PREVALENCE AND IMPACT OF MULTIPLE CHILDHOOD CHRONIC ILLNESSES

Objective: To determine the prevalence and impact of multiple chronic conditions on children's health status and utilization of health servi ces. Design: Analysis of the 1988 National Health Interview Survey on Child Health.Setting: Nationally representative sample of the U.S. civ ilian, noninstitutionalized population. Participants: A total of 17,71 0 children less than 18 years of age selected in a stratified cluster sampling of U.S. households. Intervention: None. Results: We estimated that fewer than 5% of children have multiple (two or more) chronic co nditions and that less than 1% of children had three or more such cond itions. However, despite this low overall prevalence, some notable fea tures of multiple chronic conditions stand out. Many of the most preva lent condition-pairs were allergy related, and the rates of co-occurre nce of these disorders were generally higher than would be predicted o n the basis of prevalence rates for the individual conditions. Childre n with multiple chronic conditions had more mental and physical health problems and used substantially more health services than other child ren. For example, the prevalence of developmental delay, learning disa bilities, and emotional and behavioral problems increased sharply with the number of chronic conditions reported. Notable deterioration in s uch health status measures as days in bed, school absences, and activi ty limitation was also observed with increasing numbers of chronic con ditions. Similarly, utilization of hospital and physician services inc reased in tandem with increasing numbers of chronic conditions. Conclu sions: Children who have multiple conditions of a chronic nature, even if few in number, have increased morbidity across a variety of measur es.