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Preschool attendance and developmental outcomes at age five in Indigenous and non-Indigenous children: a population-based cohort study of 100 357 Australian children
  1. Kathleen Falster1,2,3,
  2. Mark Hanly4,
  3. Ben Edwards2,
  4. Emily Banks3,
  5. John W Lynch5,6,
  6. Sandra Eades7,8,
  7. Nathan Nickel9,10,
  8. Sharon Goldfeld11,12,
  9. Nicholas Biddle2
  1. 1 School of Population Health, University of New South Wales, Sydney, Australia
  2. 2 ANU Centre for Social Research Methods, The Australian National University, Canberra, Australia
  3. 3 National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
  4. 4 Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
  5. 5 School of Public Health, The University of Adelaide, Adelaide, Australia
  6. 6 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
  7. 7 Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
  8. 8 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
  9. 9 Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
  10. 10 Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
  11. 11 Policy and Equity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  12. 12 Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
  1. Correspondence to School of Population Health, University of New South Wales, Sydney, Australia; k.falster{at}


Background Policies to increase Australian Indigenous children’s participation in preschool aim to reduce developmental inequities between Indigenous and non-Indigenous children. This study aims to understand the benefits of preschool participation by quantifying the association between preschool participation in the year before school and developmental outcomes at age five in Indigenous and non-Indigenous children.

Methods We used data from perinatal, hospital, birth registration and school enrolment records, and the Australian Early Development Census (AEDC), for 7384 Indigenous and 95 104 non-Indigenous children who started school in New South Wales, Australia in 2009/2012. Preschool in the year before school was recorded in the AEDC. The outcome was developmental vulnerability on ≥1 of five AEDC domains, including physical health, emotional maturity, social competence, language/cognitive skills and communication skills/general knowledge.

Results 5051 (71%) Indigenous and 68 998 (74%) non-Indigenous children attended preschool. Among Indigenous children, 33% of preschool attenders and 44% of the home-based care group were vulnerable on ≥1 domains, compared with 17% of preschool attenders and 33% in the home-based care group among non-Indigenous children. In the whole population model, the adjusted risk difference for developmental vulnerability among preschool attenders was −7.9 percentage points (95% CI, −9.8 to −6.1) in non-Indigenous children and −2.8 percentage points (95% CI −4.8 to −0.7) in Indigenous children, compared with Indigenous children in home-based care.

Conclusions Our findings suggest a likely beneficial effect of preschool participation on developmental outcomes, although the magnitude of the benefit was less among Indigenous compared with non-Indigenous children.

  • Cohort studies
  • Record linkage
  • Lifecourse/Childhood Circumstances

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  • Contributors All authors were involved in the conception and design of the study. MJH analysed the data, in consultation with KF, NB and BE. All authors contributed to the interpretation and revision of the analysis. KF and NB wrote the first draft of the paper. All authors contributed to revising the manuscript critically for intellectual content. KF further revised the manuscript for submission. All authors have given approval of the final version of the manuscript.

  • Funding This work was supported by a National Health and Medical Research Council of Australia (NHMRC) Project Grant (#1061713). KF was supported by an NHMRC Early Career Fellowship (#1016475). MJH received support from an NHMRC Centre of Research Excellence (#1135273). EB was supported by an NHMRC Principal Research Fellowship (#1136128). JL received support from an NHMRC Centre for Research Excellence (#1099422). SE was supported by an NHMRC Career Development Fellowship (#1013418). SG was supported by an NHMRC Practitioner Fellowship (#1155290). The funding agencies had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the NSW Population Health Services and Research Ethics Committee (2014/04/523), the NSW Aboriginal Health and Medical Research Council Ethics Committee (1031/14) and the Australian National University Human Research Ethics Committee (2014/384), which included a waiver of consent to obtain the de-identified, population data for this record linkage study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The datasets linked and analysed for this study are available from the national and state government data custodians for each administrative dataset, following the relevant ethical approvals. Details of the source data and record linkage for this study are available in the Seeding Success data resource profile (Falster, 2017). Researchers should contact the NSW Centre for Health Record Linkage ( regarding access to the source data, data custodian approval, and record linkage.

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