Epidemiological studies of sociodemographic factors, early life factors, health, and medical care consumption among small children

By international standards, children in Sweden experience good health. Sweden has low infant
mortality rates, low accident mortality rates, a high number of breastfed children and a high
proportion of vaccinated children. However, during the past twenty years the prevalence of
overweight children has doubled in Sweden, while that of obese children has increased 4-5 times.
Furthermore, there has been an increase in self-reported problems such as anxiety and sleeping
disturbances among adolescents. Asthma and other types of allergic diseases are the most
common chronic diseases during childhood, while infectious diseases are the most common
causes of short-term morbidity. It is well-known that the social position of the family, living
conditions, and parental health-related behaviors are closely connected with health in childhood.
The socioeconomic position (SEP) of the family affects the child’s health from the very beginning
of life through the mother’s health-related behaviors during pregnancy. Even though the
prevailing etiological model for adult chronic disease emphasizes adult risk factors, the
importance of earlier life circumstances has recently attracted considerable attention. A life course
perspective seems to increase our understanding of health in childhood as well as later on, in
adulthood. In this thesis, the associations between sociodemographic factors and early life factors
(e.g., maternal smoking during pregnancy, exposure to secondhand tobacco smoke, breastfeeding,
and high birth weight) on the one hand and health and medical care consumption on the other
hand, were investigated among small children in Malmö. The studies in the thesis were
population-based and cross-sectional, and the study populations comprised children who visited
the Child health care (CHC) centers for their 8-month or 4-year check-up during 2003-2008 and
whose parents answered a self-administered questionnaire. The self-administered questionnaire
was handed out to the parents of 8-month-old and 4-year-old children in conjunction with their
check-up at the CHC centers aiming to reach all children in Malmö in these two age groups. The
questionnaire was distributed by the pediatric nurses at the centers. The results showed that
antibiotic consumption at an early age was influenced by several factors including parental
sociodemographic factors, lifestyle factors, psychosocial support, as well as child-related factors.
The results further showed associations between exposure to unfavorable early life factors and the
development of childhood allergy and overweight or obesity. Such effects were enhanced when
there were presence of parental allergy or parental overweight, respectively. Children with less educated
mothers were exposed to more health risks, fewer health promoting factors, worse social
support and had a higher medical care consumption than children with mothers with higher levels
of education.In conclusion, the results show that children’s health seems to be highly
influenced by the characteristics of the families into which they are born. The results also put
focus on the importance of early targeted interventions.