Rise in Child Chronic Illness Could Swamp Health Care

"Rise in Child Chronic Illness Could Swamp Health Care", Forbes, June
26, 2007,
Link: http://www.forbes.com/forbeslife/hea...out605881.html

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.

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."