Rise in Child Chronic Illness Could Swamp Health Care

Mar. 23 -- TUESDAY, June 26 (HealthDay News) -- As more American children eat poorly and exercise less, rates of chronic illness such as asthma and diabetes are continuing to rise, researchers are reporting.

And because childhood illness often sets the stage for adult health woes, the U.S. health-care system could be headed toward a crisis in coming decades, experts warn in a number of reports in the June 27 issue of the Journal of the American Medical Association.

"A chronic condition in a child will become a chronic condition in an adult -- we just know that. And what you're talking about for an adult is maybe 10, 20 years of suffering. But with a child, you're talking about maybe 50, 60 years of suffering," said the journal's editor-in-chief, pediatrician Dr. Catherine DeAngelis, during a Tuesday teleconference.

A surge in childhood illness will also have a big impact on the U.S. health-care system, another expert said.

"Given these high rates of [ill children] in the next decade, there are going to be tremendously higher rates of expenditures for health care and social welfare, because a lot of these people will have health disabilities, and they won't be employable," Dr. James Perrin, director of the Center for Child and Adolescent Health Policy at MassGeneral Hospital for Children, in Boston, told HealthDay. Perrin is also co-author of a journal analysis of the prevalence and causes of childhood chronic illness.

The special themed issue of JAMA is devoted to chronic childhood illness, defined as any debilitating illness that lasts a year or more past diagnosis. A number of new studies suggest that, in many ways, the health of America's children is getting worse, not better.

Some findings:

  • According to the analysis by Perrin and colleagues, more than 7 percent of U.S. children and youth were hampered in their daily activities by an illness that lasted three months or longer in 2004, compared to just 1.8 percent of children in 1960.
  • Chronic conditions now affect 15 percent to 18 percent of children and teens, and even those estimates may not fully account for obesity and mental health woes, the Harvard team said.
  • The "big three" chronic health conditions for kids are obesity, which affected 5 percent of American children in the early 1970s but 18 percent of children today; asthma (9 percent prevalence, nearly double from the 1980s), and attention deficit hyperactivity disorder (a dramatic rise, mostly linked to better diagnosis).
  • Childhood diabetes is one of the prime results of rising obesity rates, which in turn result from more sedentary behaviors and poor diets.

    "Children's environments have really changed a lot in the last 30 to 40 years," said Perrin. "By that, we mean a big change in their diets -- much more fast-food, high-calorie foods -- and major changes in their use of electronic media, especially television. They are spending much more time in the home watching television and eating high-calorie foods while they do so."

    However, new research finds that the rise in childhood diabetes is still largely attributed to an increase in type 1 disease -- usually thought of as an inherited illness -- rather than an increase in obesity-linked type 2 disease, the form that typically strikes obese adults.

    Experts aren't sure why type 1 diabetes numbers might be rising. Some experts believe that obesity might help spur certain immune-cell changes that are seen in type 1 disease, changes that eventually lead to the destruction of insulin-producing cells in the pancreas. Or, as Dr. Rebecca Lipton of the University of Chicago noted in an editorial, many of these type 1 cases may be type 2 cases misdiagnosed by physicians.

    Diabetes does seem to be affecting different groups of American children in different ways, however.

    "We have seen an increase in type 1 diabetes over a 27-year period of about 60 percent. This translates into 2.7 percent higher annual rates for non-Hispanic white children and about 1.6 percent higher annual rates for Hispanics," said Dr. Dana Dabelea, of the University of Colorado Health Sciences Center, and lead author of the country-wide SEARCH for Diabetes in Youth study group.

    "Based on these data, we estimate that 15,000 youth are diagnosed annually with type 1 diabetes in the United States," she said.

    As for type 2 diabetes, Dabelea said that form of the disease "accounts for 1 to 2 percent of cases in Caucasian children [in Europe], whereas here in the United States, this figure is 15 percent. That figure speaks for itself... It's a deleterious consequence of obesity in this country."

    In their journal study, the researchers at University of Colorado Health Sciences Center found that non-Hispanic white children are more likely to develop type 1 diabetes than minority children. On the other hand, type 2 disease is much more likely to appear in black or Hispanic 15- to 19-year-olds than in white teens.

    Asthma, too, is affecting more and more children, and childhoods spent largely indoors may be to blame here, as well, said Perrin, who is also a professor of pediatrics at Harvard Medical School.

    While allergies to cockroaches and dust mites have long been linked to soaring asthma rates among America's urban poor, studies have shown no concurrent rise in the rate of household infestations over the past decades, he pointed out.

    "However, we do know that kids now spend much more time indoors [than they used to] in intimate contact with cockroaches and dust mites," Perrin said.

    Even the good news on childhood illness comes mixed with a little bad news. Dutch researchers note that more and more children are claiming victory over a wide variety of cancers. However, the study also suggests that battling cancer in childhood boosts risks for adult illnesses.

    The study of almost 1,400 five-year survivors of childhood cancer tracked these young people to an average of just over 24 years of age. Three-quarters of these survivors experienced some form of adverse medical event in young adulthood, and one-quarter suffered five or more such events, the researchers found. More than one-third (36.8 percent) developed a life-threatening or disabling disorder years after beating their cancer, the researchers found.

    Study author Dr. Huib Caron, of Emma Children's Hospital/Academic Medical Center, in Amsterdam, strongly supports the creation of specialized follow-up clinics that could monitor childhood cancer survivors into adulthood.

    These clinics are essential because "the majority of adult medicine physicians haven't got the faintest clue about the health risks that this population is running -- they haven't got the expertise," Caron said. And many problems, such as cardiac troubles, are asymptomatic and would only show up on doctor-ordered ultrasounds or other tests, he said.

    Getting doctors to keep closer tabs on childhood cancer survivors might not be so difficult. However, changing the poor eating habits and lax exercise patterns of America's children -- and their parents -- will be a lot tougher, Perrin said.

    Recent public policy moves -- such as bans on sugary or greasy snacks and soft drinks in schools -- are steps in the right direction. But parents, especially, "are critical to this effort," Perrin said.

    By modeling good behaviors and closely monitoring their children's behaviors, "parents can do a really good job, and it's important for them to realize that," he said. "We think that improving how parents parent is a critical way of stemming this epidemic."

    More information

    Find out more on keeping kids healthy at the American Heart Association.

    SOURCES: James Perrin, M.D., director, Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, and professor, pediatrics, Harvard School of Public Health, Boston; June 26, 2007, news teleconference with Catherine DeAngelis, M.D., editor in chief, Journal of the American Medical Association, Boston; Dana Dabelea, M.D., Ph.D., University of Colorado Health Sciences Center, Denver; Huib Caron M.D., Ph.D., Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; June 27, 2007, Journal of the American Medical Association