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Additional file 2: Table S1. Characteristics and outcomes of mothers and their singleton and twin infants born in Western Australia from 2000 to 2013 and the New South Wales 2009/2012 school starters by plurality and Aboriginality.

Additional file 1. Additional methodological details.

Additional file 3: Table S2. Codes of the International Classification of Diseases, 10th Revision (ICD-10-AM) and Australian Classification of Health Interventions (ACHI) used to identify maternal health conditions and complications during pregnancy from hospital records and Midwives Notification System (MNS, WA) data and Perinatal Data Collection (PDC, NSW).

Table S1. Comparison of characteristics of Aboriginal and non-Aboriginal children in their first year of school in New South Wales in 2009 and 2012 for the study population with missing data, children with complete covariate data, and the study population with imputed data. (DOCX 59 kb)

Objectives Almost one-fifth of Australian Aboriginal mothers give birth before 20 years of age compared with 3% of non-Aboriginal mothers. We aim to quantify the effect of maternal age at birth on child development outcomes in Aboriginal compared with non-Aboriginal children. Approach The ‘Seeding Success’ study cohort comprises an almost complete population of children who started school in Australia’s most populous state, New South Wales (NSW), in 2009 or 2012, and were born in NSW, identified by linking Australian Early Development Census (AEDC) data to perinatal and birth registration datasets. Of the 154,936 children in the cohort, 8001 (5%) were Aboriginal. We calculated the risk of developmental vulnerability on one or more AEDC domains by maternal age at birth and Aboriginality. Risk differences and risk ratios (RR) were estimated as measures of absolute and relative inequalities, respectively. Multilevel Poisson regression was used to test the effect of maternal age on child development by Aboriginality. Results 1383 (17%) Aboriginal children were born to a mother 35 years. Among Aboriginal children, the risk decreased from 46% (95%CI, 39-52) to 31% (95%CI, 24-38) in children born to mothers’ aged ≤16 years to age 35 years, respectively. In non-Aboriginal children, the risk decreased from 38% (95%CI, 33-43) to 16% (95%CI, 15-17) in those born to mothers’ aged ≤16 years to 35 years, respectively. Risk differences and risk ratios for developmental vulnerability between Aboriginal and non-Aboriginal children increased with increasing maternal age. Compared to non-Aboriginal children born to mothers aged ≥20 years (ref group, RR, 1.0), the RR for developmental vulnerability was 1.7 (95% CI, 1.6-1.9) for non-Aboriginal children born to mothers aged

Objective In Australia’s most populous state, New South Wales (NSW), children must start school in the year they turn five, unless they are born between February-July, in which case they can delay starting until the year they turn six. Consequently, children start their first year of school aged 4.5-6 years. This may translate into a wide range of developmental ability in the classroom in the first year of school and may impact on the magnitude of inequalities in longer-term educational outcomes. To inform how this policy currently translates into the demographic composition of NSW classrooms, this study aims to identify child, family, and area-level characteristics associated with the practice of delaying school entry. Approach The ‘Seeding Success’ study cohort (N=154,936) includes an almost complete population of children who started school in NSW in 2009 or 2012, and were born in NSW, identified by linking the Australian Early Development Census (AEDC) data to perinatal and birth registry data. Restricting this analysis to the 88,716 (57%) children born in February-July, we defined ‘delayed school entry’ as children who were eligible to start school the previous year (i.e. 2008 or 2011), but started in the AEDC data collection years (i.e. 2009 or 2012). Multilevel regression models were used to investigate child, family and area-level characteristics associated with delayed school entry. Results The prevalence of delayed school entry was 46% in the 2009 AEDC cohort and 47% in the 2012 AEDC cohort. Boys and children born closer to July were more likely to be delayed, as were children of older mothers. Prevalence of delay was similar in Aboriginal and non-Aboriginal children, however, children of mothers born overseas were less likely to delay school entry compared to Australian-born mothers. Delaying was less common in major cities compared to remote and regional areas, and less common in socio-economically disadvantaged areas. Conclusion Children born in February-July who live in socio-economically disadvantaged urban areas are more likely to start school up to a year earlier than their peers, with poorly understood educational consequences. The current policy on school starting age results in an 18-month age range in classrooms, which may be challenging for teachers and confusing for parents who need to make a decision regarding their child’s ‘school readiness’. It is likely that access and affordability of childcare during the study period impacted on parent’s decisions about when to send their children to school.

(ICD-10-AM codes) and Table S2. (Potentially avoidable, ambulatory care sensitive and non-avoidable hospitalisation admission rates). Table S1. title “List of ICD-10-AM codes used to identify potentially avoidable, ambulatory care sensitive and non-avoidable hospitalisations (adapted from Andersen et al., 2012)”, and Table S2. title “Potentially avoidable, ambulatory care sensitive and non-avoidable hospitalisation admission rates (2000–2013) in a population cohort of Aboriginal and non-Aboriginal children born between July 2000 and December 2012 in New South Wales, Australia”. (DOCX 61 kb)