Mark Hanly1, Kathleen Falster1,2,3, Georgina Chambers1,4, John Lynch5,6, Emily Banks2,7, Nusrat Homaira4, Marni Brownell8, Sandra Eades9, Louisa Jorm1. 1. Centre for Big Data Research in Health, UNSW Australia, Sydney, Australia. 2. National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. 3. Centre for Social Research Methods, Australian National University, Canberra, Australia. 4. School of Women's and Children's Health, UNSW Australia, Sydney, Australia. 5. School of Public Health, University of Adelaide, Adelaide, Australia. 6. School of Social and Community Medicine, University of Bristol, Bristol, UK. 7. The Sax Institute, Sydney, Australia. 8. Department of Community Health Sciences, Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. 9. Baker Heart and Diabetes Institute, Melbourne, Australia.
Abstract
BACKGROUND: Preterm birth and developmental vulnerability are more common in Australian Aboriginal compared with non-Aboriginal children. We quantified how gestational age relates to developmental vulnerability in both populations. METHODS: Perinatal datasets were linked to the Australian Early Development Census (AEDC), which collects data on five domains, including physical, social, emotional, language/cognitive, and general knowledge/communication development. We quantified the risk of developmental vulnerability on ≥1 domains at age 5, according to gestational age and Aboriginality, for 97 989 children born in New South Wales, Australia, who started school in 2009 or 2012. RESULTS: Seven thousand and seventy-nine children (7%) were Aboriginal. Compared with non-Aboriginal children, Aboriginal children were more likely to be preterm (5% vs. 9%), and developmentally vulnerable on ≥1 domains (20% vs. 36%). Overall, the proportion of developmentally vulnerable children decreased with increasing gestational age, from 44% at ≤27 weeks to 20% at 40 weeks. Aboriginal children had higher risks than non-Aboriginal children across the gestational age range, peaking among early term children (risk difference [RD] 19.0, 95% confidence interval [CI] 16.3, 21.7; relative risk [RR] 1.91, 95% CI 1.77, 2.06). The relation of gestational age to developmental outcomes was the same in Aboriginal and non-Aboriginal children, and adjustment for socio-economic disadvantage attenuated the risk differences and risk ratios across the gestational age range. CONCLUSIONS: Although the relation of gestational age to developmental vulnerability was similar in Aboriginal and non-Aboriginal children, Aboriginal children had a higher risk of developmental vulnerability at all gestational ages, which was largely accounted for by socio-economic disadvantage.
BACKGROUND: Preterm birth and developmental vulnerability are more common in Australian Aboriginal compared with non-Aboriginalchildren. We quantified how gestational age relates to developmental vulnerability in both populations. METHODS: Perinatal datasets were linked to the Australian Early Development Census (AEDC), which collects data on five domains, including physical, social, emotional, language/cognitive, and general knowledge/communication development. We quantified the risk of developmental vulnerability on ≥1 domains at age 5, according to gestational age and Aboriginality, for 97 989 children born in New South Wales, Australia, who started school in 2009 or 2012. RESULTS: Seven thousand and seventy-nine children (7%) were Aboriginal. Compared with non-Aboriginalchildren, Aboriginal children were more likely to be preterm (5% vs. 9%), and developmentally vulnerable on ≥1 domains (20% vs. 36%). Overall, the proportion of developmentally vulnerable children decreased with increasing gestational age, from 44% at ≤27 weeks to 20% at 40 weeks. Aboriginal children had higher risks than non-Aboriginalchildren across the gestational age range, peaking among early term children (risk difference [RD] 19.0, 95% confidence interval [CI] 16.3, 21.7; relative risk [RR] 1.91, 95% CI 1.77, 2.06). The relation of gestational age to developmental outcomes was the same in Aboriginal and non-Aboriginalchildren, and adjustment for socio-economic disadvantage attenuated the risk differences and risk ratios across the gestational age range. CONCLUSIONS: Although the relation of gestational age to developmental vulnerability was similar in Aboriginal and non-Aboriginalchildren, Aboriginal children had a higher risk of developmental vulnerability at all gestational ages, which was largely accounted for by socio-economic disadvantage.
Authors: Catherine S Birken; Jessica A Omand; Kim M Nurse; Cornelia M Borkhoff; Christine Koroshegyi; Gerald Lebovic; Jonathon L Maguire; Muhammad Mamdani; Patricia C Parkin; Janis Randall Simpson; Mark S Tremblay; Eric Duku; Caroline Reid-Westoby; Magdalena Janus Journal: BMJ Open Date: 2019-11-19 Impact factor: 2.692