Parental migration, socioeconomic deprivation and hospital admissions in preschool children: national cohort study

BackgroundA third of children born in England have at least one parent born outside the UK, yet family migration history is infrequently studied as a social determinant of child health. We describe differences in rates of hospital admissions in children aged up to five years by parental migration and socioeconomic group. MethodsBirth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age five years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group. FindingsChildren of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4-171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1-156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4, 188.2). A socioeconomic gradient in emergency admissions was present across all maternal region of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42-1.44, high vs. low IMD group). Overall, children whose parents were both born abroad had lower emergency admission rates than children whose parents were both born in the UK. Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia. InterpretationThis research indicates that children whose parents who have migrated to the UK generally have lower overall usage of NHS emergency inpatient services than children of UK-born parents. Our study revealed a socioeconomically graded patterns of hospital admissions for all children born in England, which were highest amongst those with mothers born in the UK, South Asia, and the Middle East and North Africa. Future research using linked primary and secondary care datasets will improve understanding on whether healthcare use is proportionate to need. FundingNational Institute for Health Research.