Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. e60-e66 (doi:10.1542/peds.2008-1890)
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ARTICLE

School Absenteeism, Health Status, and Health Care Utilization Among Children With Asthma: Associations With Parental Chronic Disease

Ellen A. Lipstein, MDa, James M. Perrin, MDa,b and Karen A. Kuhlthau, PhDa,b

a Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Massachusetts
b Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

OBJECTIVE. Parents with chronic disease may be more likely than healthy parents to perceive their children with chronic conditions as medically vulnerable. Our objective for this study was to determine if children with asthma whose parents have chronic disease differ in health care utilization, school absenteeism, and reported child health status compared with those whose parents do not have chronic disease.

PATIENTS AND METHODS. We selected children with asthma, 5 to 17 years of age, and their parents from the 2003 National Health Interview Survey. We determined whether parents had chronic disease and examined associations of parental chronic disease with child health status, school absenteeism, and health care utilization. We controlled for factors known to influence our dependent variables, including an indicator of child disease severity, in multivariable regression.

RESULTS. Among 561 parent-child dyads, children with asthma whose parents had chronic disease were more likely to have less than very good health and missed an average of 1.3 more school days annually than other children with asthma. Among children with less severe asthma, those whose parents had chronic disease had lower reported health status but did not miss more school (mean difference: 0.39) than children whose parents did not have chronic disease. Having a parent with chronic disease was not associated with increased health care utilization.

CONCLUSIONS. Compared with other children with asthma, children whose parents have chronic disease have worse health status and miss more school, particularly among children with more severe asthma. Understanding how parents’ health influences children's health care and health status may help providers work with parents to more effectively and efficiently manage their children's asthma care so they can more fully participate in school and other activities.

Key Words: asthma • parental perceptions • chronic disease • health services utilization • absenteeism

Abbreviations: NHIS—National Health Interview Survey • ED—emergency department • aOR—adjusted odds ratio • CL—confidence limit

Accepted Oct 1, 2008.


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eLetters:

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Alternative interpretations of severity parameter?
Lani S. Wheeler
Pediatrics Online, 21 Jan 2009 [Full text]