Socioeconomic conditions and children's out-of-home care in high-income countries: a systematic review and meta-analysis.

Authors

Davara Bennett, Gabriella Melis, Paris Lee, Gillian Maudsley, Michelle Maden, Sarah Donegan, Ruaraidh Hill, Viviane Schultz Straatmann, Ylva B Almquist, Tanishta Rajesh, Hilma Forsman, David Taylor-Robinson

Published in

Journal of epidemiology and community health. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

Socioeconomic inequalities in children's out-of-home care (OHC) are a major public health problem. Though widely documented, no review has systematically synthesised evidence across high-income countries. We aimed to compare the risk of OHC for children experiencing disadvantaged versus advantaged socioeconomic conditions across Organisation for Economic Co-operation and Development countries.
We conducted a systematic review and meta-analysis, searching eight databases for studies published between January 1980 and April 2026. We included observational studies reporting quantitative associations between socioeconomic conditions and OHC in representative child populations. Two reviewers independently screened records, extracted data and assessed quality. We used random-effects meta-analysis stratified by exposure type and effect measure, along with harvest, forest, line and scatter plots, to synthesise findings.
Of 12 328 unique records screened, 150 studies from 13 countries met inclusion criteria, yielding 447 estimates. Of these, 390 showed positive associations between disadvantaged socioeconomic conditions and OHC across area deprivation, parental employment and education, income and eligibility for social assistance. The meta-analysis included 79 estimates across 19 strata. Very high heterogeneity across pooled estimates limited interpretation. However, associations were consistently positive and most consistent for area deprivation and eligibility for social assistance. Sensitivity analyses using higher-quality studies strengthened our main findings.
Across high-income settings, disadvantaged socioeconomic conditions were consistently associated with increased risk of OHC. Policies addressing the socioeconomic drivers of childhood adversity may help reduce care entry. Limitations of studies included socioeconomic conditions rarely being a primary study focus, inconsistent confounder adjustment and high heterogeneity. Future research should evaluate the impact of social and economic policy reforms on OHC risk.
CRD42021266991.

PMID:
42547411
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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