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Paediatrics
Original research
Socioeconomic gradient in the developmental health of Canadian children with disabilities at school entry: a cross-sectional study
  1. Dena Zeraatkar1,
  2. Eric Duku2,
  3. Teresa Bennett2,
  4. Martin Guhn3,
  5. Barry Forer3,
  6. Marni Brownell4,
  7. Magdalena Janus2
  1. 1Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2Offord Centre for Child Studies, Department of Psychiatry and Behvioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  3. 3Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Magdalena Janus; janusm{at}mcmaster.ca

Abstract

Objective To examine the relationship between developmental health and neighbourhood socioeconomic status (SES) in kindergarten children with disabilities.

Design Cross-sectional study using population-level database of children’s developmental health at school entry (2002–2014).

Setting 12 of 13 Canadian provinces/territories.

Measures Taxfiler and Census data between 2005 and 2006, respectively, were aggregated according to custom-created neighbourhood boundaries and used to create an index of neighbourhood-level SES. Developmental health outcomes were measured for 29 520 children with disabilities using the Early Development Instrument (EDI), a teacher-completed measure of developmental health across five domains.

Analysis Hierarchical generalised linear models were used to test the association between neighbourhood-level SES and developmental health.

Results All EDI domains were positively correlated with the neighbourhood-level SES index. The strongest association was observed for the language and cognitive development domain (β (SE): 0.29 (0.02)) and the weakest association was observed for the emotional maturity domain (β (SE): 0.12 (0.01)).

Conclusions The magnitude of differences observed in EDI scores across neighbourhoods at the 5th and 95th percentiles are similar to the effects of more established predictors of development, such as sex. The association of SES with developmental outcomes in this population may present a potential opportunity for policy interventions to improve immediate and long-term outcomes.

  • community child health
  • social medicine
  • public health
  • developmental neurology & neurodisability
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-032396

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    Footnotes

    • Contributors DZ, ED, TB, MJ, MG, BF and MB conceived the study. DZ analysed and ED provided technical expertise. DZ wrote the first draft of the manuscript and all authors made significant contributions to the manuscript.

    • Funding This work was supported by an operating grant from the Canadian Institutes of Health Research, grant number 142416. DZ was supported by a Canada Graduate Scholarships-Master's Award and is currently supported by a CIHR Doctoral Award. TB is supported by a Hamilton Health Sciences Early Career Award. MJ is supported by the Ontario Chair in Early Childhood Development.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The project was approved by the Hamilton Integrated Research Ethics Board (no. 2403).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement The dataset analysed in the current study is not publicly available due to multiple jurisdictional privacy restrictions, but it is available at the host institution upon reasonable request.