Epidemiological studies of sociodemographic factors, early life factors, health, and medical care consumption among small children

University dissertation from Department of Clinical Sciences, Lund University

Abstract: By international standards, children in Sweden experience good health. Sweden has low infant mortality rates, low accident mortality rates, a high number of breastfed children and a high proportion of vaccinated children. However, during the past twenty years the prevalence of overweight children has doubled in Sweden, while that of obese children has increased 4-5 times. Furthermore, there has been an increase in self-reported problems such as anxiety and sleeping disturbances among adolescents. Asthma and other types of allergic diseases are the most common chronic diseases during childhood, while infectious diseases are the most common causes of short-term morbidity. It is well-known that the social position of the family, living conditions, and parental health-related behaviors are closely connected with health in childhood. The socioeconomic position (SEP) of the family affects the child’s health from the very beginning of life through the mother’s health-related behaviors during pregnancy. Even though the prevailing etiological model for adult chronic disease emphasizes adult risk factors, the importance of earlier life circumstances has recently attracted considerable attention. A life course perspective seems to increase our understanding of health in childhood as well as later on, in adulthood. In this thesis, the associations between sociodemographic factors and early life factors (e.g., maternal smoking during pregnancy, exposure to secondhand tobacco smoke, breastfeeding, and high birth weight) on the one hand and health and medical care consumption on the other hand, were investigated among small children in Malmö. The studies in the thesis were population-based and cross-sectional, and the study populations comprised children who visited the Child health care (CHC) centers for their 8-month or 4-year check-up during 2003-2008 and whose parents answered a self-administered questionnaire. The self-administered questionnaire was handed out to the parents of 8-month-old and 4-year-old children in conjunction with their check-up at the CHC centers aiming to reach all children in Malmö in these two age groups. The questionnaire was distributed by the pediatric nurses at the centers. The results showed that antibiotic consumption at an early age was influenced by several factors including parental sociodemographic factors, lifestyle factors, psychosocial support, as well as child-related factors. The results further showed associations between exposure to unfavorable early life factors and the development of childhood allergy and overweight or obesity. Such effects were enhanced when there were presence of parental allergy or parental overweight, respectively. Children with less educated mothers were exposed to more health risks, fewer health promoting factors, worse social support and had a higher medical care consumption than children with mothers with higher levels of education.In conclusion, the results show that children’s health seems to be highly influenced by the characteristics of the families into which they are born. The results also put focus on the importance of early targeted interventions.