Socioeconomic status and child health: what is the role of health care, health conditions, injuries and maternal health?

Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador

Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.

Parental BMI and country classification by Gross National Income are stronger determinants of prospective BMI deterioration compared to perinatal risk factors at pre-adolescence: Feel4Diabetes Study

OBJECTIVES

This study aimed to evaluate all known risk factors, from perinatal to adolescence and identify those predominantly related with prospective BMI deterioration.

METHODS

Prospective data analysis from the European Feel4Diabetes-study involving 12,211 children from six countries. Details on perinatal and sociodemographic characteristics were collected by parental self-reported questionnaires. Children's anthropometric data were measured by research personnel. Associations between risk factors and children's BMI deterioration (i.e increase) from baseline (mean age 8.2 ± 0.98 years) to the 2-year follow-up (10.3 ± 1.0 years) were explored by applying logistic regression analyses.

RESULTS

Univariate analysis revealed that all known risk factors for early overweight/obesity development, remained dominant in prospective BMI deterioration. When multivariate analysis was applied including additional variables such as parents' current BMI status, family socio-demographic characteristics and country economic classification based on Gross National Income, most perinatal risk factors were no longer significant. Multivariate analysis revealed that pre-pregnancy maternal overweight/obesity (OR, 95%CI: 2.71, 1.67-4.38), early introduction of solid foods (2.54, 1.21-5.31), parental current BMI status (3.53, 2.17-5.72) and country economic classification (low income: 4.67, 2.20-9.93; under austerity measures: 6.78, 3.18-14.48) were the only parameters associated with higher odds for children's BMI deterioration from the study baseline to 2-year follow-up after adjusting for children's gender.

CONCLUSIONS

The most predominant risk factors influencing children's prospective BMI deterioration were parental BMI and country economic classification as compared to perinatal. These findings should guide public health initiatives aiming to tackle the childhood obesity epidemic and social inequalities on a European level.

Neighborhood disadvantage and health-related quality of life in pediatric epilepsy

INTRODUCTION

While several demographic and epilepsy-specific characteristics are associated with diminished HRQoL in children and adolescents with epilepsy, prior investigations have failed to incorporate and address the influence of broader social contextual factors on functional outcomes. To address this gap, the purpose of the current study was to investigate the role of neighborhood disadvantage on HRQoL, including the extent to which familial and seizure-specific risk factors are impacted.

METHODS

Data included parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 135 children and adolescents with epilepsy, and the Area Deprivation Index (ADI) to measure neighborhood disadvantage. Bivariate correlations were conducted to identify significant associations with neighborhood disadvantage, followed by a three-stage hierarchical multiple regression to predict HRQoL. Follow-up binary logistic regressions were used to determine the risk conferred by neighborhood disadvantage on sociodemographic, seizure-specific, and HRQoL factors.

RESULTS

Moderate associations between neighborhood disadvantage and familial factors, including parental psychiatric history and Medicaid insurance, were identified, while disadvantage and greater seizure frequency were marginally associated. Neighborhood disadvantage independently predicted HRQoL, and was the sole significant predictor of HRQoL when familial factors were incorporated. Children with epilepsy living in disadvantaged areas were four times more likely to have diminished HRQoL, five times more likely to live with a parent with a significant psychiatric history, and four times more likely to reside with a family receiving Medicaid insurance.

CONCLUSIONS

These results highlight the importance of identifying high-risk groups, as the cumulative burden of social context, familial factors, and seizure-specific characteristics contribute to lower HRQoL in pediatric epilepsy which disproportionately affects patients from lower-resourced backgrounds. Potentially modifiable factors such as parental psychiatric status exist within the child's environment, emphasizing the importance of a whole-child approach to patient care. Further exploration of disadvantage in this population is needed to better understand these relationships over time.

Promoting the health and wellbeing of children: A feasibility study of a digital tool among professionals

The foundations of children’s health and wellbeing are laid in early childhood. A gamified app (EmpowerKids tool) was designed to support professionals to have discussions with 6- to 12-year-olds from low-income families about their health and wellbeing. The aim of this feasibility study was to evaluate the usability and acceptability of the tool from the perspective of professionals in social, health and education settings. The study was conducted using a one-group post-test-only design. The usability data were collected using System Usability Scale and the acceptability data were collected using an open-ended questionnaire distributed to professionals (n = 24) in Estonia, Finland and Latvia. The data were collected during two phases. The tool was modified further on the basis of the results. The total usability scores were 82/100 (first testing) and 84/100 (second testing), indicating excellent usability. The answers related to acceptability were divided into four categories: suitability for the context; satisfaction and quality; attractiveness; modification needs. The professionals perceived that the tool helped them to build an overall picture of a child’s health and wellbeing, and to gain information about the child’s individual needs. The requirements for modification detected during the first testing were mostly related to difficulties with textual expressions and graphics. No major modification requirements were expressed during the second testing. The tool is considered feasible and may be used by professionals from different settings to support children’s health and wellbeing. Further studies are needed to evaluate the effectiveness of the tool from the perspective of child outcomes.

Risk-guided maternity care to enhance maternal empowerment postpartum: A cluster randomized controlled trial

OBJECTIVE

To investigate whether a structured inquiry during pregnancy of medical factors and social factors associated with low socioeconomic status, and subsequent patient-centred maternity care could increase maternal empowerment.

DESIGN

Cluster-randomised controlled trial.

SETTING

This study was conducted among pregnant women in selected urban areas in the Netherlands. This study was part of the nationwide Healthy Pregnancy 4 All-2 programme.

POPULATION

Pregnant women listed at one of the sixteen participating maternity care organisations between July 1, 2015, and Dec 31, 2016.

METHODS

All practices were instructed to provide a systematic risk assessment during pregnancy. Practices were randomly allocated to continue usual care (seven practices), or to provide a patient-centred, risk-guided approach to addressing any risks (nine practices) identified via the risk assessment during pregnancy.

MAIN OUTCOME MEASURES

Low postpartum maternal empowerment score.

RESULTS

We recruited 1579 participants; 879 participants in the intervention arm, and 700 participants in the control arm. The prevalence of one or more risk factors during pregnancy was similar between the two arms: 40% and 39%, respectively. In our intention-to-treat analysis, the intervention resulted in a significant reduction in the odds of having a low empowerment score [i.e. the primary outcome; adjusted OR 0.69 ((95% CI 0.47; 0.99), P 0.046)].

CONCLUSIONS

Implementation of additional risk assessment addressing both medical and social factors and subsequent tailored preventive strategies into maternity care reduced the incidence of low maternal empowerment during the postpartum period. Introducing this approach in routine maternity care may help reduce early adversity during the postpartum period.

Women's economic empowerment, participation in decision-making and exposure to violence as risk indicators for early childhood caries

Objectives

In view of the association between early childhood caries (ECC])and maternal social risk factors, this study tried to determine if there were associations between indicators of processes, outputs and outcomes of women’s empowerment, and the prevalence of ECC.

Methods

In this ecological study, indicators measuring the explanatory variables - economic empowerment, decision-making and violence against women - were selected from the Integrated Results and Resources Framework of the UN-Women Strategic Plan 2018–2021 and WHO database. Indicators measuring the outcome variables - the prevalence of ECC for children aged 0 to 2 years, and 3 to 5 years - were extracted from a published literature. The general linear models used to determine the association between the outcome and explanatory variables were adjusted for economic level of countries. Regression estimates (B), 95% confidence intervals and partial eta squared (η²) were calculated.

Results

Countries with more females living under 50% of median income had higher prevalence of ECC for 3 to 5-year olds (B = 1.82, 95% CI = 0.12, 3.52). Countries with higher percentage of women participating in their own health care decisions had higher prevalence of ECC for 0 to 2-year-olds (B = 0.85, 95% CI = 0.03, 1.67). Countries with higher percentage of women participating in decisions related to visiting family, relatives and friends had higher prevalence of ECC for 3 to 5-year-olds (B = 0.67, 95% CI = 0.03, 1.32). None of the indicators for violence against women was significantly associated with the prevalence of ECC.

Conclusion

Empowerment of women is a welcome social development that may have some negative impact on children’s oral health. Changes in policies and norms are needed to protect children’s oral health while empowering women.

How does perinatal maternal mental health explain early social inequalities in child behavioural and emotional problems? Findings from the Wirral Child Health and Development Study

BACKGROUND

This study aimed to assess how maternal mental health mediates the association between childhood socio-economic conditions at birth and subsequent child behavioural and emotional problem scores.

METHODS

Analysis of the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological longitudinal study of the early origins of child mental health (n = 664). Household income at 20-weeks gestation, a measure of socio-economic conditions (SECs) in pregnancy, was the main exposure. The outcome measure was externalising and internalising problems, as measured by the Child Behaviour Checklist at 5 years. We assessed the association of household income with child behavioural outcomes in sequential linear models adjusting for maternal mental health in the pre- and post- natal period.

RESULTS

Children of mothers in more disadvantaged households had higher scores for externalising behaviour with a difference of 3.6 points comparing the most affluent to the most disadvantaged families (the socio-economic (SEC) gap). In our regression model adjusting for baseline confounders, comparing children of mothers in the most disadvantaged households to the least disadvantaged, we found that most disadvantaged children scored 45 percentage points (95% CI 9, 93) higher for externalising problems, and 42% of this difference was explained in the fully adjusted model. Adjusting for prenatal maternal depressive symptomology attenuated the SEC gap in externalising problems by about a third, rendering the association non-significant, whilst adjusting for pre- and post-natal maternal mental health attenuated the SEC gap by 42%. There was no significant relationship between household income and internalising problems.

CONCLUSION

Social disadvantage is associated with higher child externalising behaviour problems score at age 5, and about 40% of this was explained by maternal perinatal mental health. Policies supporting maternal mental health in pregnancy are important to address the early emergence of inequalities in child mental health.

The Impact of Age on Income-Related Health Status Inequalities from Birth to Adolescence: A Systematic Review with Cross-Country Comparisons

OBJECTIVES

To examine the effect of age on associations between household income and overall health from birth to adolescence, and whether age patterns vary by country. It is uncertain whether income-related health inequalities remain stable, widen, or narrow as children age, which impacts optimal timing of equity-focused interventions.

STUDY DESIGN

Systematic review (CRD42016038583) of MEDLINE, Embase, PsycINFO, CINAHL, SocINDEX (full-text), and EconLit (full-text) to April 2017. We included observational studies and trials in children and adolescents (0-18 years of age), examining age differences in associations between income and overall health (self-rated, clinician-rated, proxy-rated). One reviewer extracted data; 2 evaluated risk of bias.

RESULTS

Thirty-eight articles containing 43 studies (30 cross-sectional, 13 cohort) were identified, from high-income (n = 39) and middle-income (n = 4) countries. In the US (n = 21), positive income-health associations emerged in early childhood, and these inequalities typically widened progressively into adolescence. Relative to 0- to 3-year-olds, ratios of income-health coefficients ranged from 1.10-3.71 for 4-8 years of age, 1.26-3.86 for 9-12 years of age, 1.36-6.71 for 13-17 years. In the United Kingdom and Ireland (n = 8), inequalities emerged in early-to-mid childhood, but age patterns were less consistent. In other high-income countries (Australia, Canada, France, Germany, Japan, Republic of Korea), inequalities mostly persisted or widened with age. In middle-income countries, inequalities appeared to narrow (Indonesia n = 2) or persist (Brazil n = 2) with age. Limitations are unclear/high risk of bias and dataset overlap for some studies.

CONCLUSIONS

In many countries, income-related health status inequalities persist or widen as children age. Interventions that improve health equity early in the life-course are needed.

Processo de trabalho em saúde bucal na atenção básica: desigualdades intermunicipais evidenciadas pelo PMAQ-AB

RESUMO O objetivo deste estudo exploratório foi identificar desigualdades na organização do processo de trabalho das Equipes de Saúde Bucal (ESB) na Estratégia Saúde da Família, comparando municípios do Estado do Paraná quanto à condição social, econômica e demográfica. Foram utilizados dados secundários obtidos na etapa de avaliação externa do Programa de Nacional do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), referentes aos padrões de certificação de acesso, qualidade e organização do processo de trabalho das equipes. Os municípios foram estratificados segundo o índice proposto pelo programa. Houve ampla participação dos municípios no PMAQ-AB, com predominância de equipes de saúde da família com saúde bucal. Os resultados demonstram desigualdades desfavoráveis aos municípios menores e mais carentes, o que revela a necessidade de compreender o papel da gestão como apoiadora das ESB, favorecendo o resgate de competências e habilidades necessárias para a boa gestão da clínica e do cuidado na Atenção Primária à Saúde. Evidencia-se a necessidade da qualificação da gestão, com apoio federal e estadual, principalmente aos municípios menores e com baixa capacidade de resposta dos sistemas de saúde. É importante que a regionalização seja efetiva, e que a rede de atenção à saúde bucal seja organizada de forma equânime, para incluir esses municípios.

Prevalence of antibiotic resistance in commensal Escherichia coli among the children in rural hill communities of Northeast India

Commensal bacteria are the representative of the reservoir of antibiotic resistance genes present in a community. The usage of antibiotics along with the demographic factors is generally associated with an increase in antibiotics resistance in pathogens. Northeast (NE) India is untapped with regard to antibiotic resistance prevalence and spread. In the current study, the prevalence of antibiotic-resistant commensal Escherichia coli in pre-school and school-going children (n = 550, 1–14 years old) from the rural areas of the state of Sikkim—an NE Indian state, with respect to associated demographic factors was investigated. A total of 550 fecal E. coli isolates were collected during July 2015 to June 2017. A structured questionnaire was used to collect data to ascertain the potential factors associated with the carriage of antibiotic resistance E. coli among the children. Statistical analysis along with a logistic regression identified potential external factors affecting the observed antibiotic resistance pattern. The data indicated a high prevalence of resistance to common antibiotics like ampicillin (92%), ceftazidime (90%), cefoxitin (88%), streptomycin (40%) and tetracycline (36%), but no resistance to chloramphenicol. The resistance to the combination of penicillin and quinolone group of antibiotics was observed in fifty-two percent of the isolates. A positive correlation between the harboring of antibiotics resistant E. coli with different demographic factors was observed such as, with children living in nuclear family (vs joint family 63.15%, OR 0.18, 95% CI:0.11–0.28, p < 0.01), below higher secondary maternal education (vs college graduates 59.27% OR 0.75, 95% CI:0.55–1.02, p < 0.02). A close association between different demographic factors and the high prevalence of antibiotic-resistant commensal E. coli in the current study suggests a concern over rising misuse of antibiotics that warrants a future threat of emergence of multidrug-resistant pathogen isolates.

Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children

This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

The dynamics of physical and mental health in the older population

Mental and physical aspects are both integral to health but little is known about the dynamic relationship between them. We consider the dynamic relationship between mental and physical health using a sample of 11,203 individuals in six waves (2002-2013) of the English Longitudinal Study of Ageing (ELSA). We estimate conditional linear and non-linear random-effects regression models to identify the effects of past physical health, measured by Activities of Daily Living (ADL), and past mental health, measured by the Centre for Epidemiological Studies Depression (CES-D) scale, on both present physical and mental health. We find that both mental and physical health are moderately state-dependent. Better past mental health increases present physical health significantly. Better past physical health has a larger effect on present mental health. Past mental health has stronger effects on present physical health than physical activity or education. It explains 2.0% of the unobserved heterogeneity in physical health. Past physical health has stronger effects on present mental health than health investments, income or education. It explains 0.4% of the unobserved heterogeneity in mental health. These cross-effects suggest that health policies aimed at specific aspects of health should consider potential spill-over effects.

Household income determines access to specialized pediatric chronic pain treatment in Germany

BACKGROUND

Families with lower socioeconomic status (SES) often face problems with gaining access to health care services. Information is scarce on the relationship between SES and health care delivery for children suffering from chronic pain.

METHODS

Families presenting to a specialized pain center (N = 1,001) provided information on 'household income, 'parental education' and 'occupation' to aid the evaluation of their SES. To assess whether the SES of the clinical sample is representative of the general population, it was compared to data from a community sample (N = 14,558). For the clinical sample, travel distance to the clinic was described in relation to the 75% catchment area. Multiple logistic regression was used to analyze the association between SES and the journey from outside the catchment area.

RESULTS

The SES was significantly higher in the clinical sample than in the community sample. Within the clinical sample, the distance traveled to the pain center increased with increasing SES. The 75% catchment area was 143 miles for families with the highest SES and 78 miles for the lowest SES. 'Household income' predicted travel distance (OR 1.32 (1.12-1.56)). Education and occupational status were not significant predictors of travel from outside the catchment area.

CONCLUSIONS

In Germany, specialized care for children with chronic pain is subject to disparities in access. Future activities should focus on identifying barriers to access and seeking to prevent inequalities in specialized pediatric health care delivery. Increasing the number of specialized treatment facilities could improve access to specialized pediatric pain treatment, regardless of socioeconomic determinants.

Income-related children's health inequality and health achievement in China

Introduction

This study assessed income–related health inequality and health achievement in children in China, and additionally, examined province-level variations in health achievement.

Methods

Longitudinal data on 19,801 children under 18 years of age were derived from the China Health and Nutrition Survey. Income–related health inequality and health achievement were measured by the Health Concentration and Health Achievement Indices, respectively. Panel data with a fixed effect multiple regression model was employed to examine province-level variations in health achievement.

Results

A growing trend was towards greater health inequality among Chinese children over the last two decades. Although health achievement was getting better over time, the pro-rich inequality component has lessened the associated gain in achievement. Health achievement was positively impacted by middle school enrollments, the urbanization rate, inflation-adjusted per capita gross domestic product, and per capita public health spending.

Conclusion

This study has provided evidence that average health status of Chinese children has improved, but inequality has widened. Widening inequality slowed the growth in health achievement for children over time. There were wide variations in health achievement throughout China.

What roles do contemporaneous and cumulative incomes play in the income-child health gradient for young children? Evidence from an Australian panel

The literature to date shows that children from poorer households tend to have worse health than their peers, and the gap between them grows with age. We investigate whether and how health shocks (as measured by the onset of chronic conditions) contribute to the income-child health gradient and whether the contemporaneous or cumulative effects of income play important mitigating roles. We exploit a rich panel dataset with three panel waves called the Longitudinal Study of Australian children. Given the availability of three waves of data, we are able to apply a range of econometric techniques (e.g. fixed and random effects) to control for unobserved heterogeneity. The paper makes several contributions to the extant literature. First, it shows that an apparent income gradient becomes relatively attenuated in our dataset when the cumulative and contemporaneous effects of household income are distinguished econometrically. Second, it demonstrates that the income-child health gradient becomes statistically insignificant when controlling for parental health and health-related behaviours or unobserved heterogeneity.

Antibiotic resistance among Escherichia coli isolates from stool samples of children aged 3 to 14 years from Ujjain, India

Background

Antibiotic resistance is a major global public health concern, particularly in settings where few treatment options are available. Limited research has been done on antibiotic resistance in Escherichia coli of Indian children at community level. Therefore we studied antibiotic resistance patterns in E. coli isolates from stool samples of children aged 3-14 years from Ujjain, Central India, to investigate associations of resistance with demographic variables.

Methods

Children, 3-14 years of age, were included from 30 randomly selected villages of Palwa demographic surveillance site, Ujjain, India. Parents were interviewed using a questionnaire, and stool samples were collected from participating children. E. coli were isolated from stool samples (n = 529), and susceptibility testing to 18 different antibiotics was done using standard methods.

Results

The proportions of isolates resistant to various antibiotics were, nalidixic acid, (45%), tetracycline (37%), ampicillin (37%), sulfamethoxazole/trimethoprim (29%) and amoxicillin/clavulanic acid (29%). No isolates were resistant to imipenem. Overall, 72% of isolates were resistant to at least one antibiotic and 33% were multi-drug resistant. High rates of cross-resistance were seen for 15 (83%) of the antibiotics studied. E. coli isolates from children with literate mothers were more resistant to penicillins and fluoroquinolones. ESBL-producers comprised 9% of the isolates.

Conclusion

Antibiotic resistance and cross-resistance were common in E. coli from stools of children. Resistance rates were associated with maternal literacy.

Housing and child health

The connection between housing and health is well established. Physical, chemical, and biological aspects of the child's home, such as cleanliness, moisture, pests, noise, accessibility, injury risks, and other forms of housing environmental quality, all have the potential to influence multiple aspects of the health and development of children. Basic sanitation, reduced household crowding, other improvements in housing and expanded, and improved housing regulations have led to advances in children's health. For example, lead poisoning prevention policies have profoundly reduced childhood lead exposure in the United States. This and many other successes highlight the health benefits for families, particularly children, by targeting interventions that reduce or eliminate harmful exposures in the home. Additionally, parental mental health problems, food insecurity, domestic violence, and the presence of guns in children's homes all are largely experienced by children in their homes, which are not as yet considered part of the Healthy Homes agenda. There is a large movement and now a regulatory structure being put in place for healthy housing, which is becoming closely wedded with environmental health, public health, and the practice of pediatrics. The importance of homes in children's lives, history of healthy homes, asthma, and exposures to lead, carbon monoxide, secondhand/thirdhand smoke, radon, allergy triggers is discussed, as well as how changes in ambient temperature, increased humidity, poor ventilation, water quality, infectious diseases, housing structure, guns, electronic media, family structure, and domestic violence all affect children's health.

Family income and child health in the UK

Recent studies examining the relationship between family income and child health in the UK have produced mixed findings. We re-examine the income gradient in child general health and its evolution with child age in this country, using a very large sample of British children. We find that there is no correlation between income and child general health at ages 0-1, that the gradient emerges around age 2 and is constant from age 2 to age 17. In addition, we show that the gradient remains large and significant when we reduce the endogeneity of income. Furthermore, our results indicate that the gradient in general health reflects a greater prevalence of chronic conditions among low-income children and a greater severity of these conditions. Taken together, these findings suggest that income does matter for child health in the UK and may play a role in the intergenerational transmission of socioeconomic status.