Hoffmann Stephanie, Michalski Niels, Dragano Nico, Spallek Jacob
Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.
Lusatian Center for Digital Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.
Eur J Public Health. 2025 Aug 1;35(4):611-616. doi: 10.1093/eurpub/ckaf082.
Early childhood is a public health priority for enhancing health equity across the life course. Children are susceptible to individual-level socio-economic position (SEP) and the socio-economic deprivation of their place of residence, both of which contribute to differences in psychomotor development, including language. This study investigates whether individual-level SEP modifies the association between area-level deprivation and language development. This study used population-based, cross-sectional data from a School Entry Survey in Germany (2021; female: n = 9751, male: n = 10 623; age in years: ≤6 n = 11 423; 6-≤7 n = 8 746; >7 n = 205; native language: German n = 18 752; not German n = 943; bilingual n = 679), which was linked to the 'German Index of Socioeconomic Deprivation' (GISD). Binary multilevel models [odds ratio (OR), 95% CI] were used to analyse the interaction of GISD (measured continuously) with individual-level SEP (categorized as high/medium/low) according to delayed language development (DLD in % yes/no), which was assessed using validated instruments of 'social-pediatric screening of developmental status for school entry'. Individual SEP was tested as a moderator by stratifying the analyses. The interaction of GISD with SEP was associated with DLD (ORmediumSEPGISD = 1.13; 1.04-1.24; ORlowSEPGISD = 1.27; 1.13-1.43), with the main effect of GISD (OR = 0.85; 0.77-0.93). In SEP stratification, GISD was only partially associated with DLD (ORhighSEP = 0.81; 0.73-0.91; ORmediumSEP = 0.97; 0.89-1.07; ORlowSEP = 1.14; 0.99-1.32). This study demonstrates an association between area-level deprivation and DLD that is modified by individual-level SEP. The findings underscore the importance of stratification by individual-level SEP in analysing area-level effects on health, as the area-level effects can be contradictory according to individual-level SEP.
幼儿期是促进一生健康公平的公共卫生重点领域。儿童易受个人层面社会经济地位（SEP）及其居住地区社会经济剥夺状况的影响，这两者都会导致包括语言在内的心理运动发育差异。本研究调查个人层面的SEP是否会改变地区层面剥夺与语言发育之间的关联。本研究使用了德国一项入学调查的基于人群的横断面数据（2021年；女性：n = 9751，男性：n = 10623；年龄（岁）：≤6岁，n = 11423；6 - ≤7岁，n = 8746；>7岁，n = 205；母语：德语，n = 18752；非德语，n = 943；双语，n = 679），该数据与“德国社会经济剥夺指数”（GISD）相关联。使用二元多水平模型[比值比（OR），95%置信区间]，根据语言发育迟缓（DLD，是/否的百分比）分析GISD（连续测量）与个人层面SEP（分为高/中/低）之间的相互作用，DLD使用“入学社会儿科发育状况筛查”的有效工具进行评估。通过分层分析将个人SEP作为调节因素进行检验。GISD与SEP的相互作用与DLD相关（OR中SEPGISD = 1.13；1.04 - 1.24；OR低SEPGISD = 1.27；1.13 - 1.43），GISD的主要效应为（OR = 0.85；0.77 - 0.93）。在SEP分层中，GISD仅部分与DLD相关（OR高SEP = 0.81；0.73 - 0.91；OR中SEP = 0.97；0.89 - 1.07；OR低SEP = 1.14；0.99 - 1.32）。本研究表明地区层面剥夺与DLD之间存在关联，且这种关联会因个人层面SEP而改变。研究结果强调了在分析地区层面健康影响时按个人层面SEP进行分层的重要性，因为根据个人层面SEP，地区层面的影响可能相互矛盾。
