Abstract
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 age2, 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.
Highlights
The adverse life-long consequences of being looked-after as a child are well recognised, but followup 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
Statement of principal findings In this large, nationally representative follow-up study of dependent children resident in England and Wales, consistent with hypothesis 1, all-cause mortality was higher among adults who had been in care up to 42 years earlier
The excess mortality for those who had been in care was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes
Summary
The adverse life-long consequences of being looked-after as a child are well recognised, but followup 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. As of March 2018, the number of children looked-after by local authorities in England and Wales was 75,420 and 6407 respectively; equivalent to 62 and 102 per 10, 000 population under aged 18 [1, 2] Both the number of, and rate of children being looked-after, have increased steadily over the past decade, due to a combination of more children entering, and fewer children leaving, care [1]. It is important to understand whether the previously observed higher mortality risk for looked-after children in residential settings applies to all looked-after children, extends beyond the early adult years, and has continued in later cohorts, in order to identify and hopefully reduce preventable deaths in this vulnerable population
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