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Out-of-home care placement and mortality rate in early adulthood: identifying vulnerable subgroups in a nationwide cohort study

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Abstract

Out-of-home care has been linked to excess mortality across the lifespan. We examined whether this association is modified by the age at first out-of-home care placement and the number of placements. In this population-based cohort study, we used register data covering all children born in Denmark between 1 and 1980 and 31 December 1999, totalling 1,111,193 individuals followed until 31 December 2018. We divided participants according to sex, out-of-home care status, age at first placement, and the number of placements. We estimated adjusted hazard ratios and hazard differences per 10,000 person-years for all-cause mortality and mortality due to suicide, accidents, and cancer between ages 18 and 39. 53,015 (4.8%) of the participants were placed in out-of-home care before age 18. The adjusted hazard ratio for all-cause mortality was 3.4 (95% CI 3.1–3.7) for males and 4.7 (4.0–5.4) for females, corresponding to 20.6 (19.0–22.2) and 10.3 (9.1–11.5) additional deaths per 10,000 individuals annually among males and females, respectively. Associations did not vary substantially according to age at first placement or the number of placements. Both males and females with a history of out-of-home care were more likely to die from suicide, accidents, and cancer compared with their peers. We show a markedly higher all-cause and cause-specific mortality among children who have been placed in out-of-home care, but contrary to our hypothesis, age at first placement and the number of placements did not modify this relation. These results warrant further investigation into potential target points for interventions that may prevent premature mortality in this group of disadvantaged individuals.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Post box 2099, 1014, Copenhagen K, Denmark

    Trine Toft Sørensen, Naja Hulvej Rod, Tri-Long Nguyen & Jessica Bengtsson

Authors
  1. Trine Toft Sørensen
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  2. Naja Hulvej Rod
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  3. Tri-Long Nguyen
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  4. Jessica Bengtsson
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Contributions

TTS, NHR, TLN, and JB conceived the idea and designed the study. JB did the data linkage and data cleaning for DANLIFE. TTS, TLN, and JB performed the analyses. All authors had access to all the data. JB takes responsibility for the integrity of the data and the accuracy of the data analysis. TTS wrote the first draft of the manuscript. All authors discussed the results and contributed to the final manuscript. All authors have seen and approved the final submission.

Corresponding author

Correspondence to Jessica Bengtsson.

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Conflict of interest

JB is currently an employee at Novo Nordisk A/S. She contributed to this manuscript during her previous position at the University of Copenhagen, and not during her current position. The other authors have no competing interest to declare that are relevant to the content of this article.

Ethical approval

The Danish Data Protection Agency has approved the DANLIFE study through the records of research projects (involving personal data) at the Faculty of Health and Medical Sciences, University of Copenhagen (record no 514–0641/21-3000). The Danish Data Protection Agency ensures compliance with national and EU legislation. According to Danish Law, register linkage studies do not require ethical approval by the Danish National Committee on Health Research Ethics.

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Sørensen, T.T., Rod, N.H., Nguyen, TL. et al. Out-of-home care placement and mortality rate in early adulthood: identifying vulnerable subgroups in a nationwide cohort study. Eur J Epidemiol 38, 189–197 (2023). https://doi.org/10.1007/s10654-022-00959-1

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