Just published! Using @GrowingUpinNZ data, we show how increasing levels of socioeconomic disadvantage in early childhood are linked to multiple chronic conditions in the #first1000days. https://www.sciencedirect.com/science/article/abs/pii/S1876285919303900

Let me unpack the results for you right here: THREAD /1

In studies of #multimorbidity (when a person has multiple chronic conditions), a growing area of health research, there are very few studies of children. This is because typically studies seemed to have found that children don't have many chronic conditions.... /2

However, these previous studies have often used adult-focused definitions of multimorbidity, and applied these definitions to children, rather than child-centred definitions. In our study, we define multiple chronic conditions using an age-appropriate child-centred approach. /3

We found 1-in-10 children had 1 or more chronic conditions at the age of 2. While that's lower than in adults, it's still a really significant number of children and their families experiencing multiple chronic conditions.

So what about poverty? /4

We looked at the association between cumulative socioeconomic disadvantages and whether children had multiple chronic conditions or not.

We found that as disadvantage increases or accumulates, the risk of the child having multimorbidity increases. But which risk factors? /5

Breaking down our disadvantage index, we found that parental unemployment and financial stress were strong independent predictors of whether a child had multiple chronic conditions.

Why is this important? /6

It's important because some have previously argued that poverty may just be a consequence, not a driver, of children's poor health. Perhaps, the thinking goes, poor child health means parents can't be out earning, so the family is poorer. But we don't agree... /7

While that may be a factor, our study, which measures socioeconomic disadvantage before birth, supports the argument that disadvantage DRIVES poor chronic health in childhood, instead of merely arising from it.

Is this important? /8

Yes. It is important. All children deserve the best possible start in life.

25% of children in our study had two or more disadvantages. Poverty rates in NZ are high. Disadvantage affects child chronic health, in the #first1000days. /9

It's also important for our health service. Practitioners working in disadvantaged areas are going to be dealing with children with higher rates of multimorbidity; this added medical complexity needs support and recognition. /10

We need to stop thinking about child health "one disease" at a time. Child health can be complex, and conditions can accumulate from early on. That's how children and families experience their health, so we have to make a paradigm shift too. /11

Must thank the children & families of @GrowingUpinNZ - an AMAZING study. Also co-authors, Prof Cameron Grant and Prof Susan Morton @FMHS_UoA and editors @AcademicPeds

This paper fills an important gap in studies of multi-morbidity - that of the #first1000days. #childpoverty