Chronic Disease Among Children – Changes in Incidence

http://www.vaccinationnews.com/DailyNews/January2002/ChronDisNewacheck.htm

Please note that 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%.
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TI: Prevalence, impact, and trends in childhood disability due to asthma.
AU: Newacheck,-P-W; Halfon,-N
SO: Arch-Pediatr-Adolesc-Med. 2000 Mar; 154(3): 287-93.
JN: Archives-of-pediatrics-and-adolescent-medicine;
IS: 1072-4710
LA: English
AB: 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.
TI: Prevalence and impact of disabling chronic conditions in childhood.
AU: Newacheck,-P-W; Halfon,-N
SO: Am-J-Public-Health. 1998 Apr; 88(4): 610-7.
JN: American-journal-of-public-health;
IS: 0090-0036
LA: English
AB: 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.
TI: An epidemiologic profile of children with special health care needs.
AU: Newacheck,-P-W; Strickland,-B; Shonkoff,-J-P; Perrin,-J-M; McPherson,-M; McManus,-M; Lauver,-C; Fox,-H; Arango,-P
SO: Pediatrics. 1998 Jul; 102(1 Pt 1): 117-23.
JN: Pediatrics-;
IS: 0031-4005
LA: English
AB: 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.
TI: Childhood chronic illness: prevalence, severity, and impact.
AU: Newacheck,-P-W; Taylor,-W-R
SO: Am-J-Public-Health. 1992 Mar; 82(3): 364-71.
JN: American-journal-of-public-health;
IS: 0090-0036
LA: English
AB: 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.
TI: Impact of childhood asthma on health.
AU: Taylor,-W-R; Newacheck,-P-W
SO: Pediatrics. 1992 Nov; 90(5): 657-62.
JN: Pediatrics-;
IS: 0031-4005
LA: English
AB: 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)
TI: Prevalence and impact of chronic illness among adolescents.
AU: Newacheck,-P-W; McManus,-M-A; Fox,-H-B
SO: Am-J-Dis-Child. 1991 Dec; 145(12): 1367-73.
JN: American-journal-of-diseases-of-children;
IS: 0002-922X
LA: English
AB: 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.
TI: Young adults with special health care needs: prevalence, severity, and access to health services.
AU: McManus,-M-A; Newacheck,-P-W; Greaney,-A-M
SO: Pediatrics. 1990 Nov; 86(5): 674-82.
JN: Pediatrics-;
IS: 0031-4005
LA: English
AB: 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 discussed.
TI: Adolescents with special health needs: prevalence, severity, and access to health services.
AU: Newacheck,-P-W
SO: Pediatrics. 1989 Nov; 84(5): 872-81.
JN: Pediatrics-;
IS: 0031-4005
LA: English
AB: 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.
TI: Prevalence of activity limiting chronic conditions among children based on household interviews.
AU: Newacheck,-P-W; Halfon,-N; Budetti,-P-P
SO: J-Chronic-Dis. 1986; 39(2): 63-71.
JN: Journal-of-chronic-diseases;
IS: 0021-9681
LA: English
AB: 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.
TI: Trends in activity-limiting chronic conditions among children.
AU: Newacheck,-P-W; Budetti,-P-P; Halfon,-N
SO: Am-J-Public-Health. 1986 Feb; 76(2): 178-84.
JN: American-journal-of-public-health;
IS: 0090-0036
LA: English
AB: 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.
TI: Trends in childhood disability.
AU: Newacheck,-P-W; Budetti,-P-P; McManus,-P
SO: Am-J-Public-Health. 1984 Mar; 74(3): 232-6.
JN: American-journal-of-public-health;
IS: 0090-0036
LA: English
AB: 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.
TI: Chronic disease and disability in children. Are the risks increasing?
AU: Budetti,-P-P; Newacheck,-P-W
SO: Mobius. 1984 Jul; 4(3): 14-9.
JN: Mobius-;
IS: 0272-3425
LA: English
AB: 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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