Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood: Data from mandatory school entry examinations in Germany
Open accessAbstract
BACKGROUND: From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration. METHOD: We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children's school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high). RESULTS: Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation. CONCLUSION: Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.
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The observed regional differences (city size & East/West Germany) could be explained by the availability of green or blue spaces, rurality, and infrastructure maturity, as well as the composition of the population.
“Similarly, the observed regional differences (city size & East/West Germany) could be explained by the availability of green or blue spaces, rurality, and infrastructure maturity, as well as the composition of the population (Hoffmann et al., 2022).”
From Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany (2025) · cites this paper as Hoffmann et al., 2022
Section 4.2 (Rurality; page unavailable) suggests that population composition and regional deprivation can help explain differences in health outcomes. Section 2.2.2 mentions green spaces as part of the area used to measure rurality, not as an established explanation. The study is limited to Brandenburg and does not explain East–West German differences or attribute them to blue spaces or infrastructure maturity. (LLM, conf=0.87)
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References 43 · Cited by 17
Research works printed but not linked: 4
- Hoffmann, 2021, [Evaluation of the language tasks of the socio-pediatric development screening for school entrance examinations (SOPESS): results of the prospective child health study ikidS], Gesundheitswesen, 83, 215
- Schmitz-Veltin, 2006, [Living conditions in demographic change], Raumforsch. Raumordn., 64, 343
- Stich, 2018, [Competing validity of developmental diagnostics at the time of the school entrance examination - results of a full survey in an Upper Bavarian district], Gesundheitswesen, 80, S22‐S28
- Voigtländer, 2012, [The Importance of small scale context for health: designing an explanatory model, Gesundheitswesen, 74, 702
- Authors
- Hoffmann, S., Tschorn, M., Michalski, N., Hoebel, J., Förstner, B. R., Rapp, M. A., & Spallek, J.
- Affiliations
- Brandenburg University of Technology Cottbus-Senftenberg (DE)
- University of Potsdam (DE)
- Robert Koch Institute (DE)
- Corresponding author
- Spallek, Jacob
- ORCID
- Venue
- Health & Place
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 75
- Pages
- 102794
- ISSN
- 1353-8292 (ISSN-L)
- OpenAlex
- W4220858398
- Cited by
- 17
- References
- 43
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 2
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Health & Place (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Publication server of the Robert Koch Institute (Robert Kock Institute) (submittedVersion, cc-by)
- publish.UP (University of Potsdam) (submittedVersion, cc-by-nc-nd)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Education › Early Childhood Education and Development
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- global developmental delay, socioeconomic deprivation, rurality, early childhood development, school entry examination, preschool children, regional deprivation, population density, sex differences
- MeSH terms
- Adolescent, Adult, Child, Preschool, Female, Germany, Health Promotion, Humans, Male, Rural Population, Schools, Socioeconomic Factors, Young Adult
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