Aucun titre de diapositive

1

Timing of exposure to poverty and occurrence of
asthma attack in the Quebec Longitudinal Study of
Child Development Louise Séguin, Maria-Victoria
Zunzunegui, Lise Gauvin, and Béatrice
Nikiéma. Department of Social and Preventive
Medicine Université de Montréal 12th World
Congress on Public Health Istanbul, April 2009
2
Child Poverty and Health

• Links between child poverty and health are well
  known.
• Mechanisms underlying these links are not fully
  understood in industrialized countries.
• Poverty during early childhood might have long
  term consequences for later health.

3
Our study

• In our study we examined the links between timing
  and duration of child poverty and child asthma
  attacks when children were 6-7 years old.

4
Duration/timing of poverty and child health

• Long term or chronic poverty has more impact on a
  child health than transitory poverty (Spencer,
  2000, Séguin et al, 2005, 2007)
• Some authors demonstrated that if a child grew up
  in a low SES family during his/her first 2 years
  of life, that child was more likely to experience
  a chronic illness at 10-11years old. (Chen et
  all, 2008)

5
Child Poverty and Adult Health

• Child poverty during early childhood not only
  affects child health, it also jeopardizes future
  adult health independently of adult socioeconomic
  status.

6
Child Poverty and Adult Health

• An adult who experienced early childhood poverty
  has a higher risk of
• Early mortality (Kuh, 2002 Claussen, 2003,
  Galobardes, 2008)
• Cardiovascular diseases (Barker, 1992 Barker,
  2001)
• Type 2 diabetes (Lawlor, 2002)
• Cognitive development problems (Richards, 2002
  Yeung, 2002 Cheung, 2001 Guo, 2000)
• Older age cognitive problems (Stern, 1994
  Abbott, 1998 Kaplan, 2001)

7
Child poverty in Canada

• Children are the age group most often affected by
  poverty in Canada.
• Canada has higher child poverty rates than many
  Europeans countries

8
Child Poverty in Industrialized Countries
UNICEF 2007
9
Defining poverty

• Poverty
• Absolute or relative lack of material resources
• Poverty is not only about lack of money or
  insufficient income
• Lack of money determines and limits choices of
  resources
• Being poor involves being exposed to multiple
  adversities.

10
Pediatric asthma

• Asthma is one of the most frequent health problem
  among young children in industrialized countries
• Poor children are disproportionnately burdened by
  asthma (Chen et al,, 2006 Lindbaek, et al,,
  2003 Séguin et al, 2007).
• There are still controversies and uncertainties
  concerning the factors that are involved with
  pediatric asthma (Wright Subramania, 2007
  Lougheed, 2007),

11
Objectives of the study

• The objectives of this study are to examine
• if the presence of asthma attack is related to
  the timing and duration of poverty among 5 to 7
  years old children from the QLSCD.
• the role of exposure to cumulative adversities
  before 4 years old in the occurrence of asthma
  attack among these 5 to 7 years old children.

12
The Quebec Longitudinal Study of Child
Development (QLSCD)

• Sampling from the Quebec live births records
• By the Direction Santé Québec of the Quebec
  Institute of Statistics.
• A representative cohort of 2120 singleton live
  births in Quebec excluding those
• residing in the Northern Quebec, Cree, and Inuit
  regions, and on Indian reserves
• for whom duration of gestation is unknown.
• with a gestational age 42 wks

13
The Quebec Longitudinal Study of Child
Development (QLSCD) data sources

• Birth data were extracted from hospital charts.
• Health conditions at birth (birth weight,
  gestational age, congenital malformations,...)
• Data were collected annually at home by
  interviewers. Mothers were respondents in 97-99
  of cases
• Mothers completed self-administered
  questionnaires.

14
Participation rates

• Annual follow-up of 2120 children who were 5
  months old in 1998 (initial participation rate
  83)
• Participation rate at follow-ups
• 1 yr ½ 96 , n 2045
• 2 yrs ½ 94 , n 1997
• 3 yrs ½ 92 , n 1950
• 4 yrs 92 , n 1944
• 5 yrs 83 , n 1759
• 6 yrs 70,4, n 1492
• 7 yrs 75,9, n 1528

15
Measure of poverty

• Poverty was defined as having a household income
  before taxes (previous 12 months) below the
  Low-Income Cut Offs (LICO) from Statistics
  Canada.
• Computation of the LICO takes into account the
  number of persons in the household and the number
  of residents in a rural or urban area.

16
Measure of asthma attacks

• Mother reported if the child experienced an
  asthma attack during the previous 12 months.
• Since we looked at the answers provided during
  two observation periods, when the child was 6 and
  7 years old, in fact we are examing the presence
  of an asthma attack during the period between 5
  and 7 years old.

17
Index of vulnerability/adversity

• Index of biological vulnerability at birth
• Being male, 2nd born or more, preterm.
• Index of psychosocial adversity
• Single parent family, dysfonctional family,
  maternal depression, low social support,
  neighborhood perceived as unsafe by the mother.

18

• Results

19
Timing and duration of poverty for 6-7 years old
children of the QLSCD

• (N)
• No episodes of poverty 66.1(1064)
• Poor before 4 yrs old only 13.9 (223)
• Poor between 5 to 7 yrs only 4.4 (70)
• Poor (253)

20
Chronic Poverty before 4 Years Old and Exposure
to Adversity, QLSCD
21
Frequency of asthma attack according to some
characteristics of the child, QLSCD
22
Asthma attacks according to timing of poverty and
exposure to adversity, QLSCD
23
Multivariate analysis

• Logistic regressions
• Examining potential interactions between poverty
  and biological vulnerability or psychosocial
  adversity regarding asthma attacks among children.

24
Multivariate analysis

• The multivariate model is adjusted for
• exposure to smoke from tobacco at home
• living in presence of a pet at 5-months old
• duration of breastfeeding
• the mothers educational level
• No interactions were demonstrated.

25
Probability of an asthma attack between 5 and 7
yrs old, QLSCD Odds ratios (OR) and 95
confidence interval (CI)
26
Conclusions

• The adjusted model shows that
• The probability of an asthma attack between 5 and
  7 years old is higher among children who are poor
  chronically and among those who are poor at this
  age compare to those who were never poor.
• A history of asthma among parents is associated
  with a higher probability of a child asthma
  attack.

27
Conclusions

• Early poverty (associated with the occurrence of an asthma
  attack between 5 and 7 years old.
• Actual and chronic poverty appear as the most
  important.
• However, early poverty might show an impact on
  health during adolescence and adulthood.

28
Conclusions

• While their gradient is in the expected
  direction, the cumulative biological or
  psychosocial risk factors are not associated with
  the occurrence of an asthma attack between 5 and
  7 years old when family poverty is accounted for.
  
• The link between poverty and child asthma attack
  is present whatever the level of education of the
  mother.

29
Limitations of the study

• Small number of participants.
• Lack of information on
• severity of the disease,
• exposure to other risk factors
• management and treatment of asthma.

30
Strenghts of the study

• A longitudinal prospective design
• Large participation rates
• Data collected annually at home
• trained interviewers
• validated scales.

31
Future research

• Other studies are necessary to clarify
• The mediating or modifying roles of exposure to
  diverse psychosocial risk factors regarding the
  likelihood of an asthma attack among poor
  children.
• At what age early poverty might demonstrate its
  impact on ones health

32
Acknowledgments

• The study was funded by the Canadian Institutes
  of Health Research Grant 200309MOP-123079 and
  Grant 200609MOP-165867
• The Institut de la Statistique du Québec,
  Direction Santé Québec was responsible for the
  data collection and validation of the data base.
• The GRIS receives infrastructure funding from the
  Fonds de la recherche en santé du Québec (FRSQ)

33
(No Transcript)