Health of Aboriginal Children in Western Australia: Do Grandparents Matter?

Abstract

Introduction Studies of select groups (e.g. pre-industrial or subsistence farming populations) suggest that children had improved survival if their grandparents were alive, particularly maternal grandmothers (MGMs). This question is unanswered for Aboriginal Australian communities, where care of children is commonly shared by extended family members, and it is not known if this association holds for physical health in addition to mortality. Objectives and Approach We examined relationships between the health of Aboriginal children born in Western Australia from 2000 to 2013 and the health and vital status of their grandparents. Birth, death, inpatient hospital and emergency department records of all Aboriginal children and their grandparents were linked. Grandparents were categorised as ‘healthy’ (alive with Charlson comorbidity index score of 0 or 1), ‘unhealthy’ (alive with a score of 2 or more), or dead when the child was born. Results 27,425 Aboriginal children linked to their MGM (at a minimum). Mortality up to age 2 was lower with healthy grandparents than unhealthy or dead grandparents (e.g. 11 deaths per 1000 live births with healthy MGM; 22 with unhealthy MGMs and 16 with dead MGMs). Children also had fewer acute healthcare contacts (e.g. 13% with healthy MGMs spent at least 7 days in hospital in their first 2 years compared with 19% with unhealthy or dead MGMs). However, healthcare contacts was largely unrelated to grandfathers. Outcomes were also associated with the number of living grandmothers. (e.g. 1.5% of children with 2 grandmothers were discharged against medical advice in their first 2 years, compared to 2.7% with one healthy grandmother and 3.7% with no grandmothers). Conclusion / Implications Children with healthy grandmothers have lower mortality and morbidity, possibly because of their care giving. These associations are unlikely to be due to genetic or environmental factors, as they are weaker or missing for grandfathers.