Examining Iron Status, Development, and Behavior in Young Children in the Pennsylvania Foster Care System, an Exploratory Retrospective Medicaid Claims Review
Open Access
- Author:
- Arcot, Amrita
- Graduate Program:
- Nutritional Sciences
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- June 11, 2021
- Committee Members:
- Laura E Murray-Kolb, Thesis Advisor/Co-Advisor
Sarah Anne Font, Committee Member
A Ross, Program Head/Chair
Xiang Gao, Committee Member - Keywords:
- nutrition
foster care
child welfare
iron
iron deficiency
anemia
cognition
behavior
medicaid - Abstract:
- Children in foster care are classified as a highly vulnerable health population, with nearly 40-90% of children entering foster care with a physical health problem. Nutritional examination of children in foster care is often confined to anthropometric measurements. Knowledge on the micronutrient status of this pediatric population is lacking and requires further exploration. Iron deficiency (ID) is of interest because it is the most common micronutrient deficiency worldwide and contributes to 50% of anemia diagnoses globally. Iron is important for optimal brain development and functioning, which will have downstream effects on a person’s developmental and behavioral outcomes. To our knowledge, few studies on children in U.S. Foster Care have quantified the prevalence of anemia, and no studies have examined the association between anemia status and relevant developmental and behavioral outcomes. The aims of the present study are to (1) determine the prevalence of IDA/anemia among children in Pennsylvania (PA) Foster Care, between the ages of six months to ten years and (2) examine if a child’s poor iron status is associated with greater odds of relevant developmental and behavioral diagnoses. The following study was a secondary data analysis, utilizing the Medicaid Analytic eXtract database, between 2010-2015 (most recently available data). Children (six months to ten years old) were included in analysis if they were in the PA Foster Care at one point in their life. Children who met the predetermined criterion of IDA/anemia were classified as diagnosed with IDA/anemia. The comparison group were children (six months to ten years old) who were in PA Foster Care at one point in their life but did not meet the criterion for IDA/anemia. The comparison group was classified as not diagnosed with IDA/anemia. Often hospitals and clinics will utilize hemoglobin to determine anemia, without identifying the etiology. ID is a common driver of anemia, both in the U.S. and globally; however, other etiologies exist. Due to concerns of low sample size, IDA and anemia diagnoses were combined into one larger group. Developmental and behavioral diagnoses, with well-established or strongly hypothesized relationships with ID and IDA, were extracted for analysis. 50,311 children met the eligibility criteria for the present study, of which 1,365 children were diagnosed with IDA/anemia. Overall, 2.7% of children in the PA Foster Care System were diagnosed with IDA/anemia, between 2010-2015. Children diagnosed with IDA/anemia had greater odds of moderate to profound intellectual disability (Intelligence Quotient < 49), delayed milestones, specific delays in development, and overall intellectual disability, when compared to children not diagnosed with IDA/anemia. Nearly 50% of children diagnosed with IDA/anemia were diagnosed with a specific delay in development, which includes disruptions in reading, arithmetic, and expressive language. Children diagnosed with IDA/anemia had significantly greater odds of adjustment disorder, autism spectrum disorder, restlessness and agitation, disruptive mood dysregulation disorder, and irritability, when compared to children not diagnosed with IDA/anemia. The prevalence of anemia among children in the PA Foster Care System is within the national rate of U.S. childhood anemia. The odds of developmental and behavioral diagnoses were generally greater among children diagnosed with IDA/anemia than children who were not. Future studies should comprehensively assess iron biomarkers and developmental and behavioral outcomes among children in foster care. If an association between iron status and development and behavior is found, it could reveal an affordable solution, like iron supplementation, which could dismantle at least one burden faced by this vulnerable population.