Children with disabling conditions seem to be at increased risk of registration for child abuse and neglect, although the pattern of registration varies with the specific disabling condition. The strong association with registration noted for conditions such as conduct disorder and learning difficulties is likely to arise, in part, because these conditions share a common etiologic pathway with child abuse and neglect.

Aims: To study the relation between risk of cerebral palsy and socioeconomic status. Methods: A total of 293 children with a diagnosis of cerebral palsy out of 105 760 live births between 1 January 1982 and 31 December 1997 were identified from the special conditions sub-file of the West Sussex Computerised Child Health System. Results: There was a linear association between risk of cerebral palsy and socioeconomic status (SES) measured by the Registrar General's social class (RGSC) and enumeration district (ED) ranked into quintiles by the Townsend Deprivation Index derived from 1991 census data. Fifty one per cent and 30% of cases of cerebral palsy were statistically ''attributable'' to inequality in SES using the RGSC and ED quintile respectively. A linear association was also noted for singleton live births. The association between risk of cerebral palsy and ED quintile persisted in a logistic regression model that included birth weight and gestational age, although that between RGSC and cerebral palsy no longer reached conventional levels of statistical significance after adjustment. Conclusions: A strong association was observed between socioeconomic status and the risk of cerebral palsy, which was only partly accounted for by the known social gradients in birth weight and gestational age.T he negative impact of socioeconomic deprivation has been shown for many aspects of child mortality and morbidity.1-3 The relation between socioeconomic status (SES) and the risk of cerebral palsy is not clear. An observed association between SES and cerebral palsy might suggest aetiological factors and pathways to prevention as well as being important in the planning of services and the allocation of resources.Low birth weight and prematurity are the strongest risk factors for cerebral palsy. 4 Given the observed association between these factors and SES, 5-7 an increased prevalence of cerebral palsy with low SES is expected. However, studies have produced conflicting results. Table 1 summarises the results of studies conducted in developed countries. In developing countries, there is a higher proportion of children with postnatally acquired cerebral palsy with a more clearly established socioeconomic gradient.West Sussex has a population of 750 000 with roughly 8000 births per year. Compared with national figures, fewer belong to ethnic minority groups and there is a lower rate of unemployment. However, there is a wide variation in SES with areas of deprivation. 8In the present study, population based, routinely collected data from West Sussex are used to: N Examine the relation between the prevalence of cerebral palsy and SES and between SES and the type and severity of cerebral palsy N Examine the degree to which any relation between SES and the prevalence of cerebral palsy is mediated by socioeconomic differences in birth weight and gestation.

The results of this study suggest that lower levels of fetal growth and shorter gestational duration are associated with increased likelihood of child protection registration in all categories including sexual abuse independent of maternal age or socioeconomic status. This study does not permit comment on whether poor fetal growth or preterm birth predispose to child abuse and neglect or the association arises because they share a common pathway.

No abstract