Mortality after Parental Death in Childhood: A Nationwide Cohort Study from Three Nordic Countries
Mortality after Parental Death in Childhood: A Nationwide Cohort Study from Three Nordic Countries
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DOI：
10.1371/journal.pmed.1001679
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发表时间：
2014-07-01
期刊：
影响因子：
15.8
通讯作者：
Olsen, Jorn
中科院分区：
文献类型：
--
作者：
Li, Jiong;Vestergaard, Mogens;Olsen, Jorn
背景：配偶死亡和成年后子女死亡的丧亲之痛已被证明会导致死亡风险增加。婴儿期产妇死亡或幼儿期父母死亡可能对死亡率产生影响，但证据仅限于短期或选定的死亡原因。关于父母在童年时期死亡后的长期或特定原因死亡率知之甚少。方法和结果：这项队列研究包括1968年至2008年在丹麦出生的所有人1973年至2006年在瑞典（n = 3，380，301），以及1987年至2007年在芬兰出生的89.3%的随机样本（n = 1，131，905）。共有189，094人在18岁之前失去父母时被纳入暴露队列。对数线性泊松回归用于估计死亡率比（MRR）。父母死亡与全因死亡率增加50%相关（MRR = 1.50，95% CI 1.43-1.58）。大多数特定原因组的风险增加，当儿童死亡原因和父母死亡原因属于同一类别时，观察到最高的MRR。父母非自然死亡的死亡风险（MRR = 1.84，95% CI 1.71-2.00）高于父母自然死亡（MRR = 1.33，95% CI 1.24-1.41）。在不同的随访期内，相关性的大小因死亡类型和丧亲年龄而异。这项研究的主要局限性是缺乏数据丧亲后的信息质量的亲子关系，生活方式，和共同的物理environment.Conclusions：父母在童年或青春期死亡与成年早期的全因死亡率增加。由于死亡率的增加反映了遗传易感性和父母死亡对健康和社会福祉的长期影响，我们的研究结果对临床反应和公共卫生策略具有影响。
Background: Bereavement by spousal death and child death in adulthood has been shown to lead to an increased risk of mortality. Maternal death in infancy or parental death in early childhood may have an impact on mortality but evidence has been limited to short-term or selected causes of death. Little is known about long-term or cause-specific mortality after parental death in childhood.Methods and Findings: This cohort study included all persons born in Denmark from 1968 to 2008 (n = 2,789,807) and in Sweden from 1973 to 2006 (n = 3,380,301), and a random sample of 89.3% of all born in Finland from 1987 to 2007 (n = 1,131,905). A total of 189,094 persons were included in the exposed cohort when they lost a parent before 18 years old. Log-linear Poisson regression was used to estimate mortality rate ratio (MRR). Parental death was associated with a 50% increased all-cause mortality (MRR = 1.50, 95% CI 1.43-1.58). The risks were increased for most specific cause groups and the highest MRRs were observed when the cause of child death and the cause of parental death were in the same category. Parental unnatural death was associated with a higher mortality risk (MRR = 1.84, 95% CI 1.71-2.00) than parental natural death (MRR = 1.33, 95% CI 1.24-1.41). The magnitude of the associations varied according to type of death and age at bereavement over different follow-up periods. The main limitation of the study is the lack of data on post-bereavement information on the quality of the parent-child relationship, lifestyles, and common physical environment.Conclusions: Parental death in childhood or adolescence is associated with increased all-cause mortality into early adulthood. Since an increased mortality reflects both genetic susceptibility and long-term impacts of parental death on health and social well-being, our findings have implications in clinical responses and public health strategies.