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Longitudinal analysis of health disparities in childhood
  1. Marije Oosterhoff1,
  2. Manuela A Joore1,
  3. Nina H M Bartelink2,
  4. Bjorn Winkens3,
  5. Onno C P Schayck4,
  6. Hans Bosma5
  1. 1 Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+)/Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
  2. 2 Department of Health Promotion, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
  3. 3 Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
  4. 4 Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
  5. 5 Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Marije Oosterhoff, Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht AZ 6202, The Netherlands; marije.oosterhoff{at}


Objective Combatting disparities in health outcomes among children is a major public health concern. This study focuses on two questions: (1) To what extent does socioeconomic status (SES) contribute to disparities in health outcomes? and (2) To what extent can social inequalities in health outcomes be explained by differences in children’s health behaviours?

Design This study included 2-year follow-up data of 1259 children (4–12 years of age) who participated in the ‘Healthy Primary School of the Future’ project ( NCT02800616). SES was measured by maternal and paternal education and household income (adjusted for family size). Health outcomes were body mass index (BMI) z-score, health resource use, school absenteeism, health-related quality of life and psychosocial health, measured over 2 years of follow-up (2015–2017). Health behaviours included physical activity, and consumption of fruits, vegetables and sweetened beverages. Associations between SES and baseline health behaviours were examined, and mixed models for repeated measures were used to assess associations between SES and health outcomes over 2 years of follow-up.

Results A high socioeconomic background was significantly associated with better health outcomes (all outcomes). For example, children with a low SES had higher BMI z-scores (beta coefficient: 0.42, 95% CI 0.22 to 0.62) and higher consumption healthcare costs (ratio of mean costs: 2.21, 95% CI 1.57 to 3.10). Effects of SES changed very little after controlling for health behaviours.

Discussion Our findings strongly suggest that socioeconomic background has a pervasive impact on disparities in child health, but gives little support to the idea that social inequalities in child health can be tackled by means of lifestyle interventions.

  • child
  • health status disparities
  • school health
  • health behaviours
  • quality of life

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  • Contributors MO, HB, MAJ and OCS developed the design of the study. MO collected and analysed the data. NB helped with the collection and analysis of data. BW contributed to the analysis and interpretation of data. MO produced the first draft of the manuscript. HB, MAJ and OCS were the main contributors in writing the manuscript. All authors read and approved the final manuscript.

  • Funding This study was funded by the Limburg provincial authorities (project number 200130003), the Friesland Campina (project number LLMV00) and the Maastricht University. The study protocol was peer reviewed by the Limburg provincial authorities and Maastricht University.

  • Disclaimer None of the funding bodies had a role in the design of the study or the writing of this manuscript. Nor will the funding bodies have a role in the future data collection, analysis, interpretation of data and the writing of publications.

  • Competing interests None declared.

  • Ethics approval The need for ethical approval has been waived by the Medical Ethics Committee Zuyderland in Heerlen (MEC 14-N-142).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data that support the findings of this study were collected as part of the ‘Healthy Primary School of the Future’ quasiexperimental study. Data collection will take place until 2019 to study the effects after 4 years of exposure. Data will become available following article publication on the 4-year effects and potential other comparative studies in the Netherlands.

  • Patient consent for publication Parental/guardian consent obtained.