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Intersectional inequalities in paediatric infectious diseases: a national cohort study in Sweden
Samuel Videholm1, Sven Arne Silfverdal2, Per E Gustafsson3
1Department of Clinical Sciences, Pediatrics, Umea Universitet, Umea, Sweden samuel.videholm@umu.se.
Insights
Socially deprived children face higher infection risks. Intersectional inequalities in social disadvantages significantly shape pediatric infectious disease hospitalizations, requiring comprehensive public health interventions for all children.
Area of Science:
- Pediatric infectious diseases
- Social epidemiology
- Health inequalities
Background:
- Social deprivation is linked to increased infection hospitalization in children.
- Limited understanding exists regarding the interplay of various social disadvantages.
- This study investigates intersectional inequalities in common childhood infections.
Purpose of the Study:
- To examine intersectional inequalities in overall, upper respiratory, lower respiratory, enteric, and genitourinary infections.
- To analyze how combined social disadvantages impact infection hospitalization rates in early childhood.
- To assess the role of intersecting social factors in pediatric infectious disease outcomes.
Main Methods:
- Population-based retrospective cohort study of Swedish children (1998-2015).
- Analysis of individual heterogeneity and discriminatory accuracy framework.
- Creation of 60 intersectional strata based on maternal education, income, sex/gender, and migration status.
- Logistic regression models to estimate incidence rates and associations.
Main Results:
- Included 1,785,588 children and 318,080 hospital admissions.
- Highest infection hospitalization incidence observed in boys from low-educated mothers in low-income households.
- Income had no impact on infection incidence for children of highly educated mothers.
- Intersectional strata showed poor discriminatory ability for predicting infections.
Conclusions:
- Paediatric infectious disease inequalities are significantly influenced by the intersection of social disadvantages.
- Public health policies must address these intersectional inequalities to effectively reach all vulnerable children.
- Targeted interventions are needed to mitigate the impact of combined social disadvantages on child health.
Background:
It is well known that socially deprived children are more likely to be hospitalised for infections. Less is known about how different social disadvantages interact. Therefore, we examine intersectional inequalities in overall, upper respiratory, lower respiratory, enteric and genitourinary infections in the first 5 years of life.
Methods:
We conducted a population-based retrospective cohort study of Swedish children born between 1998 and 2015. Inequalities were examined using analysis of individual heterogeneity and discriminatory accuracy as the analytical framework. A variable with 60 intersectional strata was created by combining information on maternal education, household income, sex/gender and maternal migration status. We estimated the incidence rates of infectious disease hospitalisation for each intersectional strata and the associations between intersectional strata and infectious disease hospitalisations using logistic regression models. We furthermore quantified the discriminatory ability of the intersectional strata with respect to infectious disease hospitalisation.
Results:
The study included 1785 588 children and 318 080 hospital admissions. The highest overall incidence of hospitalisations for infections was found in boys born to low-educated mothers who lived in families with the lowest household income. The overall incidence of infections was unrelated to household income in children born to highly educated mothers. The ability of the intersectional strata to discriminate between children with and without infections was poor.
Conclusion:
We found that inequalities in paediatric infectious diseases were shaped by the intersections of different social disadvantages. These inequalities should be addressed by public health policies that reach all children.
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