Do trajectories of economic, work- and health-related disadvantages explain child welfare clients’ increased mortality risk? A prospective cohort study

Abstract

Background Past research has shown that individuals who have had experiences of out-of-home care (OHC) in childhood have increased risks of premature mortality. Prior studies also suggest that these individuals are more likely to follow long-term trajectories that are characterised by economic, work-, and health-related disadvantages, compared to majority population peers. Yet, we do not know the extent to which such trajectories may explain their elevated mortality risks. The aim of this study is therefore to examine whether trajectories of economic, work-, and health-related disadvantages in midlife mediate the association between OHC experience in childhood and subsequent all-cause mortality. Methods Utilising longitudinal Swedish data from a 1953 cohort ( n = 14,294), followed from birth up until 2008 (age 55), this study applies gender-specific logistic regression analysis to analyse the association between OHC experience in childhood (ages 0–19; 1953–1972) and all-cause mortality (ages 47–55; 2000–2008). A decomposition method developed for non-linear regression models is used to estimate mediation by trajectories of economic, work-, and health-related disadvantages (ages 39–46; 1992–1999), as indicated by social welfare receipt, unemployment, and mental health problems. To account for selection processes underlying placement in OHC, an alternative comparison group of children who were investigated by the child welfare committee but not placed, is included. Results The results confirm that individuals with experience of OHC have more than a two-fold increased risk of all-cause mortality, for men (OR: 2.10, 95% CI: 1.42–3.11) and women (OR: 2.23, 95% CI: 1.39–3.59) alike. Approximately one-third (31.1%) of the association among men, and one-fourth (27.4%) of the association among women, is mediated by the long-term trajectories of economic, work-, and health-related disadvantages. The group who were investigated but not placed shows similar, yet overall weaker, associations. Conclusions Individuals who come to the attention of the child welfare services, regardless of whether they are placed in out-of-home care or not, continue to be at risk of adverse outcomes across the life course. Preventing them from following trajectories of economic, work-, and health-related disadvantages could potentially reduce their risk of premature death.

Association of public care in childhood with social, criminal, cognitive, and health outcomes in middle-age: five decades of follow-up of members of the 1958 birth cohort study

“…33 34 While the present results suggest that, instead, the impact of public care on death may be via social circumstances and potentially some indicators of health, our study sample is insufficiently mature to enable us to simultaneously run analyses in which we incorporate data on exposure, potential mediators and mortality risk. In the only study of which we are aware to have done so, indices of socioeconomic position and mental health appear to have some explanatory role in the public care–mortality relationship, 35 so providing some indirect support for the findings herein. Replication and testing using a wider range of potential mediating characteristics, such as somatic health, health behaviours, and criminality is now required.…”

Adult mortality in children exposed to state care: systematic review and meta-analysis of prospective cohort studies

“…In further analyses of data from the Stockholm Birth Cohort Study -material featured in the present review 56 -socio-economic and mental health factors would appear to partially mediate the link between public care and total mortality relationship. 33 An understanding of the role of other candidate mediators including unhealthy behaviours (smoking, heavy alcohol intake, etc), given their relationships with care 20 , and trajectories of physical diseases and death, 57 is now required.…”

“…When there were multiple reports featuring the same material (e.g., Stockholm birth cohort study [32][33][34] ), the publication with the longest duration of follow-up was included on the basis that this offered the greater statistical power. Retrieved studies were identified by GDB and any potential controversial selections were resolved amongst the authors.…”

Out-of-home care in childhood and socio-economic functioning in adulthood: ONS Longitudinal Study 1971-2011

“…Children in out-of-home care (OHC) are at higher risk of adverse outcomes later in life [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. This includes outcomes such as poorer mental and physical health [1,4,5,7,9,11], premature mortality [10,15,[19][20][21][22][23], less education and lower qualifications [3,4,11,13], unemployment and a more disadvantaged socioeconomic position [3,4,11,24], unstable relationships and earlier family formation [2,3,6] and poorer living conditions [4,14,18].…”