Children Sicker Now Than in Past, Harvard Report Says (Update1)

http://www.bloomberg.com/apps/news?pid=newsarchive&sid=a4xmH.aERohk&refer
By Angela Zimm - Jun 26, 2007

June 26 (Bloomberg) — The number of American children with chronic illnesses has quadrupled since the time when some of their parents were kids, portending more disability and higher health costs for a new generation of adults, a study estimates.

An almost fourfold increase in childhood obesity in the past three decades, twice the asthma rates since the 1980s, and a jump in the number of attention-deficit disorder cases are driving the growth of chronic illnesses, according to researchers at Harvard University in Boston. The report is published in a themed issue of the Journal of the American Medical Association focusing on children's health.

Doctors and public health officials should be bracing for a wave of chronically ill young adults with weight-related ailments that include diabetes and heart disease. In 1960, just 1.8 percent of U.S. children and adolescents were reported to have a chronic health condition that limited their activities. In 2004, the rate rose to 7 percent, researchers said.
(chronic health condition 3.9X increase in 40 years)

``We will see much greater expenditures for people in their 20s than we ever saw before, and no one is thinking how we should prepare for that, said James Perrin, professor of pediatrics at Harvard Medical School and the report's lead author, in an interview. ``We call it an epidemic. It's certainly worrisome and we look at it as a call to action.

The journal's reports also included findings that family- based weight-management programs work best, that white children have the highest rate of diabetes, that childhood cancer survivors face risks for serious health problems when they become adults, and that children with serious illness are more likely to die at home than in 1989.

Obesity

About 18 percent of children in the U.S. are obese, up from 5 percent in 1974, the study said. Obesity accounts for about 10 percent of U.S. health costs. Doubling the rate of obesity could add more than $100 billion a year in costs, researchers said.

``An estimated 60 percent of 5- to 10-year-old obese children already have one associated cardiovascular disease risk factor, and more than 20 percent have two or more risk factors,' researchers said in the report.

An estimated 9 percent of children have asthma, twice the rate it was in the 1980s. The breathing disorder persists to adulthood in about a quarter of children.

Attention deficit hyperactivity disorder, not recognized as a medical condition in 1968, is now diagnosed in about 6 percent of school-age youngsters. Research suggests that half of children with ADHD continue to have it as adults.

Environmental, Social Changes

While genes may play a role in obesity, asthma and ADHD, environmental and social changes are behind the surge, researchers said. Modern life has brought increased fast-food diets, more time spent indoors watching television or playing on the computer, as well as dwindling community and family support.

An association between asthma and obesity supports the theory that sedentary behavior diminishes lung function, researchers said. With more time indoors, children have increased exposure to indoor allergens.

Too much television has also been associated with increased risk for ADHD, as well as parent absenteeism, researchers said.

Also in this week's JAMA, a study found that inner-city black and Hispanic children who participated in a weight-loss program involving their parents were able to control their weight better than those who received traditional weight-loss counseling in a clinic. While the children in the family-based program had maintained their weight and cut their diabetes risk after a year, those who got just counseling gained weight and some developed signs of increased diabetes risk.

`No One Culprit'

``In childhood obesity, there is no one culprit, said Mary Savoye-Desanti, a Yale University dietician and the study's lead author. ``Children are alone after school. They're not supervised, so they're overeating and not doing activities. Food is more accessible than it ever was.

Researchers are seeing increasing disparities between race, ethnic and socioeconomic groups among the three main drivers of childhood chronic disease. Black children have asthma rates that are 60 percent higher than white children. ADHD is higher among children from low-income households.

``These three conditions — obesity, asthma, ADHD — overwhelm all other chronic conditions, Perrin said. ``The life of the family practitioner is very different than it was. Far more children come in with the type of chronic health problems we hardly thought about 35 years ago.

Researchers at the University of Colorado in Denver reported in the journal that non-Hispanic white youth have the highest rate diabetes among U.S. children. Most of the cases are type-1 diabetes, a form in which people must take insulin every day because their bodies don't produce the hormone, which is needed to convert sugar, starches and other food into energy.

Type-1 also reflects higher genetic susceptibility in this group, said the study's lead researcher, Dana Dabelea, associate professor of preventive medicine at the University of Colorado Health Sciences Center in Denver, during a press briefing today.

Diabetes Rates

The rate for the disease among children under 19 years of age was 24.3 per 100,000 person-years, a designation derived by multiplying the number of individuals in the study by the number of years of follow-up per person. The rate was highest among children 10 to 14 years old, and slightly higher among females, the study found.

White children had a 26.1 rate, blacks were at 25.4, and American Indian youths scored 25, the study said. American Indian youth also had the highest rate of type-2 diabetes, in which the body can't produce enough insulin or use the insulin it makes.

The journal report also included research that said the percentage of children with complex chronic conditions who die at home, rather than in a hospital, has increased to 18.2 percent in 2003 from 10.1 percent in 1989. The study was done by researchers at Children's Hospital of Philadelphia.

The odds of death occurring at home increased by 3.8 percent annually, a change the researchers said may be occurring because of advances in medical technology in the home setting and broad shifts in attitudes and decision-making processes regarding end-of-life care.

CLICK HERE for Original Contributions in the special AMA issue

• Effects of a Weight Management Program on Body Composition and Metabolic Parameters in Overweight Children: A Randomized Controlled Trial
• Medical Assessment of Adverse Health Outcomes in Long-term Survivors of Childhood Cancer
• Incidence of Diabetes in Youth in the United States
• Shifting Place of Death Among Children With Complex Chronic Conditions in the United States, 1989-2003
• Changes in the Prevalence of Cerebral Palsy for Children Born Very Prematurely Within a Population-Based Program Over 30 Years