Associations of self-reported atopic dermatitis with comorbid conditions in adults: a population-based cross-sectional study

Abstract Background The objective of this study was to investigate the relationships between atopic dermatitis (AD) and other common chronic health conditions in adults. Methods A cross-sectional survey was sent to a randomly selected population sample of 78,004 adults in Sweden. The questionnaires included measures of self-reported physical and mental health. Binary and multinomial logistic regression were used to examine the associations of AD with common chronic health conditions and psychological wellbeing. Results AD was self-reported by 4,175 respondents, representing almost 14% of the study population of 34,313 adults. Our results showed positive associations between AD and chronic health disorders, including conditions of the oral cavity: chronic obstructive pulmonary disease (adjusted odds ratio [aOR] = 1.58, 95% confidence interval [CI]: 1.30 to 1.92), asthma (aOR = 2.13, 95% CI: 1.91 to 2.38), mild recurrent gastrointestinal symptoms (adjusted relative risk ratio [aRRR] = 1.78, 95% CI: 1.64 to 1.92), high blood pressure (aOR = 1.16, 95% CI: 1.06 to 1.26), obesity (aOR = 1.34, 95% CI: 1.23 to 1.47), mild joint pain (aRRR = 1.47, 95% CI: 1.35 to 1.61), mild headache or migraine (aRRR = 1.50, 95% CI: 1.38 to 1.64), caries (aOR = 1.25, 95% CI: 1.04 to 1.49), bleeding gums (aOR = 1.69, 95% CI: 1.38 to 2.08), periodontitis (aOR = 1.42, 95% CI: 1.13 to 1.77), sensitive teeth (aOR = 1.57, 95% CI: 1.35 to 1.82), and dry mouth (aOR = 1.52, 95% CI: 1.33 to 1.74). Adjustment for asthma and depression attenuated the magnitude of the associations between AD and the study outcomes. AD was also associated with poorer general psychological wellbeing. Conclusions Adults reporting AD may be at increased risk of chronic disorders and decreased psychological wellbeing. Physicians should recognize that individuals with severe AD and those with comorbid asthma or depression may be especially vulnerable.

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Health outcomes in a national sample of American Indian and Alaska Native adults: Differences between multiple-race and single-race subgroups

PLoS ONE ◽

10.1371/journal.pone.0242934 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242934

Author(s):

Ursula Running Bear ◽

Nancy L. Asdigian ◽

Janette Beals ◽

Spero M. Manson ◽

Carol E. Kaufman

Keyword(s):

Health Care ◽

Health Outcomes ◽

American Indian ◽

Access To Health Care ◽

Multinomial Logistic Regression ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Access To Health ◽

Increased Risk

Objectives To determine differences among multi-race (MR) American Indian and Alaska Natives (AIAN), single race (SR) AIANs, and SR-Whites on multiple health outcomes. We tested the following hypotheses: MR-AIANs will have worse health outcomes than SR-AIANs; SR-AIANs will have worse health outcomes than SR-Whites; MR-AIANs will have worse health outcomes than SR-Whites. Methods Behavioral Risk Factor Surveillance System data were used to examine general health, risk behaviors, access to health care, and diagnosed chronic health conditions. Those identifying as SR-White, SR-AIAN, and MR-AIAN were included in multinomial logistic regression models. Results Compared to SR-AIANs, MR-AIANs had more activity limitations, a greater likelihood of experiencing cost as a barrier to health care and were more likely to be at increased risk and diagnosed with more chronic health conditions. Both SR and MR-AIANs have worse health than SR-Whites; MR-AIANs appear to be at increased risk for poor health. Conclusions The current study examined access to health care and nine chronic health conditions, neither of which have been considered in prior work. MR AIANs are at increased risk compared to SR groups. These observations beg for further inquire into the mechanisms underlying these differences including stress related to identify, access to care, and discrimination. Findings support the continued need to address health disparities among AIANs regardless of SR or MR identification.

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Social and early life adversity and chronic health conditions among Tunisian adults

Translational Behavioral Medicine ◽

10.1093/tbm/iby126 ◽

2018 ◽

Vol 10 (4) ◽

pp. 949-958

Author(s):

Sana El Mhamdi ◽

Andrine Lemieux ◽

Manel Ben Fredj ◽

Ines Bouanene ◽

Arwa Ben Salah ◽

...

Keyword(s):

Early Life ◽

Significant Risk ◽

Chronic Health Conditions ◽

Health Conditions ◽

Outcome Variable ◽

Collective Violence ◽

Cumulative Number ◽

Cross Sectional ◽

Mediation Effects ◽

Chronic Health

Abstract Early life adversities (ELAs) are shown as significant risk factors for chronic health conditions (CHCs). ELAs include multiple types of abuse such as the social abuse (peer, community, and collective violence). The purpose is to describe the relationship between childhood social abuse and chronic conditions in adulthood among a sample of adults in Tunisia and to investigate the role of obesity and tobacco use as mediators of this association. A cross-sectional study was conducted in Tunisia, from January to June 2016 using the Arabic Adverse Childhood Experiences International Questionnaire (ACE-IQ). Items of social abuse (peer violence, witnessing community violence, and exposure to collective violence) were analyzed. A total of 2,120 adults were enrolled. After adjustment for age, gender, and intrafamilial ELA, social adversities were associated significantly with the selected CHC. Experiencing more than two social ELA increase the risk of occurrence of hypertension and coronary diseases. After accounting for the indirect effect of body mass index, statistically significant partial mediation effects were observed for the cumulative number of social ELA as the exposure variable and chronic diseases as the outcome variable (p ≤ .001; % mediated = 44.5%). These findings support an association between many chronic health disorders and childhood social abuse, independently of intrafamilial ACEs.

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Modifiable Risk Factors for Neurocognitive and Psychosocial Problems After Hodgkin Lymphoma

Blood ◽

10.1182/blood.2021013167 ◽

2021 ◽

Author(s):

AnnaLynn M Williams ◽

Sedigheh Mirzaei Salehabadi ◽

Mengqi Xing ◽

Nicholas Steve Phillips ◽

Matthew Ehrhardt ◽

...

Keyword(s):

Quality Of Life ◽

Hodgkin Lymphoma ◽

Chronic Health Conditions ◽

Health Conditions ◽

Cross Sectional ◽

Chronic Health ◽

Modifiable Factors ◽

Task Efficiency

Long-term survivors of childhood Hodgkin lymphoma (HL) experience high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. 1,760 survivors of HL (mean[SD] age 37.5[6.0] years, time since diagnosis 23.6[4.7] years, 52.1% female) and 3,180 siblings (age 33.2[8.5] years, 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to NCI CTCAE v4.3 (1=mild, 2=moderate, 3=severe/disabling, 4=life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs. siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment factors and grade 2+ chronic health conditions. Compared with siblings, survivors had significant higher risk (p's<0.05) of neurocognitive impairment (e.g. memory 8.1% vs. 5.7%), anxiety (7.0%%vs. 5.4%),depression (9.1% vs. 7%), unemployment (9.6% vs. 4.4%), and impaired physical/mental quality of life (e.g. physical function 11.2% vs. 3.0%). Smoking was associated with higher risk of impairment in task efficiency (RR=1.56[1.02-2.39]), emotional regulation (RR=1.84[1.35-2.49]), anxiety (RR=2.43[1.51-3.93]), and depression (RR=2.73[1.85-4.04]). Meeting CDC exercise guidelines was associated with lower risk of impairment in task efficiency (RR=0.70[0.52-0.95]), organization (RR=0.60[0.45-0.80]), depression (RR=0.66[0.48-0.92]), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.

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Long-Term Health-Related Outcomes In Survivors Of Childhood Hematopoietic Cell Transplantation (HCT): A Report From The Bone Marrow Transplant Survivor Study (BMTSS)

Blood ◽

10.1182/blood.v122.21.553.553 ◽

2013 ◽

Vol 122 (21) ◽

pp. 553-553

Author(s):

Saro Armenian ◽

Can-Lan Sun ◽

Mukta Arora ◽

K. Scott Baker ◽

Liton Francisco ◽

...

Keyword(s):

Premature Death ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Allogeneic Hct ◽

Increased Risk ◽

Life Threatening ◽

Grade 3

Abstract Introduction HCT is frequently offered as a curative option for children with benign and malignant conditions. Improvement in HCT strategies have increased survival by approximately 10% per decade. Adult HCT survivors are at increased risk for chronic health conditions (Sun, Blood 2010), and premature death (Bhatia, Blood 2007; 2005). The magnitude of risk of these chronic health conditions and of premature death in childhood HCT survivors is not known. Methods Participants were drawn from the BMTSS, and included patients undergoing HCT between 1976 and 1998 at City of Hope or University of Minnesota. Participants were ≤21 years of age at HCT and were ≥2 yrs from myeloablative HCT. Participants completed a questionnaire addressing the diagnosis of physical health conditions (endocrinopathies, central nervous system compromise, cardiopulmonary dysfunction, gastrointestinal sequelae, musculoskeletal abnormalities, and subsequent malignancies), chronic GvHD (cGVHD), and sociodemographics. Chronic physical health conditions were graded using CTCAE v 3.0 (grade 1-5, ranging from mild to death due to chronic health condition). Relative risk (RR) regression was used to identify risk of health conditions and 95% confidence interval (CI). Information on vital status and cause of death was obtained from medical records, National Death Index, and Social Security Death Index, and compared with age-, sex-and calendar-specific mortality of the US general population (standardized mortality ratio [SMR]). Results The current study included 317 BMTSS participants. Median age at HCT was 7.9 yrs, and at study participation was 19.9 yrs; time from HCT was 10.3 yrs; 42% were female, 86.7% were non-Hispanic white, and 79% underwent allogeneic HCT. The most frequent indications for HCT included AML (27%), ALL (21%), SAA (13%), lymphoma (6%), and CML (5%). Total body irradiation (TBI) was used in 61% of 2 year survivors, and cGvHD was reported in 26%. Health Conditions: The cumulative incidence of a chronic health condition (grade 1-5) was 56% (95% CI: 51%-60%) at 15 years after HCT, with a cumulative incidence of 25% (95% CI: 20%-30%) for severe/life-threatening or fatal condition (grade 3-5, Figure). The highest incidence of grade 3-5 conditions was in allogeneic HCT recipients with cGvHD (32% at 15 years, 95% CI: 20%-44%; Figure). Risk Factors: After adjustment for age at HCT, follow-up, ethnicity/race, diagnosis, relapse risk at HCT, and treatment era, female participants were 1.2 (1.0-1.4, p=0.02) times more likely to report a chronic health condition, and 1.6 (1.1-2.4, p=0.01) times more likely to report a severe/life-threatening/fatal condition. Exposure to TBI was associated with a 1.3-fold (1.0-1.5, p=0.02) risk of a chronic health condition, and a 2.6-fold (1.4-4.91, p=0.003) risk of a severe/life-threatening/fatal condition compared to chemotherapy-only conditioning. Among allogeneic HCT recipients, cGvHD was associated with a 2.0-fold (1.2-3.2, p<0.01) risk of severe/life-threatening/fatal conditions when compared to survivors without cGvHD. Healthcare utilization: 92% of the survivors carried health insurance and 68% had been seen at their transplant center within the past 2 yrs. Late mortality: Overall survival in 2 year survivors was 80% at 10 years (68% autologous, 83% allogeneic, p<0.01). The primary cause of death included primary disease (61%), secondary cancer (8%), cGvHD (6%), cardiopulmonary compromise (5%), and other causes (21%). The cohort was at a 22-fold (SMR 22.0, 18.9-25.5, p<0.01) increased risk of premature death compared to age-and sex-matched general population. Female participants, those treated with TBI, and autologous HCT survivors had the highest risk of premature death (Table). Conclusions Childhood HCT survivors carry a substantial burden of morbidity, years following completion of therapy, providing clear evidence for their close monitoring in a specialized setting targeting these high risk complications. Disclosures: No relevant conflicts of interest to declare.

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Perceived Treatment Satisfaction and Effectiveness Facilitators Among Patients With Chronic Health Conditions: A Self-Reported Survey

Interactive Journal of Medical Research ◽

10.2196/13029 ◽

2020 ◽

Vol 9 (1) ◽

pp. e13029

Author(s):

Kathryn Volpicelli Leonard ◽

Courtney Robertson ◽

Amrita Bhowmick ◽

Leslie Beth Herbert

Keyword(s):

Treatment Satisfaction ◽

Survey Design ◽

Strong Relationship ◽

Chronic Health Conditions ◽

Health Conditions ◽

Perceived Effectiveness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chronic Health ◽

Factors Associated

Background Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to improved adherence. However, how patients perceive effectiveness is poorly understood. Objective The aim of this study was to elucidate factors associated with perceived treatment satisfaction and effectiveness among patients with chronic health conditions. Methods We conducted a descriptive study using a cross-sectional survey design. We administered a Web-based survey to participants with migraine, multiple sclerosis (MS), or rheumatoid arthritis (RA). Patients were recruited from established online communities of Health Union. Descriptive statistics, correlations, and comparison tests were used to examine outcomes. Results Data were collected from 1820 patients: 567 with migraine, 717 with MS, and 536 with RA. The majority of participants were female (1644/1820, 90.33%), >40 years old (1462/1820, 80.33%), and diagnosed >5 years ago (1189/1820, 65.33%). Treatment satisfaction and perceived medication effectiveness were highly correlated (r=0.90, P<.01). Overall, three temporal factors were positively correlated with satisfaction or perceived effectiveness: time on current medication (satisfaction rs=0.22, P<.01; effectiveness rs=0.25, P<.01), time since diagnosis (satisfaction rs=0.07, P<.01; effectiveness rs=0.09, P<.01), and time on treatment (effectiveness rs=0.08, P<.01). Conclusions Findings validated the strong relationship between treatment satisfaction and perceived effectiveness. Understanding the (1) positive relationship between time and treatment satisfaction and effectiveness and (2) factors associated with determining medication effectiveness can help clinicians better understand the mindset of patients regarding treatment. Clinicians may be better prepared to elicit patient beliefs, which influence medication adherence, for people diagnosed with chronic health conditions.

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Perceived Treatment Satisfaction and Effectiveness Facilitators Among Patients With Chronic Health Conditions: A Self-Reported Survey (Preprint)

10.2196/preprints.13029 ◽

2018 ◽

Author(s):

Kathryn Volpicelli Leonard ◽

Courtney Robertson ◽

Amrita Bhowmick ◽

Leslie Beth Herbert

Keyword(s):

Treatment Satisfaction ◽

Survey Design ◽

Strong Relationship ◽

Chronic Health Conditions ◽

Health Conditions ◽

Perceived Effectiveness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chronic Health ◽

Factors Associated

BACKGROUND Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to improved adherence. However, how patients perceive effectiveness is poorly understood. OBJECTIVE The aim of this study was to elucidate factors associated with perceived treatment satisfaction and effectiveness among patients with chronic health conditions. METHODS We conducted a descriptive study using a cross-sectional survey design. We administered a Web-based survey to participants with migraine, multiple sclerosis (MS), or rheumatoid arthritis (RA). Patients were recruited from established online communities of Health Union. Descriptive statistics, correlations, and comparison tests were used to examine outcomes. RESULTS Data were collected from 1820 patients: 567 with migraine, 717 with MS, and 536 with RA. The majority of participants were female (1644/1820, 90.33%), >40 years old (1462/1820, 80.33%), and diagnosed >5 years ago (1189/1820, 65.33%). Treatment satisfaction and perceived medication effectiveness were highly correlated (r=0.90, P<.01). Overall, three temporal factors were positively correlated with satisfaction or perceived effectiveness: time on current medication (satisfaction rs=0.22, P<.01; effectiveness rs=0.25, P<.01), time since diagnosis (satisfaction rs=0.07, P<.01; effectiveness rs=0.09, P<.01), and time on treatment (effectiveness rs=0.08, P<.01). CONCLUSIONS Findings validated the strong relationship between treatment satisfaction and perceived effectiveness. Understanding the (1) positive relationship between time and treatment satisfaction and effectiveness and (2) factors associated with determining medication effectiveness can help clinicians better understand the mindset of patients regarding treatment. Clinicians may be better prepared to elicit patient beliefs, which influence medication adherence, for people diagnosed with chronic health conditions.

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Psychosocial Challenges and Opportunities for Youth With Chronic Health Conditions During the COVID-19 Pandemic (Preprint)

10.2196/preprints.23057 ◽

2020 ◽

Author(s):

Anna Serlachius ◽

Sherif M Badawy ◽

Hiran Thabrew

Keyword(s):

Clinical Care ◽

Well Being ◽

Economic Stress ◽

School Closure ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Access To Health ◽

Increased Risk ◽

Challenges And Opportunities

UNSTRUCTURED School closures, altered access to health services, and economic stress during the COVID-19 pandemic have likely had an impact on the mental and physical well-being of youth worldwide, particularly among those with chronic health conditions (CHCs). A number of challenges and opportunities have emerged during the COVID-19 pandemic for youth with CHCs. Challenges include heightened anxiety, disrupted routines, academic and social stresses associated with school closure, increased risk of domestic violence and abuse, and reduced access to physical and psychosocial support. On the other hand, opportunities include reduced academic and social stress, increased time with families, reduced access to substances, easier access to health care using technology, and opportunities to build resilience. This viewpoint paper highlights both challenges and opportunities for youth with CHCs during the pandemic and offers recommendations for further research and clinical care.

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Physical multimorbidity patterns and depressive symptoms: a nationwide cross-sectional study in Japan

Family Medicine and Community Health ◽

10.1136/fmch-2019-000234 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000234

Author(s):

Takuya Aoki ◽

Yosuke Yamamoto ◽

Sayaka Shimizu ◽

Shunichi Fukuhara

Keyword(s):

Depressive Symptoms ◽

Cross Sectional Study ◽

Chronic Health Conditions ◽

Health Conditions ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chronic Health ◽

Japanese Residents ◽

Quota Sampling ◽

Multimorbid Patients

ObjectiveThe associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies. However, whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear. This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms.DesignThis study was designed as a nationwide cross-sectional survey in Japan.SettingGeneral sample of the Japanese population.ParticipantsAdult Japanese residents were selected by a quota sampling method. Data were analysed from 1788 residents who reported one or more chronic health conditions.ResultsAmong four physical multimorbidity patterns: cardiovascular-renal-metabolic (CRM), skeletal-articular-digestive (SAD), respiratory-dermal (RDE) and malignant-digestive-urologic (MDU), multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms (aOR=1.68, 95% CI: 1.21 to 2.31 for the pattern score highest quartile, compared with the lowest quartile), followed by SAD and MDU patterns (aOR=1.41, 95% CI: 1.01 to 1.98 for the SAD pattern score highest quartile; 1.41, 95% CI: 1.01 to 1.96 for the MDU pattern score highest quartile, compared with the lowest quartile). In contrast, the CRM pattern score was not significantly associated with depressive symptoms (aOR=1.31, 95% CI: 0.90 to 1.89 for the pattern score highest quartile, compared with the lowest quartile).ConclusionsPhysical multimorbidity patterns have different associations with depressive symptoms. Among these patterns, patients with the RDE pattern may be at a higher risk for developing depressive symptoms. This study reinforces the evidence that cluster pattern of chronic health conditions is a useful measure for clinical management of multimorbidity as it is differently associated with mental health status, which is one of the crucial outcomes for multimorbid patients.

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Increasing risk of chronic health conditions in aging survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9514 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9514-9514

Author(s):

Gregory T. Armstrong ◽

Toana Kawashima ◽

Wendy M. Leisenring ◽

Marilyn Stovall ◽

Charles A Sklar ◽

...

Keyword(s):

Childhood Cancer ◽

Cumulative Incidence ◽

Premature Aging ◽

Chronic Health Conditions ◽

Health Conditions ◽

High Risk Population ◽

Chronic Health ◽

Increased Risk ◽

Grade 3 ◽

Survivors Of Childhood Cancer

9514 Background: Survivors of childhood cancer are at an increased risk for treatment-related chronic health conditions during early adulthood. However, the incidence, severity, and spectrum of chronic health conditions in the fourth and fifth decades of life have not been well studied. Methods: Analyses included 14,358 > 5 yr survivors of childhood cancer (median age at last follow-up 32.3 yrs, range 8.0-58.0; 21.4% > 40 years) and a sibling comparison group (n = 4,031). Self-reported health conditions were classified using NCI CTCAE 4.0 grading system. Analyses focused on two primary outcomes: severe/life-threatening/fatal conditions (grades 3-5), and multiple (≥ 2) conditions. Cumulative incidence of a new chronic health condition was calculated from age 26 yrs. Cox proportional hazards models adjusted for gender and race, were evaluated using age as the time scale. Results: Among survivors with no previous health conditions through age 25, the cumulative incidence for a new grade 3-5 condition by age 50 compared to siblings was 45.9% (95% CI 45.9-45.9) vs. 13.9%, (95% CI 13.9-14.0) and for new onset of ≥ 2 conditions 33.0% (95% CI 33.0-33.1) vs. 24.9% (95% CI 24.8-24.9) . Survivors ≥ 40 yrs of age had a 5.8-fold (95% CI 5.3 – 6.5) increased risk of a grade 3-5 condition compared to same age siblings, in contrast to those < 40 years of age (HR 2.7, 95% CI 2.5-3.0). A similar magnitude of difference was present for risk of >2 conditions (HR 2.7 vs. 1.2). In comparison to siblings, survivors > 40 years of age had a significantly increased risk for: congestive heart failure (HR 15.7, 95% CI 9.2-26.7), myocardial infarction (HR 8.8, 95% CI 6.0-12.9), stroke (HR 8.6, 95% CI 5.6-13.2),joint replacement (HR 6.8, 95% CI 4.1-11.4), renal failure (HR 5.1, 95% CI 2.2-11.9) among other serious conditions. Conclusions: As they age, adult survivors of childhood cancer continue to develop new and serious health conditions at substantially higher rates than siblings. These data emphasize the importance of placing a greater focus on investigations of premature aging and organ senescence in this high risk population.

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53 Health Outcomes of Siblings of Children with Chronic Health Conditions: A Systematic Review and Meta-Analysis

Paediatrics & Child Health ◽

10.1093/pch/pxab061.042 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e38-e39

Author(s):

Benjamin Martinez ◽

Petros Pechlivanoglou ◽

Dorisa Meng ◽

Benjamin Traubici ◽

Quenby Mahood ◽

...

Keyword(s):

Health Outcomes ◽

Rating Scale ◽

Well Being ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Increased Risk ◽

Scale Scores

Abstract Primary Subject area Mental Health Background Chronic childhood health conditions are known to have an impact on the well-being of family members. Parental caregivers face well-defined adverse health outcomes, though less is known about the health impacts on siblings. Objectives To assess clinical health outcomes in siblings of children with chronic health condition(s) compared to siblings of healthy children or normative data. Design/Methods We searched Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL through June 4, 2020. We included English-language studies that: (1) reported clinically diagnosable mental or physical health outcomes of siblings of children (0-18 years old) diagnosed with any childhood chronic health condition; (2) included a comparison group; and (3) used an experimental or observational study design. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results We included 28 studies of the 9053 screened, comprising 10 cohort studies and 18 cross-sectional studies. Studies from 11 different countries reported most commonly on siblings of children with disabilities (12 studies), cancer (8 studies), or psychiatric disorders (4 studies). Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference 0.49; 95% CI 0.33-0.65; P < .001 [5 studies]) (Fig. 1), whereas anxiety scores did not differ significantly (standardized mean difference 0.24; 95% CI -0.03-0.52; P = .08 [6 studies]) (Fig. 2). Studies that reported on prevalence of psychiatric diagnoses, rather than rating scale scores, had mixed results, either indicating increased risk (3 studies) or no increased risk (4 studies) among exposed siblings. We did not meta-analyze effects for mortality (3 studies) or physical health outcomes (dental caries [1 study], traumatic brain injury [1 study], sexually transmitted infection [1 study], overweightness/obesity [1 study]) given the limited number of studies and between-study heterogeneity. Included studies were rated as high quality (12 studies) or of moderate quality (16 studies). Conclusion Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.

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