Understanding socio-economic inequalities in childhood respiratory health

Asthma is the most common chronic disease of childhood. Recent evidence has shown a socio-economic gradient in its distribution. This paper examines whether a number of factors argued to have led to a rise in the incidence of asthma might also explain the social gradient. Several of these have been the object of policy intervention, though not necessarily with the aim of lowering childhood respiratory conditions. Using a large cohort study (the Avon Longitudinal Study of Parents and Children) we find significant inequalities in three respiratory conditions in middle childhood. We investigate eight potential mediating factors: exposure to other children in infancy, child's diet, poor housing conditions, maternal smoking, parental history of asthma, poor child health at birth, maternal age at child's birth and local deprivation. We find that each of these alone typically explains a relatively modest part of each respiratory inequality, with child's diet, local deprivation and maternal smoking generally the most important. But taken together, the mediating factors account for a substantial part of the respiratory inequalities. So the socio-economic gradient appears to operate through a number of inter-correlated pathways, some of which may be amenable to policy intervention.Asthma, wheeze, socio-economic inequalities, mediating

Health Supplier Quality and the Distribution of Child Health

There is emerging evidence to suggest that initial differentials between the health of poor and more affluent children in the UK do not widen over early childhood. One reason may be that through the universal public funded health care system all children have access to equally effective primary care providers. This paper examines this explanation. The analysis has two components. It first examines whether children from poorer families have access to general practitioners of a similar quality to children from richer families. It then examines whether the quality of primary care to which a child has access has an impact on their health at birth and on their health during early childhood. The results suggest that children from poor families do not have access to markedly worse quality primary care, and further, that the quality of primary care does not appear to have a large effect on differentials in child health in early childhood.primary care quality, child health

The Impact of Low Income on Child Health: Evidence from a Birth Cohort Study

There is a growing literature that shows that higher family income is associated with better health for children. Wealthier parents may have more advantaged children because they have more income to buy health care or because parental wealth is associated with beneficial behaviours or because parental health is associated with both income and children¿s health. The policy implications of these transmission mechanisms are quite different. We attempt to unpick the correlation between income and health by examining routes by which parental disadvantage is transmitted into child disadvantage. Using a UK cohort study that has rich information on mother¿s early life events, her health, her behaviours that may affect child health, and her child¿s health, we examine the impact of being in low income compared to that of mother child health related behaviours and mother¿s own health on child health. We find children from poorer households have poorer health. But we find the direct impact of income is small. A larger role is played by mother¿s own health and events in her early life. No clear role is played by mother child health production behaviours.child health, income, maternal health, tranmission mechanisms

Is There an Income Gradient in Child Health? It Depends Whom You Ask

A large literature uses parental evaluations of child health status to provide evidence on the socioeconomic determinants of health. If how parents perceive health questions differs by income or education level, then estimates of the socioeconomic gradient are likely to be biased and potentially misleading. In this paper we examine this issue. We directly compare child mental health evaluations from parents, teachers, children and psychiatrists for mental health problems, test whether these differences are systematically related to observable child and parent characteristics, and examine the implications of the different reports for the estimated income gradient. We find that respondents frequently evaluate children differently and while the sign of the income gradient is in the same direction across respondents, systematic differences in evaluations mean that the estimated magnitude and significance of the health-income gradient is highly dependent upon the choice of respondent and the measure of child health.child health, income, reporting bias

Child Mental Health and Educational Attainment: Multiple Observers and the Measurement Error Problem

We examine the effect of survey measurement error on the empirical relationship between child mental health and personal and family characteristics, and between child mental health and educational progress. Our contribution is to use unique UK survey data that contains (potentially biased) assessments of each child's mental state from three observers (parent, teacher and child), together with expert (quasi-)diagnoses, using an assumption of optimal diagnostic behaviour to adjust for reporting bias. We use three alternative restrictions to identify the effect of mental disorders on educational progress. Maternal education and mental health, family income, and major adverse life events, are all significant in explaining child mental health, and child mental health is found to have a large influence on educational progress. Our preferred estimate is that a 1-standard deviation reduction in 'true' latent child mental health leads to a 2-5 months loss in educational progress. We also find a strong tendency for observers to understate the problems of older children and adolescents compared to expert diagnosis.Strengths and Difficulties Questionnaire, education, child mental health, measurement error

Is there an Income Gradient in Child Health? It depends whom you ask

A large literature uses parental evaluations of child health status to provide evidence on the socioeconomic determinants of health. If how parents perceive health questions differs by income or education level, then estimates of the socioeconomic gradient are likely to be biased and potentially misleading. In this paper we examine this issue. We directly compare child mental health evaluations from parents, teachers, children and psychiatrists for mental health problems, test whether these differences are systematically related to observable child and parent characteristics, and examine the implications of the different reports for the estimated income gradient. We find that respondents frequently evaluate children differently and while the sign of the income gradient is in the same direction across respondents, systematic differences in evaluations mean that the estimated magnitude and significance of the health-income gradient is highly dependent upon the choice of respondent and the measure of child health.Child Health, Income, Reporting Bias

Genetic Markers as Instrumental Variables:An Application to Child Fat Mass and Academic Achievement

The use of genetic markers as instrumental variables (IV) is receiving increasing attention from economists. This paper examines the conditions that need to be met for genetic variants to be used as instruments. We combine the IV literature with that from genetic epidemiology, with an application to child adiposity (fat mass, determined by a dual-energy X-ray absorptiometry (DXA) scan) and academic performance. OLS results indicate that leaner children perform slightly better in school tests compared to their more adipose counterparts, but the IV findings show no evidence that fat mass affects academic outcomes.Instrumental variables; Mendelian randomization; Genetic variant; Potential outcomes; Academic performance; Educational attainment; Adiposity; Fat mass; Body Mass Index; ALSPAC

Genetic Markers as Instrumental Variables

The use of genetic markers as instrumental variables (IV) is receiving increasing attention from epidemiologists, economists, statisticians and social scientists. This paper examines the conditions that need to be met for genetic variants to be used as instruments. Although these have been discussed in the epidemiological, medical and statistical literature, they have not been well-defined in the economics and social science literature. The increasing availability of biomedical data however, makes understanding of these conditions crucial to the successful use of genotypes as instruments for modifiable risk factors. We combine the econometric IV literature with that from genetic epidemiology using a potential outcomes framework and review the IV conditions in the context of a social science application, examining the effect of child fat mass on academic performance.ALSPAC; Fat mass; Genetic Variants; Instrumental Variables; Mendelian Randomization; Potential Outcomes

Child height, health and human capital: evidence using genetic markers

Height has long been recognised as associated with better outcomes: the question is whether this association is causal. We use children’s genetic variants as instrumental variables (IV) to deal with possible unobserved confounders and examine the effect of child and adolescent height on a wide range of outcomes: academic performance, IQ, self-esteem, symptoms related to depression and behavioural problems, including hyperactivity, emotional, conduct and peer problems. OLS findings show that taller children have higher IQ scores, perform better in school tests, and are less likely to have emotional or peer problems. The IV results differ. They show that taller children have better cognitive performance but, in contrast to the OLS, indicate that taller children are more likely to have behavioural problems. The magnitude of these IV estimates is large. For example, the effect of one standard deviation increase in height on IQ is comparable to the IQ difference for children born approximately 6 months apart within the same school year, while the increase in hyperactivity is comparable to the raw difference in hyperactivity between boys and girls.Child and adolescent height; human capital; mental health; behavioural outcomes; instrumental variables; Mendelian randomization; genetic variants; ALSPAC

Genetic markers as instrumental variables: an application to child fat mass and academic achievement

The use of genetic markers as instrumental variables (IV) is receiving increasing attention from economists. This paper examines the conditions that need to be met for genetic variants to be used as instruments. We combine the IV literature with that from genetic epidemiology, with an application to child adiposity (fat mass, determined by a dual-energy X-ray absorptiometry (DXA) scan) and academic performance. OLS results indicate that leaner children perform slightly better in school tests compared to their more adipose counterparts, but the IV findings show no evidence that fat mass affects academic outcomes.