Miriam Evensen

Child poverty has been steadily rising across high-income countries, including Scandinavia, raising concerns about its spatial concentration and potential impact on inequality. This study uses administrative data to investigate the development of geographic concentration of child poverty in Norway from 2004 to 2022, with a focus on variations across immigrant and native-born children. We analyze neighborhood poverty trends and measure overexposure to capture shifts in spatial inequality. Our key findings are that segregation, as measured by overexposure, has not increased over time despite a rise in child poverty. However, substantial differences persist, where overexposure to low-income neighbors is particularly pronounced among low-income immigrant children. Additionally, while aggregate levels of overexposure have remained stable, we observe local spatial shifts, particularly in the capital, Oslo, with some areas exhibiting increasing overexposure. Together, these patterns highlight persistent disparities among children, with potential consequences for child development and social integration.

Educational inequalities in childlessness have grown across cohorts. It remains unclear to what extent this development was driven by a decline in resources and abilities in groups with low education. Using high-quality Norwegian population registers (n=683,882 men born 1963-1991), we find that increasing educational inequalities in childlessness are mirrored by growing educational gaps in employment participation and income. Educational groups have diverged on resources (parental income rank) but converged on abilities (relative cognitive ability). Regression models show that changes in the composition of educational groups in terms of parental income explain 6%-7% of the growth in educational gaps in childlessness, employment participation and income. In contrast, gaps in life outcomes would have grown more than observed had educational groups not converged on cognitive abilities. We conclude that relative education-specific changes in financial resources and cognitive abilities explain little, if any, of the growing educational inequalities in the life outcomes studied.

Background: Child mortality has declined rapidly over the last century in many high-income countries. However, little is known about the socio-economic differences in this decline and whether these vary across causes of death. Methods: We used register data that included all Norwegian births between 1968 and 2010 (2.1 million), and we analysed how all-cause and cause-specific child (0–4 years) and adolescent (5–20 years) mortality rates vary with relative parental income the year before the birth. Results: Child and adolescent all-cause mortality decreased with increasing parental relative income within all birth cohorts. Among children aged 0–4 years, the socio-economic gradient in all-cause mortality and in mortality due to external causes, sudden infant deaths and perinatal factors declined over the period, while there was no systematic decline in mortality from congenital malformations. Among children aged 5–20 years, the gradient did not weaken similarly, although there were indications of declines in the socio-economic gradient related to all-cause deaths and deaths because of suicides and other external causes. While the absolute differences in mortality declined over time, the relative differences remained stable. Conclusions: Although children of low-income parents still have elevated mortality, there has been a large reduction in child mortality in all socio-economic groups across 50 years for all causes combined and most of the groups of specific causes of death.

The COVID-19 pandemic and its associated restrictions may have affected children and adolescent’s mental health adversely. We cast light on this question using primary and specialist consultations data for the entire population of children of age 6–19 years in Norway (N = 908 272). Our outcomes are the monthly likelihood of having a consultation or hospitalization related to mental health problems and common mental health diagnoses. We compared a pandemic (2019–2021) to a pre-pandemic (2017–2019) cohort using event study and difference-in-difference designs that separate the shock of the pandemic from linear period trends and seasonal variation. We found temporary reductions in all mental health consultations during lockdown in spring 2020. In fall 2020 and winter 2021, consultation volumes in primary care increased, stabilizing at a higher level in 2021. Consultations in specialist care increased from spring 2021. Our findings could suggest a worsening of mental health among adolescents.

BACKGROUND There have been widespread concerns about the impact of the COVID-19 pandemic and its associated restrictions on children’s and adolescent’s mental health. While some studies have found increasing rates of mental health problems during the pandemic, other evidence suggest that mental symptoms and disorders were increasing before the pandemic. This study compared trends in mental healthcare use during the first 15 months of the pandemic with similar pre-pandemic trends. METHODS Consultations related to mental symptoms and disorders were identified through national registries from primary and specialist healthcare services, including hospitalizations, covering the entire population of children 6-18 years in Norway (N=908 272). The monthly likelihood of having a consultation or hospitalization related to overall mental health problems, and specific diagnoses for depression, anxiety, ADHD and sleep problems were plotted from January 2020 to May 2021 and compared to trends over the same period between 2017-2019 using event study and difference-in-difference designs. FINDINGS We found reductions in consultations for mental health symptoms and disorders in primary and specialist healthcare during the first weeks of lockdown in 2020. This decline was temporary, and volumes of consultations quickly returned to pre-pandemic levels. However, during fall 2020, consultation volumes related to mental health in primary care increased. This increase persisted into the winter of 2021 but levelled off by the last month of the sample period. The increase in consultation volumes was about 50 % compared to the pre-pandemic period. We did not find increases in consultations in specialist healthcare, except for hospitalizations. CONCLUSION We found an increase in primary care consultation volumes related to mental health among children that depart from the previously established increases over recent years. We did not see similar increases in consultations in the specialist healthcare. It is unknown whether increases in primary care consultations represent milder cases, which primarily do not need specialist treatment, or if the stability in specialist healthcare consultations reflects capacity problems or timelags in referrals.

Background: Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities, and it remains unclear how the shape of the gradient varies across health conditions. This study examined the association between parental income in childhood and several measures of morbidity in adulthood. Methods: We used administrative data on seven complete Norwegian birth cohorts born in 1967–1973 (N = 429,886) to estimate the association between parental income from birth to age 18, obtained from tax records available from 1967, linked with administrative registries on health. Health measures, observed between ages 39 and 43, were taken from registry data on consultations at primary health care services based on diagnostic codes from the International Classification of Primary Care (ICPC-2) and hospitalizations and outpatient specialist consultations registered in the National Patient Registry (ICD-10). Results: Low parental income during childhood was associated with a higher risk of being diagnosed with several chronic and pain-related disorders, as well as hospitalization, but not overall primary health care use. Absolute differences were largest for disorders related to musculoskeletal pain, injuries, and depression (7–9 percentage point difference). There were also differences for chronic disorders such as hypertension (8%, CI 7.9–8.5 versus 4%, CI 4.1–4.7) and diabetes (3.2%, CI 3.0–3.4 versus 1.4%, CI 1.2–1.6). There was no difference in consultations related to respiratory disorders (20.9%, CI 20.4–21.5 versus 19.7%, CI 19.2–20.3). Childhood characteristics (parental education, low birth weight, and parental marital status) and own adult characteristics (education and income) explained a large share of the association. Conclusions: Children growing up at the bottom of the parental income distribution, compared to children in the top of the income distribution, had a two- to threefold increase in somatic and psychological disorders measured in adulthood. This shows that health inequalities by socioeconomic family background persist in a Scandinavian welfare-state context with universal access to health care.

Children with low-income parents have a higher risk of mental disorders, although it is unclear whether other parental characteristics or genetic confounding explain these associations and whether it is true for all mental disorders. In this registry-based study of all children in Norway (n = 1 354 393) aged 5–17 years from 2008 to 2016, we examined whether parental income was associated with childhood diagnoses of mental disorders identified through national registries from primary healthcare, hospitalizations and specialist outpatient services. There were substantial differences in mental disorders by parental income, except for eating disorders in girls. In the bottom 1% of parental income, 16.9% [95% confidence interval (CI): 15.6, 18.3] of boys had a mental disorder compared with 4.1% (95% CI: 3.3, 4.8) in the top 1%. Among girls, there were 14.2% (95% CI: 12.9, 15.5) in the lowest, compared with 3.2% (95% CI: 2.5, 3.9) in the highest parental-income percentile. Differences were mainly attributable to attention-deficit hyperactivity disorder in boys and anxiety and depression in girls. There were more mental disorders in children whose parents had mental disorders or low education, or lived in separate households. Still, parental income remained associated with children’s mental disorders after accounting for parents’ mental disorders and other factors, and associations were also present among adopted children. Mental disorders were 3- to 4-fold more prevalent in children with parents in the lowest compared with the highest income percentiles. Parents’ own mental disorders, other socio-demographic factors and genetic confounding did not fully explain these associations.

INTRODUCTION: Disparities in health by adult income are well documented, but we know less about the childhood origins of health inequalities. This study examined the association between parental income in childhood and health in adulthood. METHODS: We used administrative data on seven complete Norwegian birth cohorts born 1967-1973 (N = 429, 886) to estimate the association between parental income from birth to age 18, obtained from tax records available from 1967, linked with administrative registries on health. Health measures, observed between ages 39 to 43, were taken from registry data on consultations at primary health care services and hospitalizations and out-patient specialist consultations registered in the National Patient Registry. RESULTS: Low parental income during childhood was associated with a 10, 2 percentage-point higher risk of overall disorders between the 5% highest (66.8%, CI 66.2-67.3) and lowest (77.2%, CI 76.6-77.8) parental income vigintiles. Absolute differences were largest for disorders related to musculoskeletal pain, injuries, and depression (7-9 percentage-point difference). There were also differences for hypertension (8%, CI 7.9-8.5 versus 4%, CI 4.1-4.7) and diabetes (3.2%, CI 3.0-3.4 versus 1.4%, CI 1.2-1.6), but smaller differences in consultations related to respiratory disorders (20.9% CI 20.4-21.5 versus 19.7% CI 19.2-20.3). Stratified analyses by other parental characteristics (education and marital status) and own adult characteristics (education and income) still showed a parental income gradient. CONCLUSIONS: Low parental income in childhood was typically associated with a two-to-threefold increase in somatic and psychological disorders measured in adulthood, even in a setting with universal health care. This indicates that access alone is not enough to break intergenerational patterns of socioeconomic differences in health. WHAT IS KNOWN: It is well documented that higher incomes among adults is positively associated with health and longevity, however, less is known about how childhood parental income is related to adult health. WHAT THIS STUDY ADDS: We used administrative data on seven full Norwegian birth cohorts with information on parental income covering the whole childhood and a broad set of adult health measures taken from primary and secondary health service consultations. We demonstrate substantial associations between childhood parental income and overall measures of adult health, as well as for a large number of specific diagnoses, within a societal context where access to high-quality health care is universal. These gradients in adult health by childhood parental income did not vary substantively by other childhood circumstances, such as health at birth, mother’s marital status, and parental education. Despite individuals’ own completed education and adult income being strongly related to adult health, we found remaining adult health gradients by childhood parental income within all subpopulations stratified by own level of adult socioeconomic attainment.