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Ear Infection Trajectories and Academic, Behavioral, and Quality-of-Life Outcomes: A Population-Based Longitudinal
Jing Wang1,2, Jon Quach1,3, Valerie Sung1,2,4
1Murdoch Children's Research Institute, the Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Persistent childhood ear infections are linked to adverse adolescent outcomes. Early identification and management of children with ongoing infections are crucial for better child development and well-being.
Area of Science:
- Pediatrics
- Developmental Psychology
- Epidemiology
Background:
- Parent-reported ear infections are common in childhood.
- Understanding the long-term impact of ear infection trajectories on child development is essential.
Purpose of the Study:
- To investigate typical parent-reported ear infection patterns throughout childhood.
- To examine the associations between these ear infection trajectories and various child outcomes.
Main Methods:
- Utilized two parallel cohorts from the Longitudinal Study of Australian Children (n=3721 and n=3489).
- Employed latent class models to identify ear infection trajectories based on parent reports.
- Applied linear regression to analyze associations between trajectories and academic, behavioral, and quality-of-life outcomes.
Main Results:
- Identified four ear infection trajectories: "consistently low," "moderate to low," "low to moderate," and "consistently high."
- The "consistently high" ear infection group exhibited the poorest outcomes, particularly in psychosocial and language domains (effect sizes 0.2-0.8 SDs).
- Persistent ear infections, even if moderate, were associated with poorer behavior and quality of life compared to the "consistently low" group.
Conclusions:
- Persistent ear infections throughout childhood are associated with significant adverse adolescent outcomes.
- Cumulative burden of ear infections, rather than age-specific occurrences, appears most critical.
- Proactive identification and management of children with persistent ear infections are recommended.
Objective:
The purpose of this study was to investigate (1) typical trajectories of parent-reported ear infections throughout childhood and (2) their associations with child outcomes.
Method:
Design and participants: Two parallel cohorts assessed biennially from 2004 to 2014 spanning ages 0-1 to 10-11 years (B cohort, n = 3721) and ages 4-5 to 14-15 years (K cohort, n = 3489) in the Longitudinal Study of Australian Children. Ear infection: Parent-reported ongoing ear infections (B: waves 1-6; K: waves 1, 2, 4, and 5). Outcomes (wave 6): National academic standardized test, teacher-reported learning, parent- and teacher-reported behavior, and self-reported quality of life. Analysis: Latent class models identified ear infection trajectories. Linear regression quantified associations between trajectories and outcomes.
Results:
Four probability trajectories of ear infections emerged in both cohorts: "consistently low" (B 86.2%, K 87.0%), "moderate to low" (5.5%, 9.7%), "low to moderate" (7.0%, 1.5%), and "consistently high" (1.4%, 1.8%). In K cohort, the "consistently high" group had the worst outcomes (effect sizes 0.2-0.8 SDs), with effect sizes largest for psychosocial and language outcomes. "Moderate to low" and "low to moderate" groups showed marginal to no academic associations, although behavior and quality-of-life scores were 0.2 to 0.3 SDs poorer than the "consistently low" group. Similar but attenuated associations were seen in B cohort.
Conclusion:
Sizable adverse adolescent outcomes follow parent reports of persistent ongoing ear infections throughout childhood. Despite a possibility of reverse causation, this suggests that cumulative rather than age-specific ear infections are most important to outcomes. Clinicians may generally be reassuring about ongoing ear infections limited to either early or middle childhood but should proactively identify and manage the small subgroup whose early infections persist throughout the elementary school years.
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