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Abstract
Background In recent decades the proportion of infants and young children being cared for in childcare has increased. Little is known about the impact that non-parental care has on childhood unintentional injury and whether this varies by socioeconomic group.
Methods Using data from a contemporary UK cohort of children at age 9 months (N = 18 114) and 3 years (N = 13 718), Poisson regression was used to explore the association between childcare type (parental, informal, formal) and the risk of unintentional injury, overall and by socioeconomic group.
Results At age 9 months there was no overall association between childcare and injury. However, when stratifying the analyses, infants from higher socioeconomic groups were less likely to be injured if they were cared for in formal childcare (compared with being cared for only by a parent), whereas those from lower social groups were more likely to be injured. At age 3 years informal childcare was associated with an increased risk of injury overall; in the stratified analyses this increased risk occurred only in less affluent groups. Formal childcare was no longer associated with injury at age 3 in any strata.
Conclusions Previous findings have shown that childcare can have a positive influence on childhood injury; however, a recent Unicef report highlighted that a lack of access to high-quality childcare could lead to a widening of inequalities. Our analyses indicate that childcare does have the potential to widen inequalities in injury; further research is required to understand why childcare has a differential impact on unintentional injury and how this might be prevented.
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Footnotes
↵* Carol Dezateux, Catherine Peckham, Lucy Griffiths, Summer Sherburne Hawkins, Jugnoo Rahi, Tim Cole, Helen Bedford, Carly Rich, Phillippa Cumberland, Richard Pulsford, Flo Kinnafick, Jane Ahn and Sanja Stanojevic of the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK.
Funding This work was undertaken as part of the Public Health Research Consortium. The Public Health Research Consortium is funded by the Department of Health Policy Research Programme. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. Information about the wider programme of the PHRC is available from www.york.ac.uk/phrc. The Centre for Paediatric Epidemiology and Biostatistics was supported in part by the Medical Research Council in its capacity as the MRC Centre of Epidemiology for Child Health. LL is funded by a Medical Research Council Career Development Award in Biostatistics. Research at the University College London Institute of Child Health and Great Ormond Street Hospital for Children receives a proportion of the funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme. The Millennium Cohort Study is funded by grants to Professor Heather Joshi, Director of the study, from the Economic and Social Research Council and a consortium of government funders. The study sponsors played no part in the design, data analysis and interpretation of this study, the writing of the manuscript, or the decision to submit the paper for publication, and the authors' work was independent of their funders.
Competing interests None.
Ethics approval Ethical approval was received for the Millennium Cohort Study from the South West and London Multi-Centre Research Ethics Committees.
Provenance and peer review Not commissioned; externally peer reviewed.