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Longitudinal Study: LSAC
Title: Social gradients in ADHD by household income and maternal education exposure during early childhood: Findings from birth cohort studies across six countries
Authors: Spencer, Nicholas James 
Ludvigsson, Johnny
Bai, Guannan
Gauvin, Lise
Clifford, Susan A 
Awad, Yara Abu
Goldhaber-Fiebert, Jeremy D
Markham, Wolfgang
Faresjö, Åshild
White, Pär Andersson
Raat, Hein
Jansen, Pauline 
Nikiema, Béatrice
Mensah, Fiona K 
McGrath, Jennifer J
Publication Date: 16-Mar-2022
Pages: e0264709
Journal: PloS one
Keywords: Birth cohort
Educational status
Social Class
Socioeconomic factors
Attention Deficit Disorder with Hyperactivity
Abstract: This study aimed to examine social gradients in ADHD during late childhood (age 9-11 years) using absolute and relative relationships with socioeconomic status exposure (household income, maternal education) during early childhood (<5 years) in seven cohorts from six industrialised countries (UK, Australia, Canada, The Netherlands, USA, Sweden). Secondary analyses were conducted for each birth cohort. Risk ratios, pooled risk estimates, and absolute inequality, measured by the Slope Index of Inequality (SII), were estimated to quantify social gradients in ADHD during late childhood by household income and maternal education measured during early childhood. Estimates were adjusted for child sex, mother age at birth, mother ethnicity, and multiple births. All cohorts demonstrated social gradients by household income and maternal education in early childhood, except for maternal education in Quebec. Pooled risk estimates, relating to 44,925 children, yielded expected gradients (income: low 1.83(CI 1.38,2.41), middle 1.42(1.13,1.79), high (reference); maternal education: low 2.13(1.39,3.25), middle 1.42(1.13,1.79)). Estimates of absolute inequality using SII showed that the largest differences in ADHD prevalence between the highest and lowest levels of maternal education were observed in Australia (4% lower) and Sweden (3% lower); for household income, the largest differences were observed in Quebec (6% lower) and Canada (all provinces: 5% lower). Findings indicate that children in families with high household income or maternal education are less likely to have ADHD at age 9-11. Absolute inequality, in combination with relative inequality, provides a more complete account of the socioeconomic status and ADHD relationship in different high-income countries. While the study design precludes causal inference, the linear relation between early childhood social circumstances and later ADHD suggests a potential role for policies that promote high levels of education, especially among women, and adequate levels of household income over children's early years in reducing risk of later ADHD.
DOI: 10.1371/journal.pone.0264709
Research collection: Journal Articles
Appears in Collections:Journal Articles

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