Association of childhood out-of-home care status with all-cause mortality up to 42-years later: Office of National Statistics Longitudinal Study
Association of childhood out-of-home care status with all-cause mortality up to 42-years later: Office of National Statistics Longitudinal Study
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DOI：
10.1186/s12889-020-08867-3
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发表时间：
2020-05-20
影响因子：
4.5
通讯作者：
Sacker, Amanda
中科院分区：
文献类型：
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作者：
Murray, Emily T.;Lacey, Rebecca;Sacker, Amanda
儿童时期被照顾的不良后果是众所周知的，但死亡率风险的随访期大多在青年成年期结束，在小样本中，死亡率因安置年龄、性别和队列而异。方法采用1971-2001年人口普查期间353601名美国国家统计局（Office for National Statistics Longitudinal Study，简称LS）成员的数据，并采用以年龄为时间尺度的Cox比例风险回归模型，检验2013年底前儿童外出护理是否与全因死亡率相关。在调整了基线年龄和年龄(2)、性别、出生在英国以外、童年人口普查观察次数和基线人口普查年之后，我们通过对相互作用项的单独评估，测试了受照顾者的死亡率风险是否因年龄、性别和基线人口普查年而变化。补充分析评估了结果的稳健性。结果在任何一次普查中接受过护理的成年人（最多两次）的调整后全因死亡率风险比为1.62 (95% CI 1.43, 1.86)，是从未接受过护理的成年人的1倍。过高的死亡率主要是由于自残、事故以及精神和行为原因造成的死亡。与1971年相比，如果LS成员在1981年或2001年进行首次评估，则死亡风险会升高。在年龄或性别方面，接受护理者的死亡风险没有显著差异。无论选择何种比较组（全体人口、弱势人口）、护理安置（住宿、非住宿）和死亡年龄（所有年龄，仅限成年），主要研究结果都是一致的。结论：在这项对英格兰和威尔士的受抚养儿童进行的具有全国代表性的大型研究中，那些在童年时期受到照顾的儿童在离开照顾后很长时间内平均死亡的风险更高，主要是由于非自然原因。没有发现年龄和性别的差异。随着时间的推移，接受照料的儿童并没有从死亡风险的普遍下降中受益。
BackgroundThe adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples.MethodsData on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971-2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age(2), gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings.ResultsAdults who had been in care at any census (maximum of two) had an adjusted all-cause mortality hazard ratio 1.62 (95% CI 1.43, 1.86) times higher than adults who had never been in care. The excess mortality was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes. Mortality risk was elevated if the LS member was initially assessed in 1981 or 2001, compared to 1971. There was no significant variation in mortality risk for those in care by age or gender. The main findings were consistent irrespective of choice of comparison group (whole population, disadvantaged population), care placement (residential, non-residential) and age at death (all ages, adulthood only).ConclusionsIn this large, nationally representative study of dependent children resident in England and Wales, those who had been in care during childhood had a higher risk of mortality long after they had left care on average, mainly from unnatural causes. No differences by age or gender were found. Children in care have not benefitted from the general decline in mortality risk over time.