Psychosocial Health Inequalities and Socioeconomic Deprivation Gradients Among Preschool Children in Care and Not in Care: An Administrative Health Data Study

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 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. Results: Psychosocial 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 Relevance: Psychosocial 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.