Definitions and Measurement of Chronic Health Conditions in Childhood

A Systematic Review

van der Lee, Johanna H. MD, PhD
Mokkink, Lidwine B. MSc
Grootenhuis, Martha A. PhD
Heymans, Hugo S. MD, PhD
Offringa, Martin MD, PhD

Department of Pediatric Clinical Epidemiology (Drs van der Lee and Offringa), Pediatric Psychosocial Department (Ms Mokkink and Dr Grootenhuis), and Departments of Pediatrics (Dr Heymans) and Neonatology (Dr Offringa), Emma Children's Hospital, Academic Medical Center, University of Amsterdam, the Netherlands. Ms Mokkink is currently with the Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit University Medical Center, Amsterdam.

Corresponding Author: Johanna H. van der Lee, MD, PhD, Department of Pediatric Clinical Epidemiology, Emma Children's Hospital, Academic Medical Center, Room H3-144, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands ([email protected]).

Author Contributions: Dr van der Lee had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: van der Lee, Mokkink, Grootenhuis, Heymans, Offringa.

Acquisition of data: van der Lee, Mokkink.

Analysis and interpretation of data: van der Lee, Mokkink.

Drafting of the manuscript: van der Lee, Mokkink.

Critical revision of the manuscript for important intellectual content: van der Lee, Mokkink, Grootenhuis, Heymans, Offringa.

Obtained funding: Grootenhuis, Heymans

Administrative, technical, or material support: van der Lee, Mokkink.

Study supervision: Grootenhuis, Heymans, Offringa.

Financial Disclosures: None reported.

Funding/Support: Financial support was obtained from the Dutch Ministry of Social Affairs and Employment.

Role of the Sponsor: The funder had no role in the design or conduct of the study; collection, management and interpretation of the data; or preparation, review, or approval of the manuscript.

JAMA: The Journal of the American Medical Association 297(24):p 2741-2751, June 27, 2007.

Context

Changes in the prevalence of chronic health conditions in childhood have considerable societal consequences for health care planning and for employment. To obtain valid and reliable estimates of the prevalence of chronic health conditions, a clear definition is needed.

Objective

To present an overview of all definitions and operationalizations that have been applied to measure the prevalence of chronic health conditions in childhood.

Data Sources

PubMed and the Web of Science were searched for articles published up to December 2006. Also, references were searched by hand for related articles.

Study Selection

Non–English- and non–Dutch-language articles were excluded. Of 7252 articles found, 64 articles that stated a conceptual definition and/or operationalization of chronic health conditions in children (aged 0–18 years) were included.

Data Extraction

Data on the (1) definition; (2) operationalization in terms of source of information, method of information retrieval, and study population; and (3) resulting prevalence rate were extracted by 2 independent reviewers.

Data Synthesis

A large range of definitions were in use, of which 4 were cited by many authors. Various operationalizations of the concepts that were measured were identified. Chronic health conditions in childhood prevalence estimates ranged from 0.22% to 44%, depending on these operationalizations.

Conclusions

The wide variability in reported prevalence rates of chronic health conditions in childhood can be explained by considerable diversity in the concepts and operationalizations used. International consensus about the conceptual definition of chronic health conditions in childhood is needed.