Prevalence and impact of multiple childhood chronic illnesses.

OBJECTIVE To determine the prevalence and impact of multiple chronic conditions on children's health status and utilization of health services. DESIGN Analysis of the 1988 National Health Interview Survey on Child Health. SETTING Nationally representative sample of the U.S. civilian, noninstitutionalized population. PARTICIPANTS A total of 17,710 children less than 18 years of age selected in a stratified cluster sampling of U.S. households. INTERVENTION None. RESULTS We estimated that fewer than 5% of children have multiple (two or more) chronic conditions and that less than 1% of children had three or more such conditions. However, despite this low overall prevalence, some notable features of multiple chronic conditions stand out. Many of the most prevalent condition-pairs were allergy related, and the rates of co-occurrence of these disorders were generally higher than would be predicted on the basis of prevalence rates for the individual conditions. Children with multiple chronic conditions had more mental and physical health problems and used substantially more health services than other children. For example, the prevalence of developmental delay, learning disabilities, and emotional and behavioral problems increased sharply with the number of chronic conditions reported. Notable deterioration in such health status measures as days in bed, school absences, and activity limitation was also observed with increasing numbers of chronic conditions. Similarly, utilization of hospital and physician services increased in tandem with increasing numbers of chronic conditions. CONCLUSIONS Children who have multiple conditions of a chronic nature, even if few in number, have increased morbidity across a variety of measures.

[1]  I B Pless,et al.  Issues involved in the definition and classification of chronic health conditions. , 1993, Pediatrics.

[2]  B. Starfield,et al.  Childhood morbidity: comparisons, clusters, and trends. , 1991, Pediatrics.

[3]  P. Newacheck,et al.  Prevalence and impact of chronic illness among adolescents. , 1991, American journal of diseases of children.

[4]  B. Starfield,et al.  Morbidity in childhood--a longitudinal view. , 1984, The New England journal of medicine.

[5]  T. B. Jabine Reporting chronic conditions in the National Health Interview Survey. A review of findings from evaluation studies and methodological test. , 1987, Vital and health statistics. Series 2, Data evaluation and methods research.

[6]  R. Stein,et al.  Reinterpreting disability: changes in supplemental security income for children. , 1991, Pediatrics.

[7]  P. Szatmari,et al.  Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study. , 1987, Pediatrics.

[8]  P. Newacheck,et al.  Morbidity and use of ambulatory care services among poor and nonpoor children. , 1988, American journal of public health.

[9]  S. Gortmaker,et al.  Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents. , 1990, Pediatrics.

[10]  A. Beautrais,et al.  Life events and childhood morbidity: a prospective study. , 1982, Pediatrics.

[11]  Parsons Vl,et al.  Current estimates from the National Health Interview Survey. United States, 1985. , 1986, Vital and health statistics. Series 10, Data from the National Health Survey.

[12]  N. Roth,et al.  Coincidence of attention deficit disorder and atopic disorders in children: Empirical findings and hypothetical background , 1991, Journal of abnormal child psychology.

[13]  P. Newacheck,et al.  Childhood chronic illness: prevalence, severity, and impact. , 1992, American journal of public health.

[14]  S. Gortmaker,et al.  Use of Health Services by Chronically Ill and Disabled Children , 1984, Medical care.

[15]  C. Power,et al.  Childhood morbidity and adulthood ill health. , 1990, Journal of epidemiology and community health.

[16]  I. B. Pless,et al.  Chronic illness and its consequences: observations based on three epidemiologic surveys. , 1971, The Journal of pediatrics.

[17]  N. Breslau Psychiatric disorder in children with physical disabilities. , 1985, Journal of the American Academy of Child Psychiatry.

[18]  Madow Wg Interview data on chronic conditions compared with information derived from medical records. , 1967 .

[19]  P. Newacheck,et al.  Prevalence of activity limiting chronic conditions among children based on household interviews. , 1986, Journal of chronic diseases.