Early Poverty, Early Poor Health, and Health Outcomes in Later Childhood: A Birth Cohort Study

Background: This study analyses the mediation effects of early health prior to age 3 on the association between early poverty and the health outcomes of children at age 12. Methods: Data for the analysis came from the Taiwan Birth Cohort Study (TBCS), a nationally representative sample of 16,847 children who completed six waves of surveys between 2005 and 2017. The outcome variables were child’s general health and hospitalization experience at 12 years of age. Multiple logistic regression and causal mediation analysis were conducted. Findings: Among the TBCS children, the prevalence of fair/poor health and hospitalization was 20 · 8% and 2 · 5% at age 12. The odds ratios of experiencing fair/poor health and hospitalization at age 12 were 1 · 33 (95% confidence interval 1 · 21 to 1 · 45) and 1 · 35 (1 · 07 to 1 · 69) for early poverty, respectively. When early poor health was added in the multiple logistic regression models, the effects of early poverty were attenuated on poor general health and no longer significant on hospitalizations for children aged 12 years. Mediation analysis showed that 50-87% of the total effect of early poverty on health at age 12 was mediated by early health status before age 3. Interpretation: This study suggests that the negative effects of early poverty on early health prior to age 3 have long-lasting impacts on the later health status of children. Protecting children from growing up in poverty may help prevent poor health throughout the life course. Funding: The Health Promotion Administration, Department of Health and Welfare and the Ministry of Science and Technology in Taiwan. Declaration of Interests: None declared. Ethics Approval Statement: The study was approved by the Institutional Review Board at National Taiwan University Hospital (reference number 201612181RIND).