Chronic pediatric conditions better managed at local level

Despite the decline of infectious disease rates in children since the early 20th century, there’s been a rapid rise in chronic health conditions and disabilities over the past 50 years, according to a recent study published this month in Health Affairs.

The rise has been from four primary classes, including asthma, obesity, mental health conditions and neurodevelopmental disorders, wrote James M. Perrin, MD, a professor of pediatrics at Harvard Medical School, and colleagues.

The rates of these conditions, the authors said, grew substantially in the 1980s and 1990s.

“Increasingly, evidence points to genetic bases for these conditions, but genetic drift—changes in the gene pool of reproductive-age adolescents and young adults—alone cannot explain this rapid growth,” Perrin and colleagues wrote.

In 2010, more than 8 percent of children had a health condition that interfered with daily activities. This was an increase of more than 400 percent since 1960 when 1.8 percent of children had a chronic health condition.

The authors contend that genetic susceptibility interacting with environmental factors could be a potential driving force in the rise of these conditions.

Additionally, socioeconomic factors increase a child’s risk for chronic conditions.

“Recent data show that children living at or below the federal poverty level have a one-third increased risk of a chronic health care need,” the team wrote.

Publicly insured children, the authors found, had more chronic conditions that privately insured children (24 percent versus 18 percent, respectively).

“Race has a less straightforward relationship with special health care needs,” the authors wrote. “While some studies report that non-Hispanic white children are most likely to have a chronic health condition, 15 others report higher rates among non-Hispanic black and Hispanic children.”

Perrin and team contend that focusing care in regionalized subspecialty centers for youth with the chronic conditions unrealistic due to the sheer number of affected children—and that the majority of care for these children should take place in the primary care setting.

Recent innovations in the primary care setting make decentralizing the management of these chronic conditions more realistic, including co-locating other health care specialists within a primary practice, medical home programs and new and emerging technologies that focus on mobile devices and web-based technologies that add to a provider’s ability to deliver care for chronic conditions.

“The differential epidemiology in these groups of conditions calls for a system of regionalized care for rare, complex conditions, based mainly in pediatric hospitals, and decentralized care for the common conditions, with the bulk of care delivered and received in primary care settings,” the authors wrote.