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Troubled childhoods cast long shadows: Childhood adversity and premature all-cause mortality in a Swedish cohort
Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).ORCID iD: 0000-0002-5958-2303
Stockholm University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-8526-9396
Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).ORCID iD: 0000-0001-7576-9410
2019 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 9, article id 100506Article in journal (Refereed) Published
Abstract [en]

Experiences of childhood adversity are common and have profound health impacts over the life course. Yet, studying health outcomes associated with childhood adversity is challenging due to a lack of conceptual clarity of childhood adversity, scarce prospective data, and selection bias. Using a 65-year follow-up of a Swedish cohort born in 1953 (n = 14,004), this study examined the relationship between childhood adversity (ages 0-18) and premature all-cause mortality (ages 19-65). Childhood adversity was operationalized as involvement with child welfare services, household dysfunction, and disadvantageous family socioeconomic conditions. Survival models were used to estimate how much of the association between child welfare service involvement and mortality could be explained by household dysfunction and socioeconomic conditions. Results show that individuals who were involved with child welfare services had higher hazards of dying prematurely than their majority population peers. These risks followed a gradient, ranging from a hazard ratio of 3.08 (95% CI: 2.68-3.53) among those placed in out-of-home care, followed by individuals subjected to in-home services who demonstrated a hazard ratio of 2.53 (95% CI: 1.93-3.32), to a hazard ratio of 1.81 among those investigated and not substantiated (95% CI: 1.55-2.12). Associations between involvement with child welfare services and premature all-cause mortality were robust to adjustment for household dysfunction and disadvantageous family socioeconomic conditions. Neither household dysfunction nor socioeconomic conditions were related with mortality independent of child welfare services involvement. This study suggests that involvement with child welfare services is a viable proxy for exposure to childhood adversity and avoids pitfalls of self-reported or retrospective measures.

Place, publisher, year, edition, pages
2019. Vol. 9, article id 100506
Keywords [en]
Sweden, Premature mortality, Cohort study, Adverse childhood experiences, Childhood social conditions, Longitudinal, Child welfare
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
URN: urn:nbn:se:su:diva-178149DOI: 10.1016/j.ssmph.2019.100506ISI: 000498893900014PubMedID: 31720363OAI: oai:DiVA.org:su-178149DiVA, id: diva2:1386954
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07148Available from: 2020-01-20 Created: 2020-01-20 Last updated: 2022-09-27Bibliographically approved
In thesis
1. Troubled childhoods cast long shadows: Studies of childhood adversity and premature mortality in a Swedish post-war birth cohort
Open this publication in new window or tab >>Troubled childhoods cast long shadows: Studies of childhood adversity and premature mortality in a Swedish post-war birth cohort
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Taking a life course approach can help us to understand health inequalities. This thesis illustrates that socially-patterned childhood experiences might play a critical role for inequalities in mortality. The association between childhood adversity and premature mortality is investigated in the context of a 1953 Stockholm birth cohort. Over a series of four empirical studies, it is shown that childhood adversity is a major risk factor for premature mortality, and is a significant contributor to socioeconomic inequalities in mortality.

More specifically, Study I found that indicators of early life socioeconomic disadvantage and childhood adversity were individually associated with adult mortality. When all of these co-occurring indicators were studied simultaneously, involvement with child welfare services – specifically involvement resulting in placement in out-of-home care – was the indicator most robustly associated with premature mortality in adulthood. Based on the results Study I, involvement with child welfare services was used as a proxy for childhood adversity the following three studies.

Study II showed that involvement with child welfare services could explain almost half of the education and income gradients in life-expectancy between ages 29–67.

Study III demonstrated that the increased mortality risk among adults who were placed in out-of-home care as children persisted to midlife. Moreover, increased mortality risks after out-of-home care were not unique to the Swedish welfare context but could be verified in a cohort from Great Britain.

Finally, Study IV found that adults who experienced involvement with child welfare services not only had increased risks of major diseases in adulthood, but also had worse survival prospects after a first hospitalisation.

Involvement with child welfare services, specifically placement in out-of-home care, can have consequences for socioeconomic attainment, and physical and mental health. Even in this cohort that entered adulthood during some of the most generous years of the Swedish welfare state, the unequal distribution of life chances following experiences of childhood adversity was not eliminated. These empirical studies extend our understanding of how childhood adversity contributes to the complex processes that generate inequalities in mortality. The results further indicate that it is never too early nor too late to prevent inequalities in health.

Place, publisher, year, edition, pages
Stockholm: Department of Public Health Sciences, Stockholm University, 2022. p. 95
Series
Health Equity Studies, ISSN 1651-5390 ; 24
Keywords
Mortality, Health Equity, Adverse Childhood Experiences, Child Welfare, Adult Survivors of Child Adverse Events, Life Course Perspective, Birth cohort, Longitudinal Studies
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Sciences Interdisciplinary
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-209892 (URN)978-91-8014-028-7 (ISBN)978-91-8014-029-4 (ISBN)
Public defence
2022-11-10, Hörsal 4, Albano, Albanovägen 18 and online via Zoom, public link is available at the department website, Stockholm, 10:00 (English)
Opponent
Supervisors
Available from: 2022-10-18 Created: 2022-09-27 Last updated: 2022-10-10Bibliographically approved

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