Association of public care in childhood with social, criminal, cognitive, and health outcomes in middle-age: five decades of follow-up of members of the 1958 birth cohort study

Cardiovascular disease in adults with a history of out-of-home care during childhood: a systematic review and meta-analysis of prospective cohort studies

Background

While individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected adverse health problems in adulthood, their risk of cardiovascular disease is uncertain. Our aim was to explore this association by pooling published and unpublished results from prospective cohort studies.

Methods

We used two approaches to identifying relevant data on childhood care and adult cardiovascular disease (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the objective of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews on childhood out-of-home care and other adult health outcomes. Included studies were required to satisfy three criteria: a cohort study in which the assessment of care was made prospectively pre-adulthood (in the avoidance of recall bias); data on an unexposed comparator group were available (for the computation of relative risk); and a diagnosis of adult cardiovascular disease events (coronary heart disease, stroke, or their combination) had been made (as opposed to risk factors only). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality.

Findings

Twelve studies (2 published, 10 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Five of the nine studies were judged to be of higher methodological quality. Relative to the unexposed, individuals with a care placement during childhood had a 51% greater risk of cardiovascular disease in adulthood (summary rate ratio after age- and sex-adjustment [95% confidence interval]: 1.51 [1.22, 1.86]; range of study-specific estimates: 1.07 to 2.06; I 2  = 69%, p = 0.001). This association was attenuated but persisted after adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.29 [1.11, 1.51]).

Interpretation

Our findings show that individuals with experience of out-of-home care in childhood have a moderately raised risk of cardiovascular disease in adulthood.

Funding

Medical Research Council; National Institute on Aging; Wellcome Trust.

Does the trauma associated with out-of-home care transmit across generations? Evidence from the 1970 British Cohort Study during a major health pandemic

OBJECTIVES

Children with experience of out-of-home care (OHC) are at an increased risk of adverse outcomes in later life, including poorer levels of psycho-social adjustment. Less is known about the intergenerational transmission of the trauma associated with OHC and psychosocial outcomes in mid-adulthood, particularly during a major health pandemic.

DESIGN

To examine if there is evidence of intergenerational transmission of trauma associated with OHC in mid-adulthood, we used data from the 1970 British Cohort Study 2020 COVID-19 Survey.

PARTICIPANTS

Cases were defined as cohort members (CMs) who had themselves experienced OHC (OHC1) and those whose mother reported to have been in OHC (OHC2). Among the 5320 CMs who participated in the second COVID-19 Survey, we have OHC information for n=4236. Our analytical samples range from n=2472 to 3864 depending on outcome: the largest sample comprised 105 (2.5%) CMs with direct OHC experience (OHC1), 93 (2.2%) CMs with a mother who had OHC experience (OHC2) and 3666 CMs with no OHC experience (OHC0).

OUTCOME MEASURES

Self-reported outcomes at age 50 included indicators of depression, health and psychological well-being. Multivariate logistic regression models control for socioeconomic childhood background and current circumstances.

RESULTS

Compared with the majority OHC0, the OHC1 group report higher levels of depression (OR 2.18 (95% CI 1.09 to 4.36) p<.05) and are at a greater risk of poor mental (OR 2.23 (95% CI 1.24 to 4.02) p<0.01) and general health (OR 3.32 (95% CI 1.65 to 6.67) p<0.001) during the pandemic. OHC2 was more than twice as likely to report poor mental health prepandemic (OR 2.52 (95% CI 1.37 to 4.64) p<0.01), but not during the pandemic.

CONCLUSION

Children of care leaver mothers (OHC2) appear to be better adjusted than those who were themselves in care (OHC1), although compared with those without care experience (OHC0) both groups had an increased risk of poorer adult outcomes. However, the findings point to both continuity and discontinuity of disadvantage.