Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; NHS England, National Disease Registration Service, UK.
Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK.
Public Health. 2023 Nov;224:215-223. doi: 10.1016/j.puhe.2023.09.001. Epub 2023 Oct 17.
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.
We constructed a prospective longitudinal cohort of children born in Wales between April 2006 and March 2021 (n = 395,610) using linked administrative records.
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.
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.
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.
1997 年至 2021 年间，英国威尔士受照顾儿童（CLA）的数量稳步增加，且存在明显的不平等现象。本研究旨在评估贫困程度以及母婴围产期特征如何影响威尔士成为 CLA 的风险。
我们使用链接的行政记录，构建了一个 2006 年 4 月至 2021 年 3 月期间在威尔士出生的儿童的前瞻性纵向队列（n=395610）。
生存模型通过小面积贫困程度和母婴围产期特征来研究出生时成为 CLA 的风险。人群归因分数量化了针对可改变风险因素采取行动的潜在影响。
来自人口最贫困五分之一的儿童进入护理机构的可能性是最不贫困儿童的 3.4 倍（人口调整后的危险比[aHR]为 3.40，95%置信区间[CI]为 3.08-3.74）。孕妇在怀孕期间存在心理健康问题（完全 aHR 为 2.03，95%CI 为 1.88-2.19）和行为因素，如吸烟（aHR 为 2.46，95%CI 为 2.34-2.60）、酗酒（aHR 为 2.35，95%CI 为 1.70-3.23）和怀孕期间使用药物（aHR 为 5.72，95%CI 为 5.03-6.51）以及儿童先天畸形（aHR 为 1.46，95%CI 为 1.16-1.84）、低出生体重（aHR 为 1.28，95%CI 为 1.17-1.39）和早产（aHR 为 1.16，95%CI 为 1.06-1.26），与更高的 CLA 状态风险相关。如果人口中最贫困的五分之二的儿童经历了最不贫困儿童的条件，那么 CLA 人群的风险可能会降低 35%（95%CI 0.33-0.38）。
贫困程度和母婴围产期健康是儿童成为 CLA 的重要可改变风险因素。我们的分析提供了对弱势儿童群体中代际劣势传递机制的深入了解，并确定了公共卫生行动的目标。
