Health of Aboriginal and Torres Strait Islander children and their grandparents: a Western Australian retrospective cohort study.

BACKGROUND: In Australian Aboriginal and Torres Strait Islander communities, childcare is traditionally shared by kin. Little is known about how grandparental care impacts Aboriginal child health and evidence from other countries is mixed. We explored relationships between grandparental health (a proxy for grandparental care) and health and health service use by Aboriginal children born in Western Australia from 2000 to 2013. METHODS: This is a retrospective cohort study using linked administrative health data. Outcomes were child mortality, hospital admissions, and emergency department (ED) presentations up to five years old. Grandparental health when the child was born was categorised as healthy (none/one Elixhauser condition), unhealthy (two or more conditions), or deceased. Grandparental-child health associations were estimated using regression with adjustment for birth year, sex, remoteness, socioeconomic advantage, maternal smoking, and maternal age. RESULTS: 29,409 Aboriginal children linked to their maternal grandmothers. 70% also linked to maternal grandfathers, 66% to paternal grandmothers, and 49% to paternal grandfathers. 86% of maternal grandmothers were healthy, 7% unhealthy, and 7% deceased. Children with healthy grandmothers had an average of 27% fewer hospital days (adjusted incidence rate ratio: 0.73, 95% CI: 0.65, 0.83) than those with deceased grandmothers. They also had lower mortality and fewer potentially avoidable admissions and emergency department presentations. Children with unhealthy or deceased grandmothers had comparable rates. These patterns were similar for all four grandparents, but generally stronger for maternal grandmothers. Stillbirth and unavoidable admissions were unrelated to grandparental health. CONCLUSIONS: Aboriginal children with healthy grandparents had better health and lower health service use. If this relationship is causal, healthy ageing and strong family connections must be supported to improve child health. Even if the relationship is not causal, healthy ageing, a family-centred approach to health care, and social support may help families experiencing poor health in multiple generations simultaneously.