Does time heal all wounds? Life course associations between child welfare involvement and mortality in prospective cohorts from Sweden and Britain

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Does time heal all wounds? Life course associations between child welfare involvement and mortality in prospective cohorts from Sweden and Britain

Jackisch, J; Ploubidis, GB; Gondek, D; (2021) Does time heal all wounds? Life course associations between child welfare involvement and mortality in prospective cohorts from Sweden and Britain. SSM - Population Health , 14 , Article 100772. 10.1016/j.ssmph.2021.100772. Green open access

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Abstract

Child welfare involvement reflects childhood adversity and is associated with increased adult mortality, but it remains unclear how this association changes over the life course. Drawing on the Stockholm Birth Cohort Multigenerational Study (Sweden) and the National Childhood Development Study (Great Britain) this study examines whether inequalities within these cohorts diverge or converge. Involvement with child welfare services (ICWS) is divided into two levels (‘child welfare contact’ and ‘out-of-home care’). For each cohort, we quantify absolute health inequalities as differences in cumulative probabilities of death (18–58 years) and temporary life expectancy; and relative inequalities as hazard ratios in ten-year intervals and ratios of lifetime lost. Persistently, ICWS was associated with premature mortality. The strength of the association varied by age, sex and level of ICWS. Consistently across both countries, the most robust relationship was between out-of-home care and mortality, with statistically significant age-specific hazard ratios ranging between 1.8 and 3.4 for males and 1.8–2.1 for females. Child welfare contact that did not result in out-of-home placement showed less consistent results. Among females the mortality gap developed later compared to males. Estimates attenuate after controlling for family socioeconomic and other background variables but patterns remain intact. Our results show that absolute inequalities widen with increasing age, while relative inequalities might peak in early adulthood and then stabilize in midlife. The relative disadvantage among looked-after children in early adulthood is heightened by overall low rates of mortality at this age. Absolute inequality increases with age, highlighting the weight of the accumulation of disadvantage in mortality over time. The bulk of excess deaths that could be attributed to ICWS occurs from midlife onwards. Mechanisms that uphold the disadvantage after childhood experiences require further exploration. This study highlights that the association between out-of-home care and premature mortality seems to transcend welfare systems.

Type:	Article
Title:	Does time heal all wounds? Life course associations between child welfare involvement and mortality in prospective cohorts from Sweden and Britain
Open access status:	An open access version is available from UCL Discovery
DOI:	10.1016/j.ssmph.2021.100772
Language:	English
Additional information:	© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
UCL classification:	UCL UCL > Provost and Vice Provost Offices > School of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education > IOE - Social Research Institute
URI:	https://discovery.ucl.ac.uk/id/eprint/10126183