Systematic review of the relationship between chronic health conditions in childhood and economic outcomes in adulthood

Abstract

Background: Our objective was to update a 2015 systematic review of the literature which identified associations between chronic health conditions before age 18 years and economic outcomes in adulthood.

Methods: The following databases were searched: MEDLINE, Embase, PsycINFO, CINAHL, EconLit, EBM Reviews, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, Web of Science Core collection, ERIC and British Education Index. Eligible papers were assessed for quality.

Results: There were 24 eligible studies. Childhood illnesses were grouped into chronic mental health (n=15), chronic health conditions (n=7) and neurodiverse conditions (n=6); some papers reported outcomes for more than one group. For chronic mental health conditions in childhood, for example anxiety and depression, meta-analysis found increased risk in adulthood for unemployment (OR 2.1 (95% CI 1.5, 2.9)), not being in employment, education or training (NEET) (OR 1.6 (95% CI 1.2, 2.0)) and for being in receipt of benefits (OR 2.6 (95% CI 1.7, 3.9)). Chronic physical health conditions in childhood were associated with adverse economic outcomes in adulthood in five of the seven studies. Only one of the three studies showed a risk of being NEET. Attention-deficit hyperactivity disorder (ADHD) in childhood was associated with increased risk of adult unemployment in three of five studies, increased risk of receiving benefits in three of four studies and with reduced income in the two studies where it was reported.

Conclusions: Chronic mental illness and ADHD in childhood are associated with adverse economic outcomes in adulthood in most populations identified. Future research should determine whether early identification and interventions for childhood-onset mental illness and ADHD improve economic outcomes in adulthood.

Prospero registration number: CRD42023440899.

Keywords: Child Health; Employment; Mental health.