15 - Demographic, Health-Related, and Social Correlates of Digestive Problems Among U.S. Children

Publication Number: 3014.15

Evangelos D. Katsanos, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Jakob von Morgenland, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Rebecca N. Dudovitz, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Kathryn Leifheit, UCLA Fielding School of Public Health, Los Angeles, CA, United States

Background: Gastrointestinal conditions are common in children and impact growth, nutrition, and well-being. Yet, national data on how social and environmental factors influence these symptoms are limited. Social determinants of health, such as food or housing insecurity and adverse childhood experiences, may contribute through biological and psychosocial pathways. Understanding these links could guide future prevention strategies and screening recommendations in pediatrics.

Objective: To describe demographic, health-related, and social correlates of parent-reported digestive problems among U.S. children.

Design/Methods: We analyzed data from the 2023 National Survey of Children’s Health, a nationally representative parent-reported survey of children aged 0–17 years. Digestive symptoms were defined based on an affirmative parental response to the question, “During the past 12 months, has this child had frequent or chronic difficulty digesting food, including stomach/intestinal problems, constipation, or diarrhea?” We compared children with and without digestive problems across demographic, health, and social factors using weighted frequencies and chi-square tests. The study was exempt from IRB review as a secondary analysis of de-identified data.

Results: The analytic sample included 55,162 children, of whom 4,540 (7.7%) had parent-reported digestive problems. Prevalence varied by race/ethnicity (p=0.015): 8.5% in Hispanic, 7.9% in non-Hispanic White, 5.5% in non-Hispanic Black, and 7.1% in other children. No significant differences were seen by age, sex, or parental nativity, marital status, or education. Digestive problems were more common among children whose parents reported economic hardship (12.8% vs. 6.9%), food insecurity (13.3% vs. 7.4%), or housing insecurity (12.8% vs. 6.9%) (all p< 0.001). Prevalence rose with increasing ACEs (6.6% vs. 9.0% vs. 12.0% for 0, 1–3, and 4+ ACEs; p< 0.001). Among ACEs, all except parental death were linked to higher prevalence, including parental divorce, mental health problems, incarceration, substance use, household physical abuse, neighborhood violence, and racial discrimination.

Conclusion(s): Children facing greater material hardship, food or housing insecurity, and more adverse childhood experiences (ACEs) had a higher prevalence of digestive problems than advantaged peers. Prevalence also varied by race and ethnicity, though not by age, sex, or parental demographics. These findings highlight the need to integrate social screening into pediatric gastroenterology to further investigate mechanisms linking social and environmental factors to digestive health.