Trajectories of childhood adversity and mortality in early adulthood: a population-based cohort study

Rod, Naja H, Bengtsson, Jessica, Budtz-Jorgensen, Esben, Clipet-Jensen, Clara, Taylor-Robinson, David ORCID: 0000-0002-5828-7724, Andersen, Anne-Marie Nybo, Dich, Nadya and Rieckmann, Andreas
(2020) Trajectories of childhood adversity and mortality in early adulthood: a population-based cohort study. LANCET, 396 (10249). pp. 489-497.

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<h4>Background</h4>Childhood is a sensitive period with rapid brain development and physiological growth, and adverse events in childhood might interfere with these processes and have long-lasting effects on health. In this study, we aimed to describe trajectories of adverse childhood experiences and relate these to overall and cause-specific mortality in early adult life.<h4>Methods</h4>For this population-based cohort study, we used unselected annually updated data from Danish nationwide registers covering more than 1 million children born between 1980 and 1998. We distinguished between three different dimensions of childhood adversities: poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics such as maternal separation. We used a group-based multi-trajectory clustering model to define the different trajectories of children aged between 0 and 16 years. We assessed the associations between these trajectories and mortality rates between 16 and 34 years of age using a Cox proportional hazards model and an Aalen hazards difference model.<h4>Findings</h4>Between Jan 1, 1980 and Dec 31, 2015, 2 223 927 children were included in the Danish Life Course cohort. We excluded 1 064 864 children born after 1998, 50 274 children who emigrated before their 16th birthday, and 11 161 children who died before their 16th birthday, resulting in a final sample of 1 097 628 children. We identified five distinct trajectories of childhood adversities. Compared with children with a low adversity trajectory, those who had early-life material deprivation (hazard ratio 1·38, 95% CI 1·27-1·51), persistent deprivation (1·77, 1·62-1·93), or loss or threat of loss (1·80, 1·61-2·00) had a moderately higher risk of premature mortality. A small proportion of children (36 081 [3%]) had multiple adversities within all dimensions and throughout the entire childhood. This group had a 4·54 times higher all-cause mortality risk (95% CI 4·07-5·06) than that of children with a low adversity trajectory, corresponding to 10·30 (95% CI 9·03-11·60) additional deaths per 10 000 person-years. Accidents, suicides, and cancer were the most common causes of death in this high adversity population.<h4>Interpretation</h4>Almost half of Danish children in our study experienced some degree of adversity, and this was associated with a moderately higher risk of mortality in adulthood. Among these, a small group of children had multiple adversities across social, health, and family-related dimensions. This group had a markedly higher mortality risk in early adulthood than that of other children, which requires public health attention.<h4>Funding</h4>None.

Item Type: Article
Uncontrolled Keywords: Humans, Registries, Mortality, Cause of Death, Proportional Hazards Models, Family Characteristics, Maternal Deprivation, Poverty, Adolescent, Adult, Denmark, Female, Male, Young Adult
Depositing User: Symplectic Admin
Date Deposited: 17 Aug 2020 08:28
Last Modified: 16 Mar 2023 20:57
DOI: 10.1016/s0140-6736(20)30621-8
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