Pediatric chronic disease prevalence has risen to nearly 30% in the last 20 years

The prevalence of chronic conditions has risen to unprecedented levels over the past twenty years, with nearly 1-in-3 young people estimated to now be living with pediatric onset conditions that significantly affect their lives, new research suggests.

This rise is largely driven by ADHD/ADD, autism, asthma, prediabetes and depression/anxiety, said Lauren Wisk, an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

“The prevalence of childhood conditions is currently higher than previous estimates suggest,” said Wisk, the study’s lead author. “Youth who are subject to socioeconomic vulnerability such as having less education, lower income, are on public insurance, or unemployed are all more likely to live with a chronic condition than youth with socioeconomic advantages.”

The findings are published in the peer-reviewed journal Academic Pediatrics.

The researchers analyzed nationally representative data for about 236,500 participants ages 5 to 25 years from the 1999-2018 National Health Interview Survey (NHIS) and estimated the annual average increase in chronic conditions (CC) and functional limitations (FL) over time. They found that the frequency among children ages 5 to 17 years rose from about 23% in 1999/2000 to more than 30% by 2017/2018. This amounts to an estimated annual increase of .24 percentage points or 130,000 additional children per year.

Among young adults ages 18 to 25 years, the prevalence increased from 18.5% to 29% over the same period, for about an annual rise of .33 percentage points or additional 80,000 young adults each year.

Nearly all of the conditions are treatable with access to high quality healthcare, Wisk said. But the U.S. health system doesn’t always provide that.

“Most youth with chronic conditions need to access health and social services for the rest of their lives, but our health system is not set up to successfully move young people from pediatric to adult focused care and so many of these youth are at risk of disengaging with care and experiencing disease exacerbations,” she said. “We should invest in assisting these youth in engaging appropriately with healthcare across their lifespan in order to protect their health and well-being, and to facilitate their maximum participation in society with respect to education, vocation, social groups, and community spaces.”

There are limitations to the study. They include a reliance on self- or caregiver-reported conditions, which is subject to recall bias, and the researchers’ ability to examine trends in some specific conditions was limited by the low prevalence of certain conditions and the design of the NHIS, the latter which results in inconsistent assessment of some conditions over the years.

The researchers could only estimate the current prevalence of these pediatric chronic conditions because the NHIS restructured its data collection procedures in 2019, Wisk said.

“This means we no longer have the ability to track and analyze trends in chronic health conditions in youth past that date,” she said. “We need to find creative new ways to continue to monitor the health of our nation’s youth if we want to further study this population.”

Study co-author is Dr. Niraj Sharma of Brigham and Women’s Hospital in Boston and Harvard Medical School.

The study was supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases (K01DK116932)