Psychosocial Health Inequalities and Socioeconomic Deprivation Gradients Among Preschool Children in Care and Not in Care: An Administrative Health Data Study
- 1University of Glasgow
Abstract
ImportancePeschool children in care are at high risk for psychosocial health concerns. Population-based evidence is limited.
ObjectiveEstimate prevalence of psychosocial health concerns in children in care and not in care, and assess care-status differences stratified by deprivation.
DesignPopulation-based cross-sectional study using linked, routinely collected 27-30 Month Health Review and Scottish Birth Record data from April 2013 to March 2023.
SettingUniversal health review program in Scotland.
Participants7887 children in care and 445 547 children not in care.
ExposuresCare status at review, classified as in care or not.
Main Outcomes and MeasuresFour 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 comparing children in care with children not in care and examined whether these varied across deprivation groups. Models included deprivation group and adjusted for sex, age, and ethnicity.
ResultsPsychosocial health concerns were more common in children in care (2290 of 7887; 29.0%) than children not in care (77 836 of 445 547; 17.5%; relative risk 1.66). Concerns were more common in children in care across all outcomes; the adjusted odds ratio 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: adjusted odds ratios were 1.58 (95% CI, 1.45-1.72) in the most deprived fifth of areas and higher at 2.61 (95% CI, 2.25-3.03) in the least deprived fifth of areas. Prevalence of any recorded concern increased with deprivation in both care groups. The relative risk comparing the most deprived with the least deprived fifths 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 RelevancePsychosocial health inequities are evident at age two 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.
Related
- Socioeconomic inequalities in biological age: multidimensional gradients and cross-national heterogeneity in SHARE
- Nutritional, psychosocial, socioeconomic, and family factors associated with conceptual skill development among preschool children: evidence from Rupandehi District, Nepal
- Socioeconomic gradients in toothache experience among Australian adults: A time trend analysis from 1994 to 2013
- Socioeconomic deprivation and dementia risk in New Zealand: A modelling study
- Socioeconomic deprivation and postoperative mortality: a retrospective analysis of prospectively collected data
BibTeX
@misc{bradford2026psychosocial,
title = {{Psychosocial Health Inequalities and Socioeconomic Deprivation Gradients Among Preschool Children in Care and Not in Care: An Administrative Health Data Study}},
author = {D. R. R. Bradford and Y. Abou Saab and A. D. McMahon and A. H. Leyland and M. Allik and D. Brown},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.25.26361327},
url = {https://www.medrxiv.org/content/10.64898/2026.08.25.26361327v2},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Psychosocial Health Inequalities and Socioeconomic Deprivation Gradients Among Preschool Children in Care and Not in Care: An Administrative Health Data Study
AU - D. R. R. Bradford
AU - Y. Abou Saab
AU - A. D. McMahon
AU - A. H. Leyland
AU - M. Allik
AU - D. Brown
PY - 2026
DA - 2026/08/25
PB - medRxiv
DO - 10.64898/2026.08.25.26361327
UR - https://www.medrxiv.org/content/10.64898/2026.08.25.26361327v2
AB - ImportancePeschool children in care are at high risk for psychosocial health concerns. Population-based evidence is limited. ObjectiveEstimate prevalence of psychosocial health concerns in children in care and not in care, and assess care-status differences stratified by deprivation. DesignPopulation-based cross-sectional study using linked, routinely collected 27-30 Month Health Review and Scottish Birth Record data from April 2013 to March 2023. SettingUniversal health review program in Scotland. Participants7887 children in care and 445 547 children not in care. ExposuresCare status at review, classified as in care or not. Main Outcomes and MeasuresFour 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 comparing children in care with children not in care and examined whether these varied across deprivation groups. Models included deprivation group and adjusted for sex, age, and ethnicity. ResultsPsychosocial health concerns were more common in children in care (2290 of 7887; 29.0%) than children not in care (77 836 of 445 547; 17.5%; relative risk 1.66). Concerns were more common in children in care across all outcomes; the adjusted odds ratio 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: adjusted odds ratios were 1.58 (95% CI, 1.45-1.72) in the most deprived fifth of areas and higher at 2.61 (95% CI, 2.25-3.03) in the least deprived fifth of areas. Prevalence of any recorded concern increased with deprivation in both care groups. The relative risk comparing the most deprived with the least deprived fifths 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 RelevancePsychosocial health inequities are evident at age two 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.
ER -