Intergenerational disadvantage and pediatric health disparities in acute respiratory illness and diarrhea

PROJECT SUMMARY Global literature underscores that certain children and families are more likely to experience persistent social and economic disadvantages often determined by their race, ethnicity, social group, or other socio- demographic characteristics. Simultaneously, studies from diverse settings demonstrate unequal burdens of

disease and unequal access to timely, quality health services in early childhood, contributing to lifelong health disparities. However, few studies have available data to examine the distinct ways that intergenerational disadvantage contributes to disparities in illness burden and healthcare utilization among children under five

when morbidity and mortality risk are high. We address a critical gap in the research by estimating the association of persistent intergenerational disadvantage and diarrheal disease and acute respiratory infection (ARI), with attention to the role of persistent disadvantage in determining the likelihood and type of healthcare

received, and potential modification by spatial remoteness. We use data from a longitudinal study of households that includes data on young children and their parents, households, and communities. The availability of detailed, high-frequency measures of the incidence and duration of diarrheal disease and ARI in combination with data on household and community context and

health services over time provides a unique opportunity to study these questions with three specific aims. The first aim uses newly collected data about experiences of diarrheal disease and ARI among children under five years of age to estimate the association between persistent disadvantage and children’s illness burden. The

second aim estimates the association between the burden of diarrheal disease and ARI and the likelihood and characteristics of healthcare utilized. This aim also tests whether this association is modified by persistent household disadvantage. The third aim investigates the roles of spatial remoteness, distance to health ser-

vices, and persistent household disadvantage as modifiers of the association between the burden of diarrheal disease and ARI, and the likelihood and type of healthcare facility utilized. We will archive and disseminate all data collected to facilitate innovative research on social and structural determinants of child health and

healthcare utilization outcomes, and inform child health and health equity programs globally. The effects of persistent, intergenerational social and economic disadvantage are increasingly important considerations for providers and policymakers seeking to improve children’s health and health service

utilization, and to reduce health disparities that emerge in early childhood. This research will enhance our understanding of the mechanisms through which exposure to persistent disadvantage shapes the health and illness burden among young children; identify promising avenues for future research in this area; and generate

rigorous evidence for effective child health policies and interventions.