TY - JOUR T1 - Childhood adversity is associated with hospitalisations and survival following external causes and non-communicable diseases: a 46-year follow-up of a Stockholm birth cohort JF - Journal of Epidemiology and Community Health JO - J Epidemiol Community Health SP - 209 LP - 215 DO - 10.1136/jech-2022-219851 VL - 77 IS - 4 AU - Josephine Jackisch AU - Ylva B Almquist Y1 - 2023/04/01 UR - http://jech.bmj.com/content/77/4/209.abstract N2 - Background Childhood adversity indicated by involvement with child welfare services (ICWS) is associated with increased risks of disease and injuries in young adulthood. It is yet unknown whether such risks are limited to external causes and mental and behavioural disorders or whether they extend beyond early adulthood and to non-communicable diseases (NCDs) with later onset. Moreover, it has not been explored whether ICWS associates with decreased survival prospects following hospitalisation.Methods Based on prospective data for a 1953 Stockholm birth cohort (n=14 134), ICWS was operationalised distinguishing two levels in administrative child welfare records (ages 0–19; ‘investigated’ and ‘placed’ in out-of-home care (OHC)). Hospitalisations and all-cause mortality (ages 20–66) were derived from national registers. Hospitalisation records were categorised into external causes and NCDs, and nine subcategories. Negative binomial regression models were used to estimate differences in hospitalisation risks between those with and without experiences of ICWS and Cox survival models to estimate mortality after hospitalisation.Results Placement in OHC was associated with higher risks of hospitalisation due to external causes and NCDs and all investigated subcategories except cancers. Risks were generally also elevated among those investigated but not placed. ICWS was further linked to higher mortality risks following hospitalisation.Conclusion Differential risk of morbidity and differential survival may explain inequalities in mortality following childhood adversity. We conclude that the healthcare sector might play an important role in preventing and mitigating the elevated risks of externally caused morbidity, disease and premature mortality observed among those with a history of ICWS.Under Swedish law and ethical approval, patient level data cannot be made publicly available. The statistical code is available from the corresponding author. Data access can be granted upon request to YBA and conditional on approval of the review board. ER -