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Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales

G. Melis, Stuart Bedston, Ashley Akbari Orcid Logo, D. Bennett, Alexandra Lee, Emily Lowthian Orcid Logo, D. Schlüter, D. Taylor—Robinson

Public Health, Volume: 224, Pages: 215 - 223

Swansea University Authors: Stuart Bedston, Ashley Akbari Orcid Logo, Alexandra Lee, Emily Lowthian Orcid Logo

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DOI (Published version): 10.1016/j.puhe.2023.09.001

Abstract

Objectives: Between 1997 and 2021, the number of children looked after (CLA) in Wales, UK, increased steadily, with stark inequalities. We aimed to assess how deprivation and maternal and child perinatal characteristics influence the risk of becoming CLA in Wales. Study design: We constructed a pros...

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Published in: Public Health
ISSN: 0033-3506
Published: Elsevier BV 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa64762
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We aimed to assess how deprivation and maternal and child perinatal characteristics influence the risk of becoming CLA in Wales. Study design: We constructed a prospective longitudinal cohort of children born in Wales between April 2006 and March 2021 (n = 395,610) using linked administrative records. Methods: Survival models examined the risk of CLA from birth by small-area deprivation and maternal and child perinatal characteristics. Population attributable fractions quantify the potential impact of action on modifiable risk factors. Results: Children from the most deprived fifth of the population were 3.4 times more likely to enter care than those in the least deprived (demographic adjusted hazard ratios [aHRs] 3.40, 95% confidence interval [CI] 3.08, 3.74). Maternal mental health problems in pregnancy (fully aHR, 2.03, 95% CI 1.88, 2.19) and behavioural factors, such as smoking (aHR 2.46, 95% CI 2.34–2.60), alcohol problems (aHR 2.35, 95% CI 1.70–3.23) and substance use in pregnancy (aHR 5.72, 95% CI 5.03–6.51), as well as child congenital anomalies (aHR 1.46, 95% CI 1.16–1.84), low birth weight (aHR 1.28, 95% CI 1.17, 1.39) and preterm birth (aHR 1.16, 95% CI 1.06, 1.26), were associated with higher risk of CLA status. The risk of CLA in the population may be reduced by 35% (95% CI 0.33, 0.38) if children in the two most deprived fifths of the population experienced the conditions of those in the least deprived. Conclusions: Deprivation and perinatal maternal health are important modifiable risk factors for children becoming CLA. Our analysis provides insight into the mechanisms of intergenerational transfer of disadvantage in a vulnerable section of the child population and identifies targets for public health action.</abstract><type>Journal Article</type><journal>Public Health</journal><volume>224</volume><journalNumber/><paginationStart>215</paginationStart><paginationEnd>223</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0033-3506</issnPrint><issnElectronic/><keywords>Children looked after, Children in care, Survival models</keywords><publishedDay>30</publishedDay><publishedMonth>11</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-11-30</publishedDate><doi>10.1016/j.puhe.2023.09.001</doi><url>http://dx.doi.org/10.1016/j.puhe.2023.09.001</url><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This study was funded by National Institute for Health research (NIHR) Public Health Policy Research Unit; NIHR School for Public Health Research; Forte - Swedish Research Council for Health, Working Life and Welfare; and Medical Research Council (MRC).</funders><projectreference/><lastEdited>2023-11-20T14:18:06.4492124</lastEdited><Created>2023-10-17T22:48:01.4032356</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>G.</firstname><surname>Melis</surname><order>1</order></author><author><firstname>Stuart</firstname><surname>Bedston</surname><order>2</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>3</order></author><author><firstname>D.</firstname><surname>Bennett</surname><order>4</order></author><author><firstname>Alexandra</firstname><surname>Lee</surname><order>5</order></author><author><firstname>Emily</firstname><surname>Lowthian</surname><orcid>0000-0001-9362-0046</orcid><order>6</order></author><author><firstname>D.</firstname><surname>Schlüter</surname><order>7</order></author><author><firstname>D.</firstname><surname>Taylor—Robinson</surname><order>8</order></author></authors><documents><document><filename>64762__29059__0d60e9782cfa49b09528f0e11165df83.pdf</filename><originalFilename>64762.VOR.pdf</originalFilename><uploaded>2023-11-20T14:12:59.7148775</uploaded><type>Output</type><contentLength>1935201</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2023 The Authors. 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spelling v2 64762 2023-10-17 Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales c79d07eaba5c9515c0df82b372b76a41 Stuart Bedston Stuart Bedston true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 7c6dc217555b0fea264ff0dd7d0aa374 Alexandra Lee Alexandra Lee true false db5bc529b8a9dfca2b4a268d14e03479 0000-0001-9362-0046 Emily Lowthian Emily Lowthian true false 2023-10-17 HDAT Objectives: Between 1997 and 2021, the number of children looked after (CLA) in Wales, UK, increased steadily, with stark inequalities. We aimed to assess how deprivation and maternal and child perinatal characteristics influence the risk of becoming CLA in Wales. Study design: We constructed a prospective longitudinal cohort of children born in Wales between April 2006 and March 2021 (n = 395,610) using linked administrative records. Methods: Survival models examined the risk of CLA from birth by small-area deprivation and maternal and child perinatal characteristics. Population attributable fractions quantify the potential impact of action on modifiable risk factors. Results: Children from the most deprived fifth of the population were 3.4 times more likely to enter care than those in the least deprived (demographic adjusted hazard ratios [aHRs] 3.40, 95% confidence interval [CI] 3.08, 3.74). Maternal mental health problems in pregnancy (fully aHR, 2.03, 95% CI 1.88, 2.19) and behavioural factors, such as smoking (aHR 2.46, 95% CI 2.34–2.60), alcohol problems (aHR 2.35, 95% CI 1.70–3.23) and substance use in pregnancy (aHR 5.72, 95% CI 5.03–6.51), as well as child congenital anomalies (aHR 1.46, 95% CI 1.16–1.84), low birth weight (aHR 1.28, 95% CI 1.17, 1.39) and preterm birth (aHR 1.16, 95% CI 1.06, 1.26), were associated with higher risk of CLA status. The risk of CLA in the population may be reduced by 35% (95% CI 0.33, 0.38) if children in the two most deprived fifths of the population experienced the conditions of those in the least deprived. Conclusions: Deprivation and perinatal maternal health are important modifiable risk factors for children becoming CLA. Our analysis provides insight into the mechanisms of intergenerational transfer of disadvantage in a vulnerable section of the child population and identifies targets for public health action. Journal Article Public Health 224 215 223 Elsevier BV 0033-3506 Children looked after, Children in care, Survival models 30 11 2023 2023-11-30 10.1016/j.puhe.2023.09.001 http://dx.doi.org/10.1016/j.puhe.2023.09.001 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University This study was funded by National Institute for Health research (NIHR) Public Health Policy Research Unit; NIHR School for Public Health Research; Forte - Swedish Research Council for Health, Working Life and Welfare; and Medical Research Council (MRC). 2023-11-20T14:18:06.4492124 2023-10-17T22:48:01.4032356 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science G. Melis 1 Stuart Bedston 2 Ashley Akbari 0000-0003-0814-0801 3 D. Bennett 4 Alexandra Lee 5 Emily Lowthian 0000-0001-9362-0046 6 D. Schlüter 7 D. Taylor—Robinson 8 64762__29059__0d60e9782cfa49b09528f0e11165df83.pdf 64762.VOR.pdf 2023-11-20T14:12:59.7148775 Output 1935201 application/pdf Version of Record true © 2023 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. Distributed under the terms of a Creative Commons Attribution 4.0 International License (CC BY 4.0). true eng https://creativecommons.org/licenses/by/4.0/
title Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales
spellingShingle Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales
Stuart Bedston
Ashley Akbari
Alexandra Lee
Emily Lowthian
title_short Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales
title_full Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales
title_fullStr Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales
title_full_unstemmed Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales
title_sort Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales
author_id_str_mv c79d07eaba5c9515c0df82b372b76a41
aa1b025ec0243f708bb5eb0a93d6fb52
7c6dc217555b0fea264ff0dd7d0aa374
db5bc529b8a9dfca2b4a268d14e03479
author_id_fullname_str_mv c79d07eaba5c9515c0df82b372b76a41_***_Stuart Bedston
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
7c6dc217555b0fea264ff0dd7d0aa374_***_Alexandra Lee
db5bc529b8a9dfca2b4a268d14e03479_***_Emily Lowthian
author Stuart Bedston
Ashley Akbari
Alexandra Lee
Emily Lowthian
author2 G. Melis
Stuart Bedston
Ashley Akbari
D. Bennett
Alexandra Lee
Emily Lowthian
D. Schlüter
D. Taylor—Robinson
format Journal article
container_title Public Health
container_volume 224
container_start_page 215
publishDate 2023
institution Swansea University
issn 0033-3506
doi_str_mv 10.1016/j.puhe.2023.09.001
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1016/j.puhe.2023.09.001
document_store_str 1
active_str 0
description Objectives: Between 1997 and 2021, the number of children looked after (CLA) in Wales, UK, increased steadily, with stark inequalities. We aimed to assess how deprivation and maternal and child perinatal characteristics influence the risk of becoming CLA in Wales. Study design: We constructed a prospective longitudinal cohort of children born in Wales between April 2006 and March 2021 (n = 395,610) using linked administrative records. Methods: Survival models examined the risk of CLA from birth by small-area deprivation and maternal and child perinatal characteristics. Population attributable fractions quantify the potential impact of action on modifiable risk factors. Results: Children from the most deprived fifth of the population were 3.4 times more likely to enter care than those in the least deprived (demographic adjusted hazard ratios [aHRs] 3.40, 95% confidence interval [CI] 3.08, 3.74). Maternal mental health problems in pregnancy (fully aHR, 2.03, 95% CI 1.88, 2.19) and behavioural factors, such as smoking (aHR 2.46, 95% CI 2.34–2.60), alcohol problems (aHR 2.35, 95% CI 1.70–3.23) and substance use in pregnancy (aHR 5.72, 95% CI 5.03–6.51), as well as child congenital anomalies (aHR 1.46, 95% CI 1.16–1.84), low birth weight (aHR 1.28, 95% CI 1.17, 1.39) and preterm birth (aHR 1.16, 95% CI 1.06, 1.26), were associated with higher risk of CLA status. The risk of CLA in the population may be reduced by 35% (95% CI 0.33, 0.38) if children in the two most deprived fifths of the population experienced the conditions of those in the least deprived. Conclusions: Deprivation and perinatal maternal health are important modifiable risk factors for children becoming CLA. Our analysis provides insight into the mechanisms of intergenerational transfer of disadvantage in a vulnerable section of the child population and identifies targets for public health action.
published_date 2023-11-30T14:18:07Z
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