Growing Up In Ireland Research Conference 2009

The Health of 9-Year-Olds

Introduction

• GUI provides some of the first nationally representative data on children’s health status and healthcare utilisation.

• Substantial details on physical and health development. Much on basis of maternal report.

• Substantial detail on healthcare use and access to services.

Structure of Presentation

- Child’s health status- Chronic illness- Oral health and healthcare- BMI, obesity and food consumption- GP utilisation- Dental care utilisation- Accidents- Summary / Conclusions

Foundations of health

• Shaped by– Biological– Psychological– Environmental– Social – Spiritual

• Health outcomes– Interaction of genetic & environment

– Plans to develop genetic arm of this study

– Begin in womb - perhaps earlier

Good child health

• A national asset

• Important for their wellbeing & development

• Good predictor of adult health

• Sensitive to socioeconomic variations

What do mothers think of their child’s health?

76 7469

23 2529

1 2 2

0

10

20

30

40

50

60

70

80

% o

f 9

-ye

ar-

old

s

Very Healthy Healthy, but a few minorproblems

Sometime quite ill /Almost always unwell

Professional/Managerial Other Non-Manual/Skilled Manual

Semi-skilled/Unskilled Manual

Prevalence of chronic illness and impact on daily activities

11% overall

10.2 10.4

14.1

3.3

6.6

9.4

0

2

4

6

8

10

12

14

16

% with chronic illness Child Severely Hampered inDaily Activities

Professional/Managerial Other Non-Manual/Skilled Manual

Semi-skilled/Unskilled Manual

0

5

10

15

20

25

30

35

40

45

50

I llness

Percenta

ge

Male

Female

Total

Chronic illnesses and child’s gender

Strengths & Difficulties Questionnaire (SDQ)

• Short behavioural screening questionnaire

• Used by clinicians & educationalists3 - 16 year olds

• 5 domains– Emotional– Conduct– Hyperactivity/inattention– Peer relationships– Prosocial behaviour

Domain

Emotional 12.5 25.8Conduct 8.7 17.2Hyperactivity 9.9 25.6Peer problems 6.9 20.4Prosocial 1.1 3.1

Total 5.5 20.0

No chronic illness

Chronic illness

Abnormal SDQ Scores (%)

Chronic illness & (SDQ)

Chronic illness & family income

13 14

11

9 9

11

0

2

4

68

10

12

14

16

Per

cent

age

with

ong

oing

chr

onic

ill

ness

Lowest 2nd 3rd 4th Highest Total

Household Annual Income Quintiles

Chronic illness & mother’s education

Chronic Illness and Mother's Education

0

2

4

6

8

10

12

14

16

Low Secondaryor less

Leaving +Vocational

Sub-degree Graduate Total

Educational level attained

Pe

rce

nta

ge

wit

h illn

ess

15

15

9

11

99

Oral Healthcare

Adds up to 6% in total

Children not brushing their teeth at least once per day by income

9

8

5

4

3

0

1

2

3

4

5

6

7

8

9

Lowestincomegroup

2nd 3rd 4th Highestincomegroup

Child’s weight and BMI

78 72 67

18

30

22

48 11

0

10

20

30

40

50

60

70

80

% o

f 9

-ye

ar-

old

s

Non Overweight Overweight Obese

Professional/Managerial Other Non-Manual/Skilled Manual

Semi-skilled/Unskilled Manual

Influence of Parental BMI on the child’s BMI

8981

67

10

1624

14

9

0

10

20

30

40

50

60

70

80

90

Non Overweight Overweight Obese

Neither caregiver overweight or obeseOne caregiver overweight or obeseBoth caregivers overweight

Food consumption and mother’s education

At least one daily portion of various foods by mother’s education

71

86

67

82

22

33

43

27

45

25

65

42

63

40

71

76

0

10

20

30

40

50

60

70

80

90

Fresh Fruit CookedVegetables

RawVegetables or

Salad

Pies, Burgers,Hotdogs

Hot Chips orFrench Fries

Crisps orSavourySnacks

Non--diet SoftDrinks

Biscuits, Cake,Chocolate

Lower secondary or less Degree

Prices of fruit & veg, sugar & sweets, fizzy drinks over 30 years in US.

NEJM 18: 360;2009

Eating Breakfast

Percentage of Children not Eating Breakfast by Family Income

5

4 4

1 1

0

1

2

3

4

5

6

% o

f 9

-ye

ar-

old

s

Lowestincomegroup

2nd 3rd 4th Highestincomegroup

Adds up to 6%

Physical Activity & Sport

Physical activity levels and sports activity classified by sex

4 5

29

21

2 3

56

33

0

10

20

30

40

50

60

% o

f 9

-ye

ar-

old

s

0 Days 7 Days Never AlmostEveryday

Boys Girls

Physically Active for 60 Minutes in Last 7 Days

How Often Do You Play Sport?

Getting to School

Usual mode of transport to school by family social class

23 22

32

11

16 16

64 61

51

2 1 10

10

20

30

40

50

60

70

% o

f 9-y

ea

r-o

lds

Walks Bus/PublicTransport

By Car Cycles

Child's Mode of Transport to School

Professional/Managerial Other Non-Manual/Skilled Manual

Semi-skilled/Unskilled Manual

General Practitioner Care

• Degree of access to GP’s can influence use of other services

• Financing of GP care has raised concerns about access

• Irish studies of adults show important income and medical card effects

GP Consultation and Family Income

Average Number of GP Visits in the Last Year by Sex of Child and Income Group

1

1.4

1.11

0.8

1

0.8 0.8 0.80.9

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Av

era

ge

nu

mb

er

of

GP

Vis

its

Lowest 2nd 3rd 4th Highest

Boys Girls

Medical Card Status

Average Number of GP Visits in the Last Year by Sex of Child and Medical Card Status

1.41.5

11.1

0.7 0.8

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Av

era

ge

Nu

mb

er

of

GP

Vis

its

Full Medical Card GP Only MedicalCard

No Card

Medical Card Type

Boys Girls

General Practitioner Care

• The differential between medical card holders and others is large

• Difficult to say whether this represents ‘over use’ by MC holders or ‘under use’ by non-holders

• Essential to control for level of ‘health need’

GP Consultation and Chronic Illness

Average Number of GP Visits in the Last Year by Chronic Illness, Degree of Hampering and Medical Card Status

0.71

1.5

2.42.2

4.6

3.5

5.1

0

1

2

3

4

5

6

Av

era

ge

Nu

mb

er o

f G

P V

isit

s

No Illness Illness, NoHampering

Illness, SomeHampering

Illness, SevereHampering

No Medical Card Medical Card

Proportion of ‘Medical Card Effect’ Explained

100

1

28

100

19

46

0

20

40

60

80

100

120

Av

era

ge

Nu

mb

er

of

GP

Vis

its

Boys Girls

Basic Difference

Controlling for family characteristics

Controlling for health

Dental Care

• Dental care utilisation among adults follows a different pattern to GP use

• Greater use as income rises largely because of more preventative care

• Studies show significantly poorer dental health among lower income group children

Visiting the Dentist

Percentage visiting their Dentist at least yearly by sex of child and family income group

5355

5459

31

62 64 65

74 71

0

10

20

30

40

50

60

70

80

% o

f 9

-ye

ar-

old

s

Lowest 2nd 3rd 4th Highest

Family Income Group

Boys Girl

Medical Specialists

• Greater health need among lower income groups is reflected in greater use of medical specialists

• As with GP, once we control for health and a number of other characteristics, differences remain

Percentage Visiting a Medical Specialist in the Last Year by Sex of Child and Medical Card

Status

15

19

15

18

0

2

4

6

8

10

12

14

16

18

20

% o

f 9

-ye

ar-

old

s

Boys Girls

No Medical Card Medical Card

Accidents

• Internationally, social disadvantage is associated with higher accident rates

• GUI survey asked about accident or injury requiring hospital treatment

• No class or income gradient in overall accident probability

• Of those that have had an accident there is a gradient in number

Visits to A&E

Percentage Visiting an Accident and Emergency Department in the Last Year Among Boys by Income Group

17 1716

15

13

0

2

4

6

8

10

12

14

16

18

% o

f 9

-ye

ar-

old

s

Lowest 2nd 3rd 4th Highest

Family Income Group

Summary / Conclusions

• The majority are healthy

• Influenced by socioeconomic status, maternal education, sex of child

• 11% have chronic illness - mainly respiratory & mental health & behaviour

• Mental & behaviour problems twice as common in boys

• 19% overweight/obese - more common in girls

• Boys a lot more active and engaged in sports

Summary / Conclusions

• As found among adults, family income and access to a medical card have an impact on utilisation of GP care

• The difference between income groups in GP use is partially explained by differences in health need, but not all

• Dental care utilisation increases with family income though data suggest oral health inversely related to income. This may suggest differences in perceived need for preventative care

• Overall, only 2% of parents report that their child did not receive medical care when required and 5%, dental care

• Of those not receiving care, being on a waiting list predominates

Growing Up In Ireland Research Conference 2009