Epidemiology - Paediatrics

Epidemiology

Measures of Child Health

·        Measures of death/disease:

o  Mortality

o  Disease specific mortality/morbidity (eg SIDS)

o  Hospital Discharges

o  Disparities: ethic, gender, age, location, etc

·        Measure of health interventions:

o  Immunisation coverage

o  Well child checks

·        Measures of health or its determinants or impacts:

o  Breast feeding at 3 months, 6 months

o  Participation: early childhood education, school, sport, etc

o  BMI: marker of appropriate nutrition

o  Self-report (eg questionnaires)

NZ Statistics

·        Numbers of children:

o  23% of NZers are aged 0 - 14 

o  Maori and PI children are about double adult proportions as percentage of total population – 1/3 of Maori and PI people are under 15, compared with 19% of Europeans 

o  Until 2050, fall in the number of children, and fast fall in their proportion of the total population (from 23 ® 16%) ® future conflict over resources: “principle of first call” – essential needs of children should be given high priority in the allocation or resources

·        Socio-economic status: 

o  Children with no parent participating in the labour force (1996): European 13%, Maori 42%, PI 37%, Asian 30% 

o  Proportion of children in one-parent families (1996): European 15%, Maori 43%, PI 27%, Asian 12%. Increased over all groups from 1986 to 1996 

o  Maori and Pacific Islanders also more likely to not have a car, share a household, less likely to leave school with a qualification

·        Mortality:

o  Under 5 mortality currently around 500 per annum 

o  Age specific rates: 7/1000 live births for 0 – 1 years, 0.4/1000 for children 1 – 4 years, 0.2/1000 after this 

o  All child mortality rates in NZ have declined by 1/3 over the last 15 years, but this is slow in comparison with other countries. Our OECD ranking for under 5 mortality has fallen from 6^th to 15^th. If we had had the same fall as Sweden 194 children would not have died.

o  Major causes of death: 

§  < 1 year: SIDS (29%), Congential abnormalities (28%), Perinatal conditions (27% - prematurity, neonatal infection, hypoxia, etc) 

§  1 – 4 years: Injury and poisoning (46%), Congenital abnormalities (18%), Cancer (11%). Maori injury and poisoning rate 3.5 time Non-Maori 

o  SIDS rate has fallen from 4/1000 in 1989 to 1.5/1000 (UK is 0.6/1000). Rate 4 times higher in Maori than non-Maori. Low income 3 times higher income (independent of ethnicity) – due to risk factors of maternal smoking, teen pregnancy, single parenthood, etc

·        Morbidity:

o  Under 1‟s most likely to be admitted: NICU, respiratory GI and infectious

o  Ethnicity patterns same as for mortality: Maori rates range from 1.7 – 4.6 times higher

·        Conclusions:

o  Despite improvements, New Zealand hasn‟t made the gains that other countries have

o  Ethnic and socio-economic disparities are growing

o  Improvements in curative medicine are unlikely to have an impact on this inequality