Children’s social care status and healthcare use across ethnic and religious groups: evidence from linked administrative data in Wales

Background Children receiving care and support (CRCS) from statutory children’s social care services are a particularly vulnerable group, often experiencing complex challenges arising from abuse, neglect, or disability. However, limited research has examined their healthcare use in comparison to similar children without social care experiences, especially across ethnic and religious identities. Methods This paper addresses this gap by drawing on linked administrative data from Wales. CRCS records (2017–2019) and a matched comparison cohort were linked to 2011 and 2021 Office for National Statistics Census data to identify religious affiliation and improve ethnicity completeness. Leveraging the linkage of these data to primary and secondary healthcare records, we assessed CRCS-related differences in healthcare use across ethnic and religious groups in two key areas: (1) the probability of accessing primary and secondary healthcare services (General Practitioner, hospital inpatient care, and Accident & Emergency) and (2) the probability of using healthcare for common conditions, mental health issues and injuries. Results CRCS status was associated with higher healthcare use for most outcomes across ethnic and religious groups, with particularly consistent patterns of higher use for mental health-related healthcare use and hospitalisation. Among White children, CRCS status was associated with higher odds of mental health-related GP use (OR [95% CI]: 3.63 [3.33–3.96]), hospitalisation (10.40 [9.04–11.97]), and A&E use (7.46 [5.60–9.95]), as well as all-cause (2.03 [1.92–2.16]) and injury-related hospitalisation (2.51 [2.24–2.82]). Similar patterns were observed among Christian children (mental health-related GP: 4.36 [3.71–5.12]; hospitalisation: 13.68 [10.59–17.66]; A&E: 12.40 [6.86–22.40]; all-cause hospitalisation: 2.47 [2.22–2.76]; injury-related hospitalisation: 2.86 [2.28–3.59]). Ethnic heterogeneity in CRCS-related healthcare use was limited and primarily observed for hospitalisation outcomes. Religious heterogeneity was more evident: compared with Christian children, children reporting no religion showed weaker CRCS-related increases in mental health-related GP use and hospitalisation, while Muslim children showed stronger increases in injury-related hospitalisation and all-cause and injury-related A&E use. Conclusions CRCS status is associated with substantially elevated use of mental health services and hospitalisation. Improving outcomes for these children will likely require more integrated mental health provision, strengthened coordination between social care and healthcare, and sustained efforts to address underlying inequalities.