How universal are universal preschool health checks? An observational study using routine data from New Zealand's B4 School Check.

OBJECTIVES: We aimed to estimate how many children were attending a universal preschool health screen and to identify characteristics associated with non-participation. DESIGN: Analysis of population-level linked administrative data. PARTICIPANTS: Children were considered eligible for a B4 School Check for a given year if:(1) they were ever resident in New Zealand (NZ),(2) lived in NZ for at least 6 months during the reference year, (3) were alive at the end of the reference year, (4) either appeared in any hospital (including emergency) admissions, community pharmaceutical dispensing or general practitioner enrolment datasets during the reference year or (5) had a registered birth in NZ. We analysed 252 273 records over 4 years, from 1 July 2011 to 30 June 2015. RESULTS: We found that participation rates varied for each component of the B4 School Check (in 2014/2015 91.8% for vision and hearing tests (VHTs), 87.2% for nurse checks (including height, weight, oral health, Strengths and Difficulties Questionnaire [SDQ] and parental evaluation of development status) and 62.1% for SDQ - Teacher [SDQ-T]), but participation rates for all components increased over time. Maori and Pacific children were less likely to complete the checks than non-Maori and non-Pacific children (for VHTs: Maori: OR=0.60[95% CI 0.61 to 0.58], Pacific: OR=0.58[95% CI 0.60 to 0.56], for nurse checks: Maori: OR=0.63[95% CI 0.64 to 0.61], Pacific: OR=0.67[95% CI 0.69 to0.65] and for SDQ-T: Maori: OR=0.76[95% CI 0.78 to 0.75], Pacific: OR=0.37[95% CI 0.38 to 0.36]). Children from socioeconomically deprived areas, with younger mothers, from rented homes, residing in larger households, with worse health status and with higher rates of residential mobility were less likely to participate in the B4 School Check than other children. CONCLUSION: The patterns of non-participation suggest a reinforcing of existing disparities, whereby the children most in need are not getting the services they potentially require. There needs to be an increased effort by public health organisations, community and whanau/family to ensure that all children are tested and screened.