994-1995 National
Health Interview Survey. MAIN OUTCOME MEASURES: Outcome measures include the
presence of disability, degree of disability, restricted activity days, school
absence days, and use of hospital and physician services. We also used data from
the 1969-1970, 1979-1981, and 1994-1995 National Health Interview Surveys to
assess trends in the prevalence of disability due to asthma. RESULTS: A small,
but significant, proportion of children, estimated at 1.4% of all US children,
experienced some degree of disability due to asthma in 1994-1995. Prevalence of
disability due to asthma was higher for adolescents (odds ratio [OR], 1.64),
black children (OR, 1.66), males (OR, 1.23), and children from low income (OR,
1.46) and single-parent families (OR, 1.37). Disabling asthma resulted in an
annual average of 20 restricted activity days, including 10 days lost from
school-almost twice the level of illness burden as experienced by children with
disabilities due to other types of chronic conditions.
Finally, prevalence of disabling asthma,
as reported in the National Health Interview Survey, has increased 232% since
1969, the first year that electronic data are available from the survey. In
contrast, prevalence of disability due to all other childhood chronic conditions
increased by 113% over the same period. CONCLUSIONS: Disabling asthma has
profound effects on children. The social costs of asthma are likely to rise in
the future if current trends in the prevalence of disabling asthma continue.
Prevalence and impact of disabling chronic conditions in
Newacheck PW, Halfon N.
Institute for Health Policy Studies, University of California, San Francisco,
OBJECTIVES: This study provides a current national profile of the prevalence
and impact of chronic conditions causing childhood disability. Disability is
defined as a long-term reduction in ability to conduct social role activities,
such as school or play, because of a chronic physical or mental condition.
METHODS: A cross-sectional descriptive analysis was performed on data from
99513 children younger than 18 years who were included in the 1992-1994
National Health Interview Survey. The response rate exceeded 93% during each
year. RESULTS: A significant
proportion of children, estimated at 6.5% of all US children, experienced some
degree of disability. The most common causes of childhood disability
were respiratory diseases and mental impairments. Prevalence of disability was
higher for older children, boys, and children from low-income and
single-parent families. Childhood disability is estimated to result in 66
million restricted activity days annually, including 24 million days lost from
school. Furthermore, disability in childhood results in an added 26 million
physician contacts and 5 million hospital days annually. CONCLUSIONS:
Childhood disability has profound impacts on children, the education system,
and the health care system.
An epidemiologic profile of children with special health
Newacheck PW, Strickland B, Shonkoff JP, Perrin JM, McPherson M, McManus M,
Lauver C, Fox H, Arango P.
Department of Pediatrics and Institute for Health Policy Studies, University
of California, San Francisco 94109, USA.
OBJECTIVE: To present an epidemiologic profile of children with special health
care needs using a new definition of the population developed by the federal
Maternal and Child Health Bureau. METHODS: We operationalized the new
definition using the recently released 1994 National Health Interview Survey
on Disability. Estimates are based on 30 032 completed interviews for children
<18 years old. The overall response rate was 87%. RESULTS:
Eighteen percent of US children <18
years old in 1994, or 12.6 million children nationally, had a chronic
physical, developmental, behavioral, or emotional condition and required
health and related services of a type or amount beyond that required by
children generally. This estimate includes children with existing
special health care needs but excludes the at-risk population. Prevalence was
higher for older children, boys, African-Americans, and children from
low-income and single-parent households. Children with existing special health
care needs had three times as many bed days and school absence days as other
children. An estimated 11% of children with existing special health care needs
were uninsured, 6% were without a usual source of health care, 18% were
reported as dissatisfied with one or more aspects of care received at their
usual source of care, and 13% had one or more unmet health needs in the past
year. CONCLUSIONS: A substantial minority of US children were identified as
having an existing special health care need using national survey data.
Children with existing special health care needs are disproportionately poor
and socially disadvantaged. Moreover, many of these children face significant
barriers to health care.
Childhood chronic illness: prevalence, severity, and
Newacheck PW, Taylor WR.
Institute for Health Policy Studies, University of California, San Francisco
BACKGROUND. Using data from the 1988 National Health Interview Survey, this
article presents national estimates of the prevalence and impact of childhood
chronic conditions. METHODS. Proxy responses to a checklist of child health
conditions administered for 17,110 children under 18 years of age were used.
Conditions were classified as chronic if they were first noticed more than 3
months prior to the interview or if they were the type that would ordinarily
be of extended duration, such as arthritis. RESULTS.
An estimated 31% of children were
affected by chronic conditions. Among these children, highly prevalent
conditions included respiratory allergies 9.7 per 100, repeated ear infections
8.3 per 100 and asthma 4.3 per 100. These children can be divided into three
groups: 66% with mild conditions that result in little or no bother or
activity limitation; 29% with conditions of moderate severity that result in
some bother or limitation of activity, but not both; and 5% with severe
conditions that cause frequent bother and limitation of activity. The 5% with
severe conditions accounted for 19% of physician contacts and 33% of hospital
days related to chronic illness. CONCLUSIONS. Childhood chronic conditions
have highly variable impacts on children's activities and use of health care.
National Center for Chronic Disease Prevention and Health Promotion, Centers
for Disease Control, Atlanta, GA 30333.
In 1988, the National Health Interview Survey contained a supplemental
questionnaire on childhood conditions that included asthma. The authors used
these data from 17,110 households to determine the disease burden resulting
from asthma and to determine the functional status of children with and
without asthma by linking information from the core and supplemental
questionnaires. The prevalence of
asthma in children younger than 18 years of age in the United States as
reported by an adult in the household was 4.3% in 1988 and was 3.2% in 1981,
the last time a comparable questionnaire was used in the National Health
Interview Survey. The difference between the prevalences of asthma was
statistically significant (95% confidence interval for the difference was 0.7%
to 1.5%). An estimated 2.7 million children younger than 18 years were
reported by an adult in the household to have had asthma in the past year. The
added burden of illness experienced by children with asthma compared with
children without asthma was an additional 10.1 million days missed from
school, 12.9 million contacts with medical doctors, and 200,000
hospitalizations. Almost 30% of children with asthma had some limitation in
activity, compared with only 5% of children without asthma. A greater
proportion of black children experienced more severe functional disability and
had more frequent hospitalizations than white children with asthma. Ten
percent of children with asthma had severe disease as measured by frequency of
bother and limitations in function; these children accounted for 35% of
hospitalizations for asthma and 77% of the days in the hospital.(ABSTRACT
TRUNCATED AT 250 WORDS)
Prevalence and impact of chronic illness among adolescents.
Newacheck PW, McManus MA, Fox HB.
Institute for Health Policy Studies, School of Medicine, University of
California at San Francisco 94143-0936.
A sample of 7465 persons aged 10 to 17 years from the 1988 National Health
Interview Survey on Child Health was used to assess the prevalence and impact
of chronic conditions in adolescents. We defined a condition as chronic if it
was first noted more than 3 months before the interview or a condition that
ordinarily would be of lengthy duration, such as arthritis or heart disease.
An estimated 31.5% of US adolescents
were reported to have one or more chronic conditions. The most commonly
reported chronic conditions included respiratory allergies, asthma, and
frequent or severe headaches. Chronic conditions had widely varying impact on
adolescent activity levels. On average, adolescents with chronic conditions
experienced 3.4 bed days and 4.4 school absence days related to their chronic
conditions in the year before the interview. Adolescents with chronic
conditions were also reported to experience 35% more behavioral problems than
their counterparts without chronic conditions. Adolescents with multiple
chronic conditions had substantially more bed days, school absence days, and
behavioral problems than adolescents with a single chronic condition.
Implications of these findings are discussed.
Young adults with special health care needs: prevalence,
severity, and access to health services.
McManus MA, Newacheck PW, Greaney AM.
McManus Health Policy, Inc, Washington, DC 20016.
Health care needs of disabled young adults and access to care are analyzed
using the 1984 National Health Interview Survey, a nationally representative
sample of 10,394 randomly selected noninstitutionalized young adults aged 19
to 24. In 1984, 1.4 million young
adults (almost 6%) suffered from disabilities. The leading cause of
disability was diseases of the musculoskeletal system and connective tissue.
Young adults living in poverty, in households where the family reference
person had less than a high school education, and who were male were at
elevated risk of disability. Disabled young adults made almost three times as
many physician contacts and were hospitalized for close to six times as many
days as nondisabled young adults. One of every 5 disabled young adults was
uninsured in 1984. Forty-one percent of disabled Hispanic 19- to 24-year-olds
and 51% of disabled young adults of other races were uninsured compared with
19% of whites and blacks. Research and financing policy implications are
Adolescents with special health needs: prevalence,
severity, and access to health services.
Institute for Health Policy Studies, School of Medicine, University of
California, San Francisco 94143-0936.
The health care needs of disabled adolescents are examined using data from a
nationally representative sample of 15,181 randomly selected adolescents aged
10 to 18 years from the 1984 National Health Interview Survey.
More than 6% of adolescents, or nearly
2 million nationwide, suffered some degree of disability or limitation in
their usual activities in 1984. The leading causes of disability were
mental disorders and respiratory diseases. Adolescents living in poverty and
in households where the adult members had completed little formal education
exhibited increased risk of disability. Disabled adolescents were shown to
have three times as many physician contacts annually and spend nine times as
many days hospitalized as their nondisabled counter-parts. One in every seven
adolescents with a disability was found to be uninsured--exposing their
families to extreme financial risks. The great cost of insurance was cited as
the primary reason for absence of coverage for 70% of all adolescents without
coverage. Public policy implications of these results are discussed.
Prevalence of activity limiting chronic conditions among
children based on household interviews.
Newacheck PW, Halfon N, Budetti PP.
According to data from the National
Health Interview Survey (NHIS)
over two million children under 17 years (3.8%) are afflicted by chronic
conditions that cause some limitation of activity. The limitations
range from complete inability to attend school for school age children or
inability to engage in play for preschoolers to limited ability to engage in
athletics or other social activities. Analysis of micro data from the NHIS
reveals that the leading causes of activity limitation include: respiratory
diseases; speech, special sense and intelligence related impairments; and
mental and nervous system disorders. Together these conditions account for 50%
of all childhood activity limitations. Despite their small numbers, children
with activity limitations are reported by the NHIS to consume a
disproportionate share of health care resources, including over twice as many
physician services and over seven times as many hospital services as other
children. Household interviews appear to be a useful vehicle for assessing
prevalence of activity limitations but researchers and others should be
cautioned about the subjective nature of the activity limitation concept.
Trends in activity-limiting chronic conditions among
Newacheck PW, Budetti PP, Halfon N.
Data from the National Health
Interview Survey indicate that the prevalence of activity-limiting chronic
conditions among children under age 17 years doubled between 1960 and 1981,
from 1.8 to 3.8 per cent. Approximately 40 per cent of the overall rise
in prevalence occurred before 1970. Most of the increase in prevalence during
this early period can be attributed to changes in questionnaire design and
aging of the child population following the "baby boom" years. The factors
responsible for increases in reported cases of activity limitation following
1970 are more difficult to specify and evaluate. During this later period, the
increase in prevalence was restricted to less severe levels of limitations.
While prevalence levels rose for a variety of conditions during this period,
respiratory conditions and mental and nervous system disorders demonstrated
the largest changes. It appears that much of the increase in reported cases of
activity limitations during the 1970s can be attributed to shifting
perceptions on the part of parents, educators, and physicians.
This article summarizes and analyzes
possible explanations for the near doubling, since 1960, of the proportion of
children with limitations of activity due to chronic illness as reported in
the National Health Interview Survey (NHIS).
We examine several possible explanations for the upward trend in prevalence
including: changes in survey design and procedures; changes in awareness of
chronic illness on the part of parents and physicians; and changes in the
institutionalized population of disabled children.
Our analysis indicates that only a
small part of the trend can be explained directly by these factors.
Further examination of the NHIS data reveals that the types of limitations of
activities now reported are less likely to cause frequent confinement in bed;
whether this indicates lesser severity or principally different types of
chronic conditions is as yet unclear.
Chronic disease and disability in children. Are the risks
Budetti PP, Newacheck PW.
Data from the nation's largest
household health survey indicate that the number of children with disabling
chronic conditions has doubled over the last 25 years. In describing
their approach to this potentially severe public health problem, the authors
advance and evaluate several possible explanations for the trend. They
conclude that while a portion of the trend may be explained away by
artifactual causes such as changes in survey procedures,
much of the increase in reporting may
be reflective of a genuine change in prevalence of chronic disease among
children. Future analysis of this data will focus on improving health
promotion programs to target those factors identified as contributing to
chronic and disabling conditions in children.
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