title: Entering out-of-home care during childhood: Cumulative incidence study in Canada and Australia.
abstract: Cumulative incidence provides a more accurate indicator than annual incidence rates of the number of children who experience out-of-home care during childhood. The study utilises a cohort of all children born in Western Australia (WA) 1994-2005 and Manitoba 1998-2008 using de-identified linked data. Life tables were used to calculate the age-specific cumulative incidence over time and for at-risk groups. Cox regression was used to compare risk factors for entry to care. Manitoba had a larger proportion of children entering care compared to WA (9.4% vs 1.5% by age 12). Over time children entered care at a younger age in both WA (HR=1.5, CI:1.4-1.5) and Manitoba (HR=1.5, CI:1.5-1.6). Similar factors were associated with earlier age care entries in both countries including: socioeconomic disadvantage, young maternal age, maternal hospital admissions for mental health issues, substance misuse and assault. Supplementary analysis for WA showed a time trend with young children (<3years of age) who entered care spending an increasing proportion of their early years in care. Whilst Manitoba had a larger proportion of children entering care, over time in Western Australia children have been entering care at a younger age and spending more time in care. These latter factors contribute to an increased burden on the out-of-home care system. Manitoba had over five times greater cumulative incidence than WA, however risk factors for entry to out-of-home care were consistent in both countries. Knowledge of the risk factors for entry to out-of-home care can inform targeted support and prevention programs.
authors: Telethon Kids Institute, The University of Western Australia, Perth, Australia. Electronic address: Melissa.O'Donnell@telethonkids.org.au.
authors: Melissa
authors: M
authors: O'Donnell
authors: Telethon Kids Institute, The University of Western Australia, Perth, Australia. Electronic address: Miriam.Maclean@telethonkids.org.au.
authors: Miriam
authors: M
authors: Maclean
authors: Telethon Kids Institute, The University of Western Australia, Perth, Australia. Electronic address: Scott.Sims@telethonkids.org.au.
authors: Scott
authors: S
authors: Sims
authors: Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: marni_brownell@cpe.umanitoba.ca.
authors: Marni
authors: M
authors: Brownell
authors: Manitoba Centre for Health Policy, Canada. Electronic address: oke_ekuma@cpe.umanitoba.ca.
authors: Okechukwu
authors: O
authors: Ekuma
authors: Population Policy and Practice Programme, University College London, Institute of Child Health, London, United Kingdom. Electronic address: r.gilbert@ich.ucl.ac.uk.
authors: Ruth
authors: R
authors: Gilbert
mesh_terms: D002648:Child; D002656:Child Day Care Centers / Q000706:statistics & numerical data* / Q000639:trends*; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008350:Manitoba; D012307:Risk Factors; D014904:Western Australia
keywords: Cumulative incidence; Out-of-home care; Risk factors