Chronic conditions in childhood: Determinants and outcomes

This tab presents a sociodemographic and health profile of children and youth aged 1 to 17 years living in the 10 Canadian provinces in 2023. All data are from the 2023 cycle of the Canadian Health Survey on Children and Youth (CHSCY).

On this page

• Sociodemographic factors
• Health status
• Movement behaviours
• Functional difficulties
• Discussion
• References

Sociodemographic factors

The distribution of family income was similar for children and youth with or without a diagnosed long-term condition.

Compared to children and youth without a long-term condition, a smaller proportion of children and youth with a long-term condition:

• lived in an urban area
• were a visible minority
• were from an immigrant family
• had parents with a bachelor’s degree or higher

About 5% of the children and youth were Indigenous (First Nations, Métis or Inuit). However, a larger proportion of children and youth with a long-term condition were of First Nation or Métis identity compared to those without a long-term condition.

Figure 1: among children and youth with and without a long-term condition, 2023, Canada, excluding territories

Figure 1: Notes

• We based percentages and 95% confidence intervals (CIs) on weighted data to represent the population aged 1 to 17 years living in the 10 Canadian provinces. The 95% CI shows an estimated range of values. It’s likely to include the true value 19 times out of 20.
• "Any long-term condition" includes asthma, diabetes, epilepsy, anxiety disorder, mood disorder, eating disorder, learning disability or disorder, attention deficit hyperactivity disorder (ADHD), autism, fetal alcohol spectrum disorder (FASD) as well as an “other” long-term condition reported by the survey respondents. We excluded allergies from “Any long-term condition” to align with the CHSCY 2019 questionnaire and for consistency throughout this report.
• Due to small cell sizes, other breakdowns of variables (such as by specific ethnicity/race, or immigration status) weren’t possible.
• In cases where multiple Indigenous identities have been indicated, each separate identity is categorized. For example, those indicating both First Nations and Métis identity are categorized as both First Nations and Métis.
• For more details on variable definitions, refer to technical notes.

Figure 1: Text description

Health status

Health encompasses both physical and mental well-being, in addition to the presence or absence of disease. General self-rated health is a common indicator of physical health, often used for comparison between groups and across time. Among adults, it has been demonstrated as a predictor of future functional and cognitive impairment, and even death,^{Footnote 1} however there is less research on this topic in children and youth. Research indicates that self-rated health in youth is moderately stable over time and can be considered part of a youth’s perception of themself.^{Footnote 2}

While most children and youth (for those age 12 to 17) or their PMKs (for those age 1 to 11) report positive perceptions of their physical health overall, notable differences emerge between those with and without a long-term condition. In 2023, a smaller proportion of children and youth with a long-term condition had high rated general health compared to those without (72.4% vs. 93.9% for those aged 1 to 11 and 65.5% vs. 82.7% for those age 12 to 17). These differences in perceived health may reflect a range of experiences, including how symptoms are managed and the accessibility of care and supports.

Positive mental health (often referred to as mental well-being) is one aspect of mental health that focuses on whether people feel good and function well. It’s essential for individual and community health.^{Footnote 3} Children and youth with a long-term condition had lower positive mental health than those without. Youth (ages 12 to 17) with a long-term condition were less likely to report:

• high self-rated mental health
• high life satisfaction
• high levels of happiness

Children (ages 1 to 11) with a long-term condition were also less likely to have high mental health, as reported by the person most knowledgeable of the child. The survey didn’t collect data on life satisfaction and happiness for children under the age of 12.

Figure 2: Physical and mental health status among children and youth with and without a long-term condition, 2023, Canada, excluding territories

Figure 2: Notes

• We based percentages and 95% confidence intervals (CIs) on weighted data to represent the population aged 1 to 17 years living in the 10 Canadian provinces. The 95% CI shows an estimated range of values. It’s likely to include the true value 19 times out of 20.
• "Any long-term condition" includes asthma, diabetes, epilepsy, anxiety disorder, mood disorder, eating disorder, learning disability or disorder, attention deficit hyperactivity disorder (ADHD), autism, fetal alcohol spectrum disorder (FASD) as well as an “other” long-term condition reported by the survey respondents. We excluded allergies from “Any long-term condition” to align with the CHSCY 2019 questionnaire and for consistency throughout this report.
• For more details on variable definitions, refer to technical notes.

Abbreviations:

• PMK: person most knowledgeable

Figure 2: Text description

Movement behaviours

Healthy behaviours including healthy eating and an active lifestyle:

• can be beneficial in preventing and managing long-term conditions
• are key ways to promote and maintain physical and mental health

In particular, adequate physical activity,^{Footnote 4} limited sedentary time^{Footnote 5} and sufficient sleep^{Footnote 6} have important physical and mental health implications for children and youth. Such behaviours contribute to a range of benefits, including:

• maintaining a healthy weight
• better academic achievement
• reduced risks of chronic disease
• various positive psychological and social outcomes^{Footnote 7}

Establishing positive habits early in childhood and adolescence can last a lifetime. It’s important to understand how the adoption of health behaviours such as physical activity, screen time and sleep varies across the population given the life-long benefits of maintaining these behaviours. In this report, we analysed data to assess whether children and youth with a long-term condition were practising these healthy behaviours in the same way as those without.

For children and youth aged 5 to 17 years, the Canadian 24-Hour Movement Guidelines recommend:

• an average of 60 minutes of physical activity per day
• no more than 2 hours per day of recreational screen time
• between 8 and 11 hours of sleep per night (depending on age)

These recommendations are meant for all apparently healthy children and youth and may also be appropriate for children and youth with a disability or long-term condition.

Overall, the proportion of children and youth who met the Canadian 24-Hour Movement Guidelines was lower among those with a long-term condition compared to those without (12.7% vs. 15.8%). This was mainly due to differences in meeting the sleep and recreational screen time recommendations. A lower proportion of children and youth with a long-term condition met the recommendations for:

• sleep (72.2% vs. 75.4%)
• recreational screen time (38.0% vs. 48.2%)

The proportion of children and youth who met the physical activity recommendation was similarly low among those with and without a long-term condition:

• physical activity (34.5% vs 36.4%)

Figure 3: Movement behaviours among children and youth (age 5 to 17 years) with and without a long-term condition, 2023, Canada, excluding territories

Figure 3: Notes

• We based percentages and 95% confidence intervals (CIs) on weighted data to represent the population aged 1 to 17 years living in the 10 Canadian provinces. The 95% CI shows an estimated range of values. It’s likely to include the true value 19 times out of 20.
• "Any long-term condition" includes asthma, diabetes, epilepsy, anxiety disorder, mood disorder, eating disorder, learning disability or disorder, attention deficit hyperactivity disorder (ADHD), autism, fetal alcohol spectrum disorder (FASD) as well as an “other” long-term condition reported by the survey respondents. We excluded allergies from “Any long-term condition” to align with the CHSCY 2019 questionnaire and for consistency throughout this report.
• Due to changes in the wording of the survey questions between 2019 and 2023, we recommend caution when comparing estimates for recreational screen time between these years.
• For more details on variable definitions, refer to technical notes.

Figure 3: Text description

Functional difficulties

Functional difficulties are challenges an individual faces in carrying out daily tasks.^{Footnote 8} It’s an important indicator of overall health and well-being in children and youth, regardless of diagnosis. Monitoring functional difficulties provides insight into population-level patterns of ability, participation and resilience. These measures can inform interventions that promote equity, inclusion and developmental potential.

Six times as many children and youth with a diagnosed long-term condition reported at least 1 of the 15 functional difficulties included in the survey compared to those without a long-term condition (37.4% vs. 6.2%). The functional difficulties included in the survey are across the following domains:

• anxiety
• seeing
• hearing
• playing
• walking
• learning
• self-care
• depression
• remembering
• concentrating
• making friends
• fine motor skills
• communication
• accepting change
• controlling behaviour

Figure 4 focuses on the 6 functional difficulties included in the Washington Group Short Set (WG-SS). All 6 of these individual difficulties were more common in children and youth with long-term conditions than in those without (between 2.8 times greater for seeing and 28.0 times greater for self-care).

Of these 6 individual difficulties, cognitive difficulties such as concentration and remembering were the most commonly reported. Cognitive difficulties were about 17 times more frequent among children and youth with a long-term condition than those without (11.8% vs. 0.7%). The next most commonly reported difficulty among children and youth with a long-term condition was communication difficulties. Communication difficulties were about 10 times more frequent among children and youth with a long-term condition than among those without (5.8% vs. 0.6%).

Figure 4: Functional difficulties among children and youth with and without a long-term condition, 2023, Canada, excluding territories

Figure 4: Notes

• We based percentages and 95% confidence intervals (CIs) on weighted data to represent the population aged 1 to 17 years living in the 10 Canadian provinces. The 95% CI shows an estimated range of values. It’s likely to include the true value 19 times out of 20.
• "Any long-term condition" includes asthma, diabetes, epilepsy, anxiety disorder, mood disorder, eating disorder, learning disability or disorder, attention deficit hyperactivity disorder (ADHD), autism, fetal alcohol spectrum disorder (FASD) as well as an “other” long-term condition reported by the survey respondents. We excluded allergies from “Any long-term condition” to align with the CHSCY 2019 questionnaire and for consistency throughout this report.
• For more details on variable definitions, refer to technical notes.

Abbreviations:

• PMK: person most knowledgeable

Figure 4: Text description

Discussion

The data in this report show that children and youth with a diagnosed long-term condition are diverse and come from many sociodemographic backgrounds.

It’s important to examine the physical health and positive mental health of children and youth, as well as their achievement of healthy behaviours, to understand their well-being.

Research shows that children with long-term conditions often face extra stress from treatments and hospital stays,^{Footnote 9} which can be associated with emotional problems later in life.^{Footnote 10Footnote 11} However, many factors play a role in a person’s mental health. In this report, youth with long-term conditions reported lower levels of:

• happiness
• life satisfaction
• self-rated mental health

Parent-reported mental health for children (ages 1 to 11) with long-term conditions was also lower than those without a long-term condition. However, despite lower levels of positive mental health, there are still many children and youth with long-term conditions that report high levels of physical health and positive mental health.

Among all children and youth, with or without long-term conditions, there was an observed decrease in mental health compared to 2019.^{Footnote 12} The results from this indicator, along with the heightened focus on youth mental health in the wake of the COVID-19 pandemic, may warrant close monitoring of child and youth mental health over time.

Children and youth with long-term conditions were less likely to meet the Canadian 24-Hour Movement Guidelines. While physical activity levels were low across all groups, the differences in screen time and sleep suggest that children and youth with long-term conditions may face unique challenges in maintaining healthy routines. Broad public health approaches to encourage healthy behaviours are important for all children and youth. However, activities targeted to address barriers and challenges faced by children and youth with long-term conditions are also warranted.

To obtain a more comprehensive health profile, data in this report have shown that’s important to study not only the health conditions themselves, but also the related functional challenges and how they change as the child develops. The data in this report shows that children and youth with long-term health conditions were 6 times more likely to experience functional difficulties than those without long-term health conditions. Functional difficulties include challenges with cognition, communication and self care. In particular, communication difficulties were almost 10 times as frequent, and self-care difficulties were 28 times as frequent. This highlights the substantial barriers to independence and participation in daily life that these children may face.

Together, these findings reflect the complex intersections between health, development and social context. They emphasize the importance of looking beyond clinical diagnoses to understand the lived experiences of children and youth with long-term conditions. It’s also important to consider that children and youth with any long-term condition represent a diverse group. The information presented in this tab provides a glimpse into where differences may exist for those with and without long-term conditions. Further analysis, by long-term condition, would provide the evidence needed to understand the unique impact, challenges and situation of each type of condition experienced by children and youth.

Learn more:

• Physical Activity, Sedentary Behaviour and Sleep Indicators
• The Positive Mental Health Surveillance Indicator Framework
• The Health Behaviour in School-aged Children (HBSC) study in Canada