Avoidable mortality among child welfare recipients and intercountry adoptees: a national cohort study
Avoidable mortality among child welfare recipients and intercountry adoptees: a national cohort study
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DOI：
10.1136/jech.2003.014282
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发表时间：
2004-05-01
影响因子：
6.3
通讯作者：
Lindblad, F
中科院分区：
文献类型：
--
作者：
Hjern, A;Vinnerljung, B;Lindblad, F
目的：比较儿童福利领取者和跨国收养者与一般人群青春期可避免的死亡率。设计：对1990年全国人口普查中出生于1973-82年的989 871名瑞典居民的整个全国队列进行登记研究。采用多因素考克斯比例风险分析方法，对1991- 2000年13 ~ 27岁儿童的可避免死亡进行分析。研究对象：12240名跨国收养儿童，6437名寄养儿童，15868名接受其他形式的儿童福利干预的儿童，其余955326名儿童。跨国收养者仅自杀死亡的性别和年龄调整相对危险度（RR）较高（经常资源3.5; 95% CI 2.3 - 5.0）与一般人群相比，而接受过其他儿童福利干预的寄养儿童和青少年自杀死亡的性别和年龄调整后的RR较高; 4.3（2.8至6.6）和2.7（1.9至3.9），以及其他可避免的死亡; RR 2.5（1.6至3.7）和2.8（2.1至3.6）。寄养儿童和其他儿童福利受助人的可避免的死亡率下降相当大的时候相比，在家庭中长大的青年，具有类似的心理社会特征，因为他们原来的home.Conclusion：儿童在幼儿期的替代护理在青春期和成年早期的自杀死亡的风险特别大。儿童福利干预措施不足以防止高危儿童过多死亡。
Objective: To compare rates of avoidable mortality in adolescence in child welfare recipients and intercountry adoptees with the general population.Design: A register study of the entire national cohort of 989 871 Swedish residents born 1973-82 in the national census of 1990. Multivariate Cox analyses of proportional hazards were used to analyse avoidable deaths between 13 to 27 years of age during 1991-2000.Participants: 12 240 intercountry adoptees, 6437 foster children, 15 868 subjected to other forms of child welfare interventions, and the remaining 955 326 children in the cohort.Results: Intercountry adoptees had a high sex and age adjusted relative risk (RR) for suicide death only (RR 3.5; 95% CI 2.3 to 5.0) in comparison with the general population, while foster children and adolescents who had received other kinds of child welfare interventions had high sex and age adjusted RRs for suicide death; 4.3 (2.8 to 6.6) and 2.7 (1.9 to 3.9) respectively, as well as for other avoidable deaths; RRs 2.5 (1.6 to 3.7) and 2.8 (2.1 to 3.6). The RRs of avoidable deaths for foster children and other child welfare recipients decreased considerably when compared with youth brought up in homes with similar psychosocial characteristics as their original home.Conclusion: Children in substitute care in early childhood were at particular risk for suicide death in adolescence and young adulthood. Child welfare interventions were insufficient to prevent excess deaths in children at risk.