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Socioeconomic Deprivation And Preterm Birth Predict Speech, Language And Communication Skills: Evidence From A Population Cohort Of 26,341 British

Daniela Ene, Geoff Der MA MSc, Sue Fletcher-Watson, Sinéad O’Carroll, Graham MacKenzie, Martin Higgins, James P Boardman 
Information Services Division, NHS Lothian; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow; Patrick Wild Centre, University of Edinburgh; Public Health and Health Policy, NHS Lothian; MRC Centre for Reproductive Health, Centre for Clinical Brain Sciences University of Edinburgh. 
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 life1,2,3.  In this paper we investigate the relative contributions of neighbourhood disadvantage, gestational age at birth and English as first language, on speech, language and communication concern at 27-30months. 
Design: record linkage cohort analysis. Setting: birth data from the National Health Service maternity electronic medical record linked to the child health surveillance programme (pre-school) for a population cohort of children within Edinburgh and the Lothians, United Kingdom. Participants: 26,341 children born between 2011-2014 who were eligible for a 27-30 month review between 2013-2016. We investigated the impact of three exposures on pre-school language function using mutually adjusted logistic regression models: gestational age at birth; neighbourhood deprivation using the Scottish Index of Multiple Deprivation 2016 quintiles; and whether English was the first language spoken in the home. Approval granted by Caldicott Guardian. Part-funded MRC Mental Health Data Pathfinder Grant MC_PC_17209. 
The prevalence of speech, language and communication concern at 27-30 months was 13%. The following associations were observed in fully adjusted analyses. For each week increase in gestational age at birth between 23 and 36 weeks, there is an 8·8% decrease in the odds of a child having SLC concern reported at 27 months (OR 0·916, 95% CI 0·900-0·931). The odds ratio for having SLC concern of children living in the most deprived compared to least deprived neighbourhoods was 2·813 (95% CI 2·518-3·142). The predicted probabilities of preterm children having SLC concern were highest for those living in the most deprived areas. There was no significant interaction between GA at birth and SIMD. 
SLC concern at 27-30 months is common and is associated independently with lower GA at birth and increasing levels of neighborhood deprivation. Policies that reduce childhood deprivation could improve pre-school language ability, and thereby avoid propagation of disadvantage across the life course, including for children born preterm. 
1van Noort-van der Spek IL et al Pediatrics 2012; 2Nobel et al Dev. Science 2007; 3Noble et al Nat. Neurosci. 2015 

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