Time trends and area-level socioeconomic inequalities in early childhood development at 2 to 2.5 years old in England between 2019 and 2024

ImportanceInternationally, there are gaps in data to monitor both early childhood development (ECD) and progress in closing the inequality gap. The unequal impact of the COVID-19 pandemic, and any differential impact on ECD domains is also not poorly understood. ObjectiveTo examine time trends and area-level socioeconomic inequalities in ECD at 2 2.5 years in England between 2019 and 2024 DesignCross-sectional and longitudinal ecological analysis Setting149 local authorities in England Participants143 local authorities (662 annual observations, publishable quality data and at least 75% coverage of eligible children) ExposureYear of assessment, area-level socioeconomic conditions (Index of Multiple Deprivation 2019, Income Deprivation Affecting Children Index (IDACI)) assessed as the Slope Index of Inequality (SII) and Relative Index of Inequality (RII)) Main outcomesAges and Stages Questionnaire 3, rate per 100 not developmentally on track (Five domains of development: Communication, Gross Motor, Fine Motor, Personal Social, or Problem Solving; and any domain) ResultsRate per 100 children not developmentally on track in any domain increased progressively from 2019 (16[95%CI: 14.2; 16.9]), and was highest in 2023 (20.6[18.9; 22.4]) and 2024 (19.8[18.2; 21.4]). Compared to 2019 rates, the largest absolute increase was in 2023 (4.9[3.6; 6.3]), largest for Communication (4.3[3.5; 5.2], followed by similar increases for Personal Social (3.3[2.5; 4]) and Problem Solving (2.9[2.2; 3.5]), and smaller increases for Fine Motor (1.4[0.6; 2]) and Gross Motor (0.9[0.2; 1.6]). All rates except Gross Motor remained elevated in 2024. On average, 21.3[19.5; 23.0] per 100 children were not on track in any domain for the most income-deprived quintile compared to 16.2[14.7;17.8] for the least income-deprived (SII: 2.9[1.8; 3.9]; RII: 23%[14%; 32%]). Inequalities were largest in Communication (SII: 2.8[2.0; 3.6]; RII: 36%[25%; 49%]). Year by area-level socioeconomic conditions interaction effects were not statistically significant. Conclusions and RelevanceIn England, ECD worsened during the pandemic, more so for children exposed for longer, or from a younger age. Children born after the pandemic continue to be affected. Area-level inequalities were striking but did not worsen during this period. Pandemic-recovery efforts need to consider the potentially enormous economic and societal cost of disruption to ECD. Key pointsO_ST_ABSQuestionC_ST_ABSWhat are the time trends and area-level socioeconomic inequalities in early childhood development at 2 to 2.5 years in England around the time of the COVID-19 pandemic? FindingsEarly childhood development at 2 to 2.5 years in England worsened in the wake of the COVID-19 pandemic. Stark socioeconomic inequalities were observed throughout the period of 2019 to 2024. MeaningPolicy makers need to prioritise early years and children services in pandemic recovery efforts to improve early developmental outcomes, especially for children from socioeconomically deprived backgrounds.