Rethinking What is Important: Biologic Versus Social Predictors of Childhood Health and Educational Outcomes

Epidemiology, Vol. 21, No. 3, pp. 314-323, 2010

10 Pages Posted: 15 Mar 2012

See all articles by Douglas P. Jutte

Douglas P. Jutte

University of California, Berkeley

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Noralou Roos

University of Manitoba - Department of Community Health Sciences (CHS)

Christine Schippers

affiliation not provided to SSRN

Thomas Boyce

University of British Columbia (UBC)

SL Syme

University of California, Berkeley

Date Written: May 15, 2010

Abstract

Social risk factors are often less vigorously pursued in clinical assessments of infant risk than are biologic risk factors. We examined the relative importance of early social and biologic risk factors in predicting poor health and educational outcomes in children.

The study was composed of all infants born in Winnipeg, Canada, during April-December 1984, who were followed up until age 19 years (n = 4667). Predictors were 3 routinely assessed biologic risks (birth weight, gestational age, and Apgar score) and 3 prominent social factors (mother's age, parent marital status, and socioeconomic status). Outcomes were childhood hospitalization and passage of a required high school examination. Analyses included logistic regression, measures of accuracy, and population attributable risk percent (PAR%).

Biologic and social risk factors were associated with similarly steep poor outcomes gradients. Social risk factors had similar, and in some cases stronger, measures of association and accuracy. Using biologic risk criteria alone misclassified as low-risk 65% of cohort children who had high rates of later hospitalization and examination failure. PAR% associated with social risk factors exceeded biologic risk factors in most cases (eg, hospitalization PAR% = 4.4 for offspring of teen mothers vs. 1.7 for low birth weight).

In a population-based sample of infants followed-up through adolescence, early social risk factors were as threatening as, and more common than, routinely documented biologic risks-frequently identifying otherwise-unrecognized at-risk children. These findings together suggest that rigorous evaluation of social factors should be made a routine part of clinical assessment to more comprehensively and accurately identify infants at risk for later serious health problems and academic failure.

Suggested Citation

Jutte, Douglas P. and Brownell, Marni D. and Roos, Noralou and Schippers, Christine and Boyce, Thomas and Syme, SL, Rethinking What is Important: Biologic Versus Social Predictors of Childhood Health and Educational Outcomes (May 15, 2010). Epidemiology, Vol. 21, No. 3, pp. 314-323, 2010. Available at SSRN: https://ssrn.com/abstract=2023916 or http://dx.doi.org/10.2139/ssrn.2023916

Douglas P. Jutte (Contact Author)

University of California, Berkeley ( email )

310 Barrows Hall
Berkeley, CA 94720
United States

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Noralou Roos

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

Christine Schippers

affiliation not provided to SSRN ( email )

Thomas Boyce

University of British Columbia (UBC) ( email )

2329 West Mall
Vancouver, British Columbia BC V6T 1Z4
Canada

SL Syme

University of California, Berkeley ( email )

310 Barrows Hall
Berkeley, CA 94720
United States

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