Maternal and Child Health Journal

, Volume 17, Issue 10, pp 1852–1861 | Cite as

Measuring Early Childhood Health and Health Disparities: A New Approach

  • Marianne M. Hillemeier
  • Stephanie T. Lanza
  • Nancy S. Landale
  • R. S. Oropesa


Efforts to improve the health of U.S. children and reduce disparities have been hampered by lack of a rigorous way to summarize the multi-dimensional nature of children’s health. This research employed a novel statistical approach to measurement to provide an integrated, comprehensive perspective on early childhood health and disparities. Nationally-representative data (n = 8,800) came from the Early Childhood Longitudinal Study, Birth Cohort. Latent class analysis was used to classify health at 48 months, incorporating health conditions, functioning, and aspects of physical, cognitive, and emotional development. Health disparities by gender, poverty, race/ethnicity, and birthweight were examined. Over half of all children were classified as healthy using multidimensional latent class methodology; others fell into one of seven less optimal health statuses. The analyses highlighted pervasive disparities in health, with poor children at increased risk of being classified into the most disadvantaged health status consisting of chronic conditions and a cluster of developmental problems including low cognitive achievement, poor social skills, and behavior problems. Children with very low birthweight had the highest rate of being in the most disadvantaged health status (25.2 %), but moderately low birthweight children were also at elevated risk (7.9 vs. 3.4 % among non-low birthweight children). Latent class analysis provides a uniquely comprehensive picture of child health and health disparities that identifies clusters of problems experienced by some groups. The findings underscore the importance of continued efforts to reduce preterm birth, and to ameliorate poverty’s effects on children’s health through access to high-quality healthcare and other services.


Child health status Health disparities Socioeconomic status Low birth weight 



Support for this research was provided by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5P01HD062498-02) for the Mexican Children of Immigrants Program Project. It also was supported by an award from the National Institute on Drug Abuse (P50-DA010075). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support services were provided by the Population Research Institute at The Pennsylvania State University, which is funded by the National Institute for Child Health and Human Development (R24HD041025). The authors are grateful to Steven A. Maczuga for programming assistance.


  1. 1.
    Institute of Medicine. (2011). Child and adolescent health and health care quality: Measuring what matters. Washington, DC: National Academies Press.Google Scholar
  2. 2.
    National Research Council and Institute of Medicine. (2004). Children’s health, the nation’s wealth: Assessing and improving child health. Washington, DC: National Academies Press.Google Scholar
  3. 3.
    Center on the Developing Child at Harvard University. (2010). The foundations of lifelong health are built in early childhood. Available at
  4. 4.
    Kuh, D., & Ben-Shlomo, Y. (2004). A life course approach to chronic disease epidemiology. New York: Oxford University Press.CrossRefGoogle Scholar
  5. 5.
    Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. Journal of American Medical Association, 301(21), 2252–2259.CrossRefGoogle Scholar
  6. 6.
    Case, A., Fertig, A., & Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics, 24(2), 365–389.PubMedCrossRefGoogle Scholar
  7. 7.
    Haas, S. A. (2007). The long-term effects of poor childhood health: An assessment and application of retrospective reports. Demography, 44(1), 113–135.PubMedCrossRefGoogle Scholar
  8. 8.
    Hertzman, C., & Boyce, T. (2010). How experience gets under the skin to create gradients in developmental health. Annual Review of Public Health, 31, 329–347.PubMedCrossRefGoogle Scholar
  9. 9.
    Barker, D. J. (2004). The developmental origins of adult disease. Journal of the American College of Nutrition, 23(6 Suppl), 588S–595S.PubMedCrossRefGoogle Scholar
  10. 10.
    Soto-Martinez, M., & Sly, P. D. (2010). Review series: What goes around, comes around: Childhood influences on later lung health?: Relationship between environmental exposures in children and adult lung disease: The case for outdoor exposures. Chronic Respiratory Disease, 7(3), 173–186.PubMedCrossRefGoogle Scholar
  11. 11.
    Elovainio, M., Ferrie, J. E., Singh-Manoux, A., Shipley, M., Batty, G. D., Head, J., et al. (2011). Socioeconomic differences in cardiometabolic factors: social causation or health-related selection? Evidence from the Whitehall II Cohort Study, 1991–2004. American Journal of Epidemiology, 174(7), 779–789. doi: 10.1093/aje/kwr149.PubMedCrossRefGoogle Scholar
  12. 12.
    Pesonen, A. K., Raikkonen, K., Heinonen, K., Kajantie, E., Forsen, T., & Eriksson, J. G. (2007). Depressive symptoms in adults separated from their parents as children: A natural experiment during World War II. American Journal of Epidemiology, 166(10), 1126–1133.PubMedCrossRefGoogle Scholar
  13. 13.
    Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.PubMedCrossRefGoogle Scholar
  14. 14.
    U.S. Department of Health and Human Services. (2010). Healthy people 2020. Available at
  15. 15.
    Flores, G. (2010). Technical report—Racial and ethnic disparities in the health and health care of children. Pediatrics, 125(4), e979–e1020.PubMedCrossRefGoogle Scholar
  16. 16.
    Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2000). Health disparities: bridging the gap. From cells to selves. Available from:
  17. 17.
    American Academy of Pediatrics. (2011). Strategic priorities and AAP initiatives 2011–2012. Available at
  18. 18.
    Federal Interagency Forum on Child and Family Statistics. (2011). America’s children: Key national indicators of well-being, 2011. Washington, DC: US Government Printing Office. Available at
  19. 19.
    Evans, R. G., & Stoddart, G. L. (1990). Producing health, consuming health care. Social Science and Medicine, 31(12), 1347–1363.PubMedCrossRefGoogle Scholar
  20. 20.
    Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health. Stockholm, Sweden: Institute for Future Studies.Google Scholar
  21. 21.
    Institute of Medicine. (2000). Promoting health: Intervention strategies from social and behavioral research. Washington, DC: National Academies Press.Google Scholar
  22. 22.
    McCormick, M. C. (2008). Issues in measuring child health. Ambulatory Pediatrics, 8(2), 77–84.PubMedCrossRefGoogle Scholar
  23. 23.
    Kohen, D. E., Brehaut, J. C., Garner, R. E., Miller, A. R., Lach, L. M., Klassen, A. F., et al. (2007). Conceptualizing childhood health problems using survey data: A comparison of key indicators. BMC Pediatrics, 7, 40. doi: 10.1186/1471-2431-7-40.PubMedCrossRefGoogle Scholar
  24. 24.
    Ketchie, B., Lang, N., Brush, L., & Kirstein, R. (2003). Recommended physical assessment instrument for the ECLS-B preschool battery: Results from the spring pilot test. Washington, DC: American Institutes for Research.Google Scholar
  25. 25.
    Najarian, M., Snow, K., Lennon, J., & Kinsey, S. (2010). Early childhood longitudinal study, birth cohort (ECLS-B): Preschool-kindergarten 2007 psychometric report (NCES 2010–009). Washington, DC: National Center for Educational Statistics.Google Scholar
  26. 26.
    Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. New York: Wiley.Google Scholar
  27. 27.
    Lanza, S. T., Collins, L. M., Lemmon, D. R., & Schafer, J. L. (2007). PROC LCA: A SAS procedure for latent class analysis. Structural Equation Modeling, 14(4), 671–694.PubMedCrossRefGoogle Scholar
  28. 28.
    Lanza, S. T., Dziak, J. J., Huang, L., Xu, S., & Collins, L. M. (2011). Proc LCA & PROC LTA user’s guide (version 1.2.7). University Park: The Methodology Center, Penn State University. Available at
  29. 29.
    van der Lee, J. H., Mokkink, L. B., Grootenhuis, M. A., Heymans, H. S., & Offringa, M. (2007). Definitions and measurement of chronic health conditions in childhood: A systematic review. Journal of American Medical Association, 297(24), 2741–2751.CrossRefGoogle Scholar
  30. 30.
    Lozoff, B. (2007). Iron deficiency and child development. Food and Nutrition Bulletin, 28(4 Suppl), S560–S571.PubMedGoogle Scholar
  31. 31.
    Schurch, B. (1995). Malnutrition and behavioral development: The nutrition variable. Journal of Nutrition, 125(8 Suppl), 2255S–2262S.PubMedGoogle Scholar
  32. 32.
    Bellinger, D. C. (2008). Very low lead exposures and children’s neurodevelopment. Current Opinion in Pediatrics, 20(2), 172–177.PubMedCrossRefGoogle Scholar
  33. 33.
    Stewart, P. W., Reihman, J., Lonky, E. I., Darvill, T. J., & Pagano, J. (2003). Cognitive development in preschool children prenatally exposed to PCBs and MeHg. Neurotoxicology and Teratology, 25(1), 11–22.PubMedCrossRefGoogle Scholar
  34. 34.
    Brooks-Gunn, J., & Duncan, G. J. (1997). The effects of poverty on children. The Future of Children, 7(2), 55–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Magnuson, K. A., & Waldfogel, J. (2005). Early childhood care and education: Effects on ethnic and racial gaps in school readiness. The Future of Children, 15(1), 169–196.PubMedCrossRefGoogle Scholar
  36. 36.
    DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. (2010). Income, poverty, and health insurance coverage in the United States: 2009. Washington, DC: US Government Printing Office.Google Scholar
  37. 37.
    Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2011). Births: Preliminary data for 2009. National Vital Statistics Reports, 59(3), 1–19.PubMedGoogle Scholar
  38. 38.
    Akresh, R., & Akresh, I. R. (2011). Using achievement tests to measure language assimilation and language bias among the children of immigrants. Journal of Human Resources, 46, 614–646.CrossRefGoogle Scholar
  39. 39.
    McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102(1 Pt 1), 137–140.PubMedCrossRefGoogle Scholar
  40. 40.
    Cohen, E., Jovcevska, V., Kuo, D. Z., & Mahant, S. (2011). Hospital-based comprehensive care programs for children with special health care needs: A systematic review. Archives of Pediatric and Adolescent Medicine, 165(6), 554–561.CrossRefGoogle Scholar
  41. 41.
    Lollar, D. J., Hartzell, M. S., & Evans, M. A. (2012). Functional difficulties and health conditions among children with special health needs. Pediatrics, 129(3), e714–e722.PubMedCrossRefGoogle Scholar
  42. 42.
    Annie E. Casey Foundation. (2011). America’s children, America’s challenge: Promoting opportunity for the next generation. Baltimore, MD: Annie E. Casey Foundation.Google Scholar
  43. 43.
    Currie, J. (2009). Policy interventions to address child health disparities: Moving beyond health insurance. Pediatrics, 124(Suppl 3), S246–S254.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Marianne M. Hillemeier
    • 1
    • 2
  • Stephanie T. Lanza
    • 3
  • Nancy S. Landale
    • 4
  • R. S. Oropesa
    • 4
  1. 1.Department of Health Policy and AdministrationPennsylvania State UniversityUniversity ParkUSA
  2. 2.Department of Public Health SciencesPenn State College of MedicineHersheyUSA
  3. 3.Pennsylvania State University Methodology CenterPennsylvania State UniversityUniversity ParkUSA
  4. 4.Department of SociologyPennsylvania State UniversityUniversity ParkUSA

Personalised recommendations