Abstract
The death of a child is an extreme life event with potentially long-term health consequences. Knowledge about its association with ischemic heart diseases (IHDs) and acute myocardial infarction (AMI), however, is very limited. We investigated whether the death of an offspring is associated with the risk of IHD and AMI. We studied parents of live-born children recorded in the Danish (1973 to 2016) and the Swedish (1973 to 2014) Medical Birth Registers (n = 6,711,952; mean age at baseline 31 years, 53% women). We retrieved information on exposure, outcomes, and covariates by linking individual-level information from several nationwide registers. We analyzed the abovementioned associations using Poisson regression. A total of 126,522 (1.9%) parents lost at least 1 child during the study period. Bereaved parents had a higher risk of IHD and AMI than the nonbereaved [incidence rate ratios (IRRs) (95% confidence intervals (CIs)): 1.20 (1.18 to 1.23), P < 0.001 and 1.21 (1.17 to 1.25), P < 0.001, respectively]. The association was present not only in case of losses due to CVD or other natural causes, but also in case of unnatural deaths. The AMI risk was highest in the first week after the loss [IRR (95% CI): 3.67 (2.08 to 6.46), P < 0.001], but a 20% to 40% increased risk was observed throughout the whole follow-up period. Study limitations include the possibility of residual confounding by socioeconomic, lifestyle, or health-related factors and the potentially limited generalizability of our findings outside Scandinavia. The death of an offspring was associated with an increased risk of IHD and AMI. The finding that the association was present also in case of losses due to unnatural causes, which are less likely to be confounded by cardiovascular risk factors clustering in families, suggests that stress-related mechanisms may also contribute to the observed associations.
Highlights
An increasing number of studies have suggested that the death of a spouse in middle and old age may increase the risk of cardiovascular mortality [1,2,3,4], in the months following the loss [1,3]
Bereaved parents had a higher risk of ischemic heart disease (IHD) and acute myocardial infarction (AMI) than the nonbereaved [incidence rate ratios (IRRs) (95% confidence intervals (CIs)): 1.20 (1.18 to 1.23), P < 0.001 and 1.21 (1.17 to 1.25), P < 0.001, respectively]
The AMI risk was highest in the first week after the loss [IRR: 3.67 (2.08 to 6.46), P < 0.001], but a 20% to 40% increased risk was observed throughout the whole follow-up period
Summary
An increasing number of studies have suggested that the death of a spouse in middle and old age may increase the risk of cardiovascular mortality [1,2,3,4], in the months following the loss [1,3]. Death of an offspring and ischemic heart disease diseases (CVDs) and of other types of losses is much more limited, though recently, a few studies have reported associations between the death of a spouse, a sibling, a child, or “a significant person” and increased risks of acute myocardial infarction (AMI), stroke, atrial fibrillation, and/or cardiovascular mortality [5,6,7,8,9,10,11]. Accepting the loss of a child—a task that according to several theories of bereavement is the most important for grief resolution—is very difficult for parents [14], as child mortality is very low in Western societies and is in sharp contrast with expectations about the life cycle. Knowledge about its association with ischemic heart diseases (IHDs) and acute myocardial infarction (AMI), is very limited.
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