Psychosocial Health Inequalities and Socioeconomic Deprivation Gradients Among Preschool Children in Care and Not in Care: An Administrative Health Data Study
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Importance
Preschool children in care are at high risk for psychosocial health concerns. Population-based evidence is limited.
Objective
Estimate prevalence of psychosocial health concerns in children in care and not in care, and assess care-status differences stratified by deprivation.
Design
Population-based cross-sectional study using linked, routinely collected 27–30 Month Health Review and Scottish Birth Record data from April 2013 to March 2023.
Setting
Universal health review program in Scotland.
Participants
7887 children in care and 445 547 children not in care.
Exposures
Care status at review, classified as in care or not.
Main Outcomes and Measures
Four outcome categories (emotional, behavioral, and/or attentional; personal and/or social; speech, language, and/or communication; and other developmental concerns) plus an aggregate indicator of any of the four. We estimated adjusted odds ratios between children in care and not in care, including variation with deprivation. Models adjusted for sex, age, ethnicity, and deprivation.
Results
Psychosocial health concerns were more common in children in care (2290; 29.0%) than children not in care (77 836; 17.5%; relative risk 1.66). Concerns were more common in children in care across all outcomes. The adjusted odds ratio comparing children in care with children not in care for any recorded concern was 1.86 (95% CI, 1.77–1.96). Adjusted odds ratios varied by outcome from 1.57 (95% CI, 1.49–1.66) for speech, language, and/or communication concerns to 2.49 (95% CI, 2.34–2.66) for emotional, behavioral, and/or attentional concerns. Relative inequities between children in care and not in care decreased with increasing deprivation from aOR of 1.58 (95% CI, 1.45–1.72) in the most deprived fifth of areas to 2.61 (95% CI, 2.25–3.03) in the least deprived fifth. Prevalence of any recorded concern increased with deprivation in both care groups. The relative risk comparing the most deprived with least deprived fifth of areas was 1.46 (95% CI, 1.29–1.66) among children in care and higher at 2.34 (95% CI, 2.29–2.40) among children not in care.
Conclusions and Relevance
Psychosocial health inequities are evident at an early age between children in care and not in care, and vary with deprivation. Support for children in care and children living in more deprived areas should be prioritized.
