Effect of Concurrent, Lagged, and Cumulative Exposure to Poverty on Childrens Health from 5 through

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Effect of Concurrent, Lagged, and Cumulative
Exposure to Poverty on Childrens Health from 5-
through 41 Months

• Béatrice Nikiéma , Lise Gauvin, Louise Séguin
  Maria Victoria Zunzunegui
• 12th World Congress on Public Health, Istanbul,
  April 2009

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Introduction

• Poverty-health links are often studied
• Dynamics of poverty across time and its
  relationship with health outcomes
• More limited data
• Even fewer data among young children, across the
  early childhood years
• Lesser quantity of data on physical health

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Objective

• To examine how different durations and timing of
  adverse economic circumstances are related to the
  likelihood of experiencing childhood physical
  health problems

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DataThe Québec Longitudinal Study of Child
Development (QLSCD)

• A birth cohort, coordinated by the Direction
  Santé Québec of the Institut de la statistique du
  Québec since 1998
• A representative sample of 2120 singleton live
  births registered in the Québec live births
  registry in 1997-1998
• Data collection 5 months annual follow-up
• By face to face interviews with parents (98
  mothers)
• Hospital records for data on neonatal conditions

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Data

• The four first waves of data
• Participation rate at baseline
• 5 months 83 n 2120
• Participation at follow-up
• 17 months 96 , n 2045
• 29 months 94 , n 1997
• 41 months 92 , n 1950

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Health Indicators

• Number of asthma attacks during the previous 12
  months
• Number of acute infections during the previous 3
  months

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Defining Poverty

• Child Poverty Living in a household with
  insufficient income
• Before taxes annual income falls below the Low
  Income Cut-Off (LICO) from Statistics Canada

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Defining Poverty

• Concurrent Poverty poverty measured
  synchronously with the assessment of the health
  outcome
• Lag of Poverty poverty status recorded at the
  previous measurement occasion
• Cumulative Poverty total number of measurement
  occasions during which a child was deemed to be
  living in conditions of poverty

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Analytic Strategies Effects of Concurrent
Poverty or Lagged Poverty (1)

• Multilevel Models for Count Data (Poisson
  regression)
• Growth Curve Analysis
• 2 Hierarchical Levels
• Level 1measurement occasion Level 2children
• Laplace Approximation (Laplace6)

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Analytic Strategies Effects of Cumulative
Poverty (2)

• Multilevel Multivariate Response Analysis
• Level 1 health outcome at each measurement
  occasion
• Level 2 Children
• Separate fixed effects at each occasion
• Accounting for within-occasion variance and
  between-occasion covariance

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Results
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Prevalence of Health Problems
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Prevalence of Insufficient Income used as a
proxy of Poverty
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Concurrent Effects of Poverty
1 Adjusted for childs sex and birth rank, type
of family, and mothers age and education 2
Adjusted for childs sex, use of daycare center,
and mothers education and immigration status
p lt .05 p lt .01
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Lagged Effects of Poverty
1 Adjusted for childs sex and birth rank, type
of family, and mothers age and education
current poverty status 2 Adjusted for childs
sex, use of daycare center, and mothers
education and immigration status current poverty
status
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Cumulative Effects of Poverty
1 Adjusted for childs sex and birth rank, type
of family, and mothers age and education 2
Adjusted for childs sex, use of daycare center,
and mothers education and immigration status
plt0.5
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Summary
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Conclusion (1)

• Our results support the hypotheses that
• Exposure to poverty may result in health problems
  at a later time
• Poverty recorded at the previous measurement
  occasion is associated with current health
  outcomes
• Accumulation of poverty insults may result in
  greater risk of health problems among young
  children
• Association between greater number of periods
  spent living in poverty greater number of
  asthma attacks

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Conclusion (2)

• Timing duration of poverty matter for child
  physical health
• Further investigation warranted
• With continuous indicator of poverty or material
  deprivation (?)
• For the effect of income instability (social
  mobility)

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Acknowledgements

• 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 who was responsible for
  the data collection and validation.
• Lise Gauvin holds a Canadian Institute for
  Health Research / Centre de Recherche en
  Prevention de lObésité Applied Public Health
  Chair in Neighborhoods, Lifestyle, and Healthy
  Body Weight.
• The GRIS and the CRCHUM receive infrastructure
  funding from the Fonds de la recherche en santé
  du Québec (FRSQ)
• The Léa-Roback Research Center is funded through
  a Research Center development initiative by the
  Canadian Institutes of Health Research.