Kinder und Familie

Einleitung / Introduction

Die COVID-19-Pandemie wurde von zahlreichen Beschränkungen des öffentlichen und sozialen Lebens begleitet. Obwohl die Regelversorgung der Patient:innen durch die niedergelassenen Ärzt:innen und Psychotherapeut:innen prinzipiell durchgängig ermöglicht war, kam es in den Monaten unmittelbar nach Beginn der Pandemie im März 2020, im Vergleich zu den Vorjahreszeiträumen, zu erheblichen Einbrüchen bei Arztbesuchen. Aufgrund der Schließungen von Kindertagesstätten und Schulen, sowie Einschränkungen der sozialen Kontakte auch in der Freizeit, stellen Kinder und Jugendliche eine besonders betroffene und belastete Gruppe dar. Insbesondere in Familien mit weiteren Belastungsfaktoren, wie beispielsweise einer angespannten finanziellen Situation oder beengten Wohnverhältnissen, waren sie zusätzlichen Herausforderungen ausgesetzt. Mit Blick auf die präventiv-pädiatrische Versorgung wurde in dieser Studie auf der Grundlage von Routinedaten die Inanspruchnahme von Früherkennungsuntersuchungen und empfohlenen oder verpflichtenden Schutzimpfungen untersucht. Veränderungen der Inanspruchnahme im Vergleich zu Vorjahreszeiträumen wurden analysiert und sozioökonomische Variablen wie der CASMIN-Index zur Einschätzung der Bildungsklassfikation, der Deprivationsindex GISD, sowie Informationen zur familiären Situation in die Modellierung einbezogen.

Methode / Method

Es erfolgte ein Aufgriff aus einer Versichertenpopulation von mehr als 500.000 Kindern mit notwendigen Früherkennungsuntersuchungen oder Impfungen im Zeitraum des ersten Quartals 2018 bis einschließlich des vierten Quartals 2020. Mittels deskriptiver Statistik und Regressionsmodellen wurden quartalsweise Korrelationen zwischen der Inanspruchnahme und Risikoexposition, sozioökonomischen Merkmalen und dem familiären Hintergrund analysiert.

Ergebnisse / Results

Die Veränderungen in der Inanspruchnahme der Früherkennungsuntersuchungen und Impfungen sind heterogen. In der Tendenz ist bei den meisten U-Untersuchungen ein Anstieg in verschiedenen Phasen der Pandemie erkennbar. Während die Inanspruchnahme im Allgemeinen signifikant von Merkmalen wie dem CASMIN-Index abhängt, können Zusammenhänge der Veränderung der Inanspruchnahme in den verschiedenen Pandemiephasen nur bei einzelnen U-Untersuchungen aufgedeckt werden.

AutorInnen

Marco Müller, WIG2

Amelie Wuppermann, Martin-Luther-Universität Halle-Wittenberg

Gerrit Stahn, Martin-Luther-Universität Halle-Wittenberg

Ines Weinhold, WIG2

Einleitung / Introduction

ADHD (attention-deficit/hyperactivity disorder, ICD10 F90) is one of the most common psychiatric disorders in childhood and adolescence worldwide. ADHD development is considered to have multifactorial causes. One suspected cause for a higher chance of ADHD development is a history of antihistamine intake which should be investigated to its correlation to the social-economic status.

Methode / Method

We analyse anonymized claims data of children and adolescents (5 to 17 years) insured at DAK-Gesundheit within 2017 to 2021. ADHD incidence represents the rate of confirmed in- or outpatient diagnoses (M1Q, ICD10 F90, "hyperkinetic disorders"), including minimum one-year disease-free pre-observation. Exposure to antihistamine is defined as at least one drug prescription (M1Q, Anatomical Therapeutic Chemical (ATC) codes: R06, A04AB and D04AA) within a predefined period. We used the German Index of Socioeconomic Deprivation (GISD) to approximate the socio-economic status of insured persons. The GISD covers three categories (low, medium, high), whereas a low GISD indicates low deprivation which is a high social-economic status and vice versa. The impact of antihistamine description and GISD on ADHD incidence is explored via logistic regression models.

Ergebnisse / Results

The prevalence of antihistamine prescriptions in 2019 is 77.34 per 1,000 children, whereby the prescription prevalence is slightly higher in boys (80.84 per 1,000) than in girls (73.68 per 1,000). ADHD prevalence (34.80 per 1,000 children) and incidence (7.06 per 1,000 children) in 2019, were also higher in boys (prevalence: 51.09, incidence: 9.98 per 1,000) than in girls (prevalence: 17.73 per 1,000, incidence: 4.00 per 1,000). Investigating the relation of ADHD incidence and GISD in 2019 for both sexes, the highest incidence can be found for boys with medium deprivation (11.79 per 1,000) and for girls with low deprivation (4.80 per 1,000). The lowest incidence is found for both boys (10.19 per 1,000) and girls with high deprivation (4.31 per 1,000). Beside other factors, children exposed to antihistamines in 2017 to 2021 had a significant higher risk (OR=1.32, p<0.001) for an onset diagnosis of ADHD in 2021, while a higher socio-economic deprivation is related to a significant lower risk of incident ADHD.

Zusammenfassung / Conclusion

The results indicate that both, antihistamine prescription and the social-economic status have an impact on ADHD in children from 5 to 17 years in descriptive analysis. Furthermore, a regression analysis underlines these assumptions as both have a significant impact on ADHD incidence in the regression.

AutorInnen

Jana Diekmannshemke, Vandage GmbH

Lena Hasemann, Vandage GmbH

Alena Zeitler, Vandage GmbH

Katharina Weinert, Vandage GmbH

Julian Witte, Vandage GmbH

Einleitung / Introduction

Parental smoking during pregnancy or infancy is often found to be associated with inferior later-life outcomes regarding health and/or education. Identification of causal effects from observational data is difficult because parental smoking is likely correlated with lower parental investment in children’s human capital in general. Recent quasi-experimental evidence using changes in tobacco taxes for identification suggests that a large part of association is indeed causal. The aim of the present paper is to corroborate those findings using an alternative identification strategy.

Methode / Method

We use data from the Longitudinal Study of Australian Children (LSAC) cohort B to study how parental smoking in the first year of life correlates with and affects educational attainment (NAPLAN test scores) and general cognitive ability (PPVT, Progressive Matrices) measured at several stages of childhood and adolescence (up to age 14). To identify causal effects, we control for a rich set of potential confounders measured at baseline, potentially reflecting parental investment throughout later childhood. We support our identifying assumption with an omitted variable test (Caetano 2015, Econometrica). The test is applicable for continuous, potentially endogenous regressors that have bunching points, for instance at zero. One can think of variables that—if they were dependent variables—would often be analyzed in a latent variable setup. Smoking during infancy is likely driven by unobserved preferences that are linked with socio-economic status an parental investment. However, whereas such preferences can have a continuous effect on educational attainment or health, harm attributable to smoking can only be caused by actual smoking, not desired smoking. Assuming that very health-conscious parents desire to but cannot smoke fewer than zero cigarettes, the health-conscious bunch at zero and can be, on average, very different in terms of preferences from those smoking very few cigarettes. Conditional independence is supported if after controlling for observed covariates that are sufficiently correlated with unobserved preferences, the large differences between parents at zero and those located just above zero vanish.

Ergebnisse / Results

Our preliminary results show strong correlations of smoking with outcomes, but controlling for just a few important proxy variables for parental investment reduces the coefficients’ size considerably and they become statistically insignificant.

Zusammenfassung / Conclusion

While children of smoking parents are clearly suffer disadvantages regarding educational outcomes, we cannot support the notion that parental smoking during infancy as such is to blame. This suggests that parental smoking remains a marker for targeting young parents for interventions. The focus of such interventions should, however, be broader than just encouragement to stop smoking.

AutorInnen

Hendrik Juerges, University of Wuppertal