1. Investigating parental socioeconomic position, in utero growth and risk of child development disorders using linked administrative data Dr Chris Playford

2. Introduction  The cognitive and emotional development of children growing up in circumstances of socioeconomic disadvantage is more likely to be abnormal compared to children raised in more advantaged families (Chin-Lun Hung et al., 2015).  This association has been noted for a range of different developmental attributes including:  gross motor skills (Ozal et al., 2015),  vision & fine motor skills (Gottschling-Lang et al., 2013; Morley et al., 2015),  social development (Bradley & Corwyn, 2002)  hearing & language development (Nicholson et al., 2010; Hartas, 2011). Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 2

3. Questions  How does child development vary by birthweight and family socioeconomic position?  Do birth factors moderate any association between family socioeconomic position and child development? Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 3

4. Rationale  Attempting to better understand social patterning of educational and developmental outcomes.  To what extent does socioeconomic variation in birthweight (and other birth outcomes) explain differences in these outcomes?  Challenge of disentangling these life course processes  Middle-range theories (Merton 1967) “Compared with children whose parents are degree- educated, those whose parents have no qualifications are more likely, amongst other things, to have younger mothers, live in lone parent families, experience lower levels of home learning activities and household rules, to have had a low birth weight, poorer general health, and a mother who smokes.” BradshawBradshaw (2011: 22) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 4

5. Scottish Longitudinal Study Source: Boyle et al. (2009: 388) – Table 2 Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 5

6. Linked Administrative Data  Maternity Inpatient and Day Case (SMR02)  Scottish Qualifications Authority (SQA)  Examination Results in Scottish Schools  Child Health Systems Programme Pre-School (CHSP Pre-School) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 6

7. Linkage Schema Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 7 SMR02 Maternity Inpatient and Day Case dataset n = 32,451 Parental RGSC and Parental Highest Qualification (Census 2001) n = 51,949 Parental RGSC and Parental Highest Qualification (Census 2001) n = 25,052 SMR02 Maternity Inpatient and Day Case dataset n = 36,699 SLS Members n = 19,223 CHSP-PS Reviews (multiple) n = 26,538 CHSP-PS Reviews (multiple) n = 30,649 Children of SLS Members n = 28,804 Joint Dataset n = 46,312 Complete Cases n = 32,238 / 31,731

8. Outcome Measures  Child Development (CHSP-PS)  Based on Woodside System (see Barber et al. 1976, Eu 1986) Eu  Indicators  Gross Motor skills  Fine motor or manipulative skills  Hearing and communication  Social skills and behaviour  Classification  Abnormal  Doubtful / Uncertain  Incomplete  Normal Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 8

9. CHSP-PS Reviews Review Gross Motor / Hearing Fine Motor / Social 6-8 Week Review21,446 - 8 to 9 Month Review22,14722,146 21 to 24 Month Review (pre Hall 4)24,488 39 to 42 Month Review (pre Hall 4)24,991 48 Month Review/ Pre-school (pre Hall 4)21,856 Total114,92893,481 Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 9 Table 1: Review coverage and number of reviews

10. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 10

11. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 11

12. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 12

13. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 13

14. Birthweight Percentiles (1) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 14

15. Birthweight Percentiles (2) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 15

16. Models Fitted  Random effects logistic regression models  Multiple CHSP-PS reviews per individual  Accounting for clustering in the parental ID variable for the COTS sample Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 16

17.  Low Birthweight  Gross Motor (OR=3.24; CI=2.33, 4.50) Fine Motor (OR=2.35; CI=1.73, 3.20) Social (OR=2.40; CI=1.68, 3.43) Hearing (OR=1.59; CI=1.29, 1.95)  Very Low Birthweight  Gross Motor (OR=8.56; CI=3.60, 20.38) Fine Motor (OR=5.36; CI=2.09, 13.75) Social (OR=6.75; CI=2.44, 18.71) Hearing (OR=2.40; CI=1.31, 4.38) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 17

18. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 18

19. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 19

20. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 20

21. Summary  Child development indicators are strongly associated with gestational age specific birthweight  Fine motor, social and hearing abnormalities are more likely for children with parents in lower grade occupations or who are long-term unemployed.  This is adjusting for other indicators of family socioeconomic position and birth outcomes  The inclusion of the birth outcomes only slightly moderates the association between parental socioeconomic position and child development. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 21

22. With thanks to chris.playford@ed.ac.uk The help provided by staff of the Longitudinal Studies Centre – Scotland (LSCS) is acknowledged. The LSCS is supported by the ESRC/JISC, the Scottish Funding Council, the Chief Scientist’s Office and the Scottish Government. The authors alone are responsible for the interpretation of the data. Census output is Crown copyright and is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland. Funder: Economic and Social Research Council Project: Administrative Data Research Centre - Scotland Grant number: ES/L007487/1

23. APPENDIX 23

24. Woodside System (see Barber et al. 1976) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 24

25. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 25

26. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 26

27. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 27

28. Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 28

29. Birthweight (1) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 29

30. Birthweight (2) Socioeconomic position, in utero growth and child development, Dr Chris Playford, 3rd June 2016 30