Economic gradients in early child neurodevelopment: a multi-country study.

Little is known about the importance of household wealth for child neurodevelopment very early in life including during infancy. Previous studies have focused on specific developmental domains instead of more holistic multi-domain measures of neurodevelopment and on economic effects for the "average" child instead of evaluating the heterogeneity in economic gradients by different levels of developmental ability. Furthermore, not much is known about whether economic gradients in early child neurodevelopment are country-specific or generalizable between populations. We evaluate wealth gradients in child neurodevelopment, an important predictor of future health and human capital, between ages 3 and 24 months in four South American countries. We also assess the heterogeneity in these gradients at different locations of the neurodevelopment distribution using quantile regression. Employing a unique dataset of 2032 children with neurodevelopment measures obtained by physicians in 2005-2006, we find a large positive wealth gradient in neurodevelopment in Brazil. The wealth gradient is larger for children at higher neurodevelopment rankings, suggesting that wealth is associated with child development inequalities in the form of a wider gap between low and high achievers on neurodevelopment in Brazil. This result highlights the need to target poverty in Brazil as a key factor in health and human capital disparities earlier in life rather than later as early developmental deficits will be carried forward and possibly multiplied later in life. More importantly, small or insignificant wealth gradients are generally found in the other countries. These results suggest that wealth gradients in child neurodevelopment are country-specific and vary with population demographic, health, and socioeconomic characteristics. Therefore, findings from previous studies based on specific populations may not be generalizable to other countries. Furthermore, wealth gradients in child neurodevelopment appear to be dynamic rather than fixed and sensitive to population characteristics that modify their intensity.