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Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review.

ABSTRACT: Understanding how child and adolescent health is influenced by fluctuations in socioeconomic status has important public health and policy implications, as children are often subjected to both micro and macro-level socioeconomic events. This study provides the first systematic review to date on the relationship between changes in household or parental socioeconomic status and subsequent child and adolescent health outcomes. Eighty articles were identified for inclusion in this review, examining 85 different socioeconomic exposures in five categories: Income (n?=?64), Employment (n?=?14), Socioeconomic Mobility (n?=?3), Education (n?=?2), and Food Insecurity (n?=?2). The health outcomes analyzed by these eighty articles were separated into eight discrete categories, with many articles examining outcomes in more than one category: Anthropometric Measurements (n?=?21), Cognition and Development (n?=?15), Dental Health (n?=?3), Health Behaviours (n?=?9), Mental Health (n?=?12), Overall Parent/Guardian Assessed health (n?=?6); Physical Health Outcomes (n?=?11), and Socio-Emotional Behaviour (n?=?30). Several consistent patterns emerged in the literature, such as a link between increased income and improved, or decreased income and deteriorating, cognition, dental health, and physical health. The results of this review suggest a need to replicate current studies in diverse geographies to expand generalizability and clarify regional patterns. There should also be an effort to go beyond income, and employment, to assess the relationship between less frequently studied socioeconomic exposures and child health outcomes.

Supplementary information

The online version contains supplementary material available at 10.1007/s40894-021-00151-8.

SUBMITTER: Levesque AR

PROVIDER: S-EPMC7853168 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review.

Levesque Alexander Ryan AR MacDonald Sarah S Berg Selinda Adelle SA Reka Roger R

Adolescent research review 20210202 2

Understanding how child and adolescent health is influenced by fluctuations in socioeconomic status has important public health and policy implications, as children are often subjected to both micro and macro-level socioeconomic events. This study provides the first systematic review to date on the relationship between changes in household or parental socioeconomic status and subsequent child and adolescent health outcomes. Eighty articles were identified for inclusion in this review, examining ...[more]

PMID: 33553578

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Project description:IntroductionOn January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD's Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue. We stratified our analysis by the socioeconomic status (SES) of the ED patient population.MethodsWe collected monthly mean data including patient volume, hospitalization percentages, payer mix, and professional revenue from January 2013 through December 2015 from a convenience sample of 11 EDs in Maryland. Using regression models, we compared each of the variables 18 months after the policy changes and a six-month washout period to the year prior to ACA/GBR implementation. We included the median income of each ED's patient population as an explanatory variable and stratified our results by SES.ResultsOur 11 EDs saw an annualized volume of 399,310 patient visits during the study period. This ranged from a mean of 41 daily visits in the lowest volume rural ED to 171 in the highest volume suburban ED. After ACA/GBR, ED volumes were unchanged (95% confidence interval [CI] [-1.58-1.24], p=.817). Hospitalization percentages decreased significantly by 1.9% from 17.2% to 15.3% (95% CI [-2.47%-1.38%], p<.001). The percentage of uninsured patients decreased from 20.4% to 11.9%. This 8.5% change was significant (95% CI [-9.20%-7.80%], p<.001). The professional revenue per relative value unit increased significantly by $3.97 (95% CI [3.20-4.74], p<.001). When stratified by the median patient income of each ED, changes in each outcome were significantly more pronounced in EDs of lower SES.ConclusionHealth policy changes at the federal and state levels have resulted in significant changes to emergency medicine practice and finances in MD. Admission and observation percentages have been reduced, fewer patients are uninsured, and professional revenue has increased. All changes are significantly more pronounced in EDs with patients of lower SES.

Project description:BackgroundMany studies have evaluated the effects that a lack of resources has in children's physical and cognitive development. Although there are reviews that have focused on applied interventions from different perspectives, there is still a need for a comprehensive review of what has been attempted with these children from the cognitive intervention field. The aim of this paper is to present a protocol for a systematic review collecting randomized controlled trials (RCTs) studies whose purpose was to enhance cognitive development through the implementation of cognitive interventions in children and adolescents (< 18 years old) from low socioeconomic Status (SES) settings.MethodsThe following databases will be searched: Web of Science (WoS core collection), PsycINFO, Cochrane Central Register of Controlled Trial, ERIC, PubMed, ICTRP and Opengrey Register (System for Information of Grey Literature in Europe). Searches will be adapted for each database. Additionally, the reference list of articles included in the review will also be searched. As part of this process, two reviewers will determine, independently, the suitability of each article taking into account predefined inclusion/exclusion criteria. Pertinent data will then be extracted, including sample characteristics, specifics of the intervention, and outcomes, as well as follow-up measures. Internal validity will be assessed using the Cochrane Risk of Bias Tool. A quantitative synthesis of results will be conducted using a meta-analysis. However, if a meta-analysis is difficult to implement due to the diversity of the studies (for example, in terms of measures used to estimate the effect size, intervention types, outcomes, etc.), the technique synthesis without meta-analysis (SWiM) will be used. A description of outcome measures will be provided, as measured by validated neuropsychological instruments of any cognitive function.DiscussionThe systematic review will offer a framework based on evidence to organisations, institutions, and experts who want to implement or promote interventions aimed at enhancing cognitive domains in children and adolescents who live in disadvantaged contexts.Systematic review registrationThis protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 16 March 2020 (registration number: CDR42020150238).

Project description:AimChildren and adolescents with low socioeconomic status (SES) suffer from mental health problems more often than their peers with high SES. The aim of the current study was to investigate the direct and interactive association between commonly used indicators of SES and the exposure to stressful life situations in relation to children's mental health problems.MethodsThe prospective BELLA cohort study is the mental health module of the representative, population-based German National Health Interview and Examination Survey for children and adolescents (KiGGS). Sample data include 2,111 participants (aged 7-17 years at baseline) from the first three measurement points (2003-2006, 2004-2007 and 2005-2008). Hierarchical multiple linear regression models were conducted to analyze associations among the SES indicators household income, parental education and parental unemployment (assessed at baseline), number of stressful life situations (e.g., parental accident, mental illness or severe financial crises; 1- and 2-year follow-ups) and parent-reported mental health problems (Strength and Difficulties Questionnaire; 2-year follow-up).ResultsAll indicators of SES separately predicted mental health problems in children and adolescents at the 2-year follow-up. Stressful life situations (between baseline and 2-year follow-up) and the interaction of parental education and the number of stressful life situations remained significant in predicting children's mental health problems after adjustment for control variables. Thereby, children with higher educated parents showed fewer mental health problems in a stressful life situation. No moderating effect was found for household income and parental employment. Overall, the detected effect sizes were small. Mental health problems at baseline were the best predictor for mental health problems two years later.ConclusionsChildren and adolescents with a low SES suffer from multiple stressful life situations and are exposed to a higher risk of developing mental health problems. The findings suggest that the reduction of socioeconomic inequalities and interventions for families with low parental education might help to reduce children's mental health problems.

Project description:BackgroundDietary patterns represent a broad picture of food and nutrient consumption and may be more predictive of health outcomes than individual foods and nutrients.ObjectiveWe investigated the relations among race, gender, family structure, parental socioeconomic status (SES), dietary patterns, and cardiovascular disease (CVD) profiles among adolescents in the southeastern region of the United States.MethodsA total of 743 adolescents from a cross-sectional study were divided into 4 dietary pattern groups by K-means cluster analysis. Multinomial logistic regression was performed to determine the relations among the parental SES, family structures, and dietary patterns of the adolescents. Associations between dietary patterns and CVD profiles were analyzed by multiple linear regression.ResultsFour dietary patterns were derived: "healthy" (17%), "snacks and sweets" (26%), "processed meat" (20%), and "sugar-sweetened beverage (SSB) and fried food" (37%). Whites and females were more likely to have a "healthy" dietary pattern (Ps < 0.001). There were significant race/ethnicity differences in family structures, SES, and dietary patterns (Ps < 0.05). In whites, higher mother's education and father's education and occupation were associated with greater likelihood of a "healthy" dietary pattern (Ps < 0.05). Stay-at-home mother was associated with less likelihood of an "SSB and fried food" pattern (P = 0.023). In blacks, higher mother's occupation, father's education, and living with both parents were associated with more likelihood of a "healthy" dietary pattern (Ps < 0.05). Stay-at-home father was associated with less likelihood of the "snacks and sweets" (P = 0.025) and "SSB and fried food" dietary patterns (P = 0.044). Overall, adolescents with poor dietary patterns exhibited higher percentage body fat, waist circumference, systolic blood pressure, fasting insulin, homeostasis model assessment of insulin resistance, C-reactive protein, and total triglyceride (Ps < 0.05).ConclusionsOur data suggest that family structure, parental working status, and SES are associated with the diet quality in adolescents. Moreover, "snacks and sweets," "processed meat," and "SSB and fried food" dietary patterns are all associated with worse CVD risk profiles.

Dataset Information

Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review.

Supplementary information

Publications

Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review.

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