Associations of Socioeconomic Deprivation and Preterm Birth With Speech, Language, and Communication Concerns Among Children Aged 27 to 30 Months

Abstract

Importance: Successful acquisition of language is foundational for health and well-being across the life course and is patterned by medical and social determinants that operate in early life.

Objective: To investigate the associations of neighborhood disadvantage, gestational age, and English as first language with speech, language, and communication concerns among children aged 27 to 30 months.

Design, setting, and participants: This cohort study used birth data from the National Health Service maternity electronic medical record linked to the Child Health Surveillance Programme for preschool children. The cohort included 28 634 children in the United Kingdom (NHS Lothian, Scotland) born between January 2011 and December 2014 who were eligible for a health review at age 27 to 30 months between April 2013 and April 2016. Data analysis was conducted between January 2018 and February 2019.

Exposures: The associations of neighborhood deprivation (using the Scottish Index of Multiple Deprivation 2016 quintiles), gestational age, and whether English was the first language spoken in the home with preschool language function were investigated using mutually adjusted logistic regression models.

Main outcomes and measures: Speech, language, and communication (SLC) concern ascertained at age 27 to 30 months.

Results: Records of 28 634 children (14 695 [51.3%] boys) with a mean (SD) age of 27.7 (2.2) months were matched. After excluding records with missing data, there were 26 341 records. The prevalence of SLC concern was 13.0% (3501 of 26 963 children with SLC data). In fully adjusted analyses, each 1-week increase in gestational age from 23 to 36 weeks was associated with an 8.8% decrease in the odds of a child having an SLC concern reported at 27 months (odds ratio, 0.92; 95% CI, 0.90-0.93). The odds of a child for whom English is not the first language of having SLC concern at age 27 to 30 months were 2.1-fold higher than those for a child whose first language is English (OR, 2.09; 95% CI, 1.66-2.64). The odds ratio for having an SLC concern among children living in the most deprived neighborhoods, compared with the least deprived neighborhoods, was 3.15 (95% CI, 2.79-3.56). The estimated probabilities for preterm children having an SLC concern were highest for those living in the most deprived areas.

Conclusions and relevance: This study found that SLC concerns at age 27 to 30 months are common and independently associated with increasing levels of neighborhood deprivation and lower gestational age. Policies that reduce childhood deprivation could be associated with improved preschool language ability and potentially avoid propagation of disadvantage across the life course, including for children born preterm.

Figure 1.. Flowchart of Data Sources and Data Matching

CHSP-PS indicates Child Health Surveillance Programme–Preschool.

Figure 2.. Number and Percentage of Children Reviewed With SLC Concerns

Scottish Index of Multiple Deprivation (SIMD) quintile 1 indicates most deprived; SIMD quintile 5, least deprived.

Figure 3.. Estimated Probability of Having SLC Concerns

Shaded areas indicate confidence bands at 1.4 × SE. Scottish Index of Multiple Deprivation (SIMD) quintile 1 indicates most deprived; SIMD quintile 5, least deprived.