Source/Disclosures
Disclosures: Chaiyachati reports that her employer receives compensation for her expert witness court testimony. Please see the study for all other authors’ relevant financial disclosures.
April 24, 2020
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Children in foster care 42% more likely to die than children in general population

Source/Disclosures
Disclosures: Chaiyachati reports that her employer receives compensation for her expert witness court testimony. Please see the study for all other authors’ relevant financial disclosures.
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Barbara H. Chaiyachati

Children in the foster care system are 42% more likely to die than children in the general population, a study published in JAMA Pediatrics showed.

Barbara H. Chaiyachati, MD, PhD, a fellow in child abuse pediatrics at the Children’s Hospital of Philadelphia, and colleagues analyzed data on children in the foster care system from 2003 to 2016 and found that there were 35.4 deaths per 100,000 person-years compared with 25 in the general population, with an incidence rate ratio of 1.42 (95% CI, 1.37-1.47).

“Clinicians should recognize that children in foster care are a particularly vulnerable population — though, importantly, we are not concluding that children in foster care have increased mortality because they are in foster care,” Chaiyachati told Healio. “While we seek to understand why children in foster care are at increased risk of death, clinicians can re-evaluate their own practices to assess if additional services may be warranted for their patients in foster care.”

There was a higher mortality rate among black children in the foster care system compared with black children in the general population — 43.8 deaths per 100,000 person-years (95% CI, 41.4-46.2) vs. 34.1 deaths per 100,000 person-years (95% CI, 33.9-34.4). A higher mortality rate was found within each race category, the researchers reported.

“As a clinician who works with children in foster care, I have seen first hand some of the challenges at the interface between child welfare and health care delivery,” Chaiyachati said. “Unfortunately, these experiences, along with the literature outlining increased disease burden for children in foster care, made our findings of increased mortality less surprising.”

There also was a higher mortality rate among children aged 1 to 4 years — 50.7 deaths per 100,000 person-years (95% CI, 47.8-53.6) vs. 27.5 deaths per 100,000 person-years (95% CI, 27.3-27.7) among children aged 1 to 4 years in the general population.

The researchers did not observe an increased mortality rate among children aged 15 to 18 years.

“While there are multiple potential influences on differences in mortality, the age-dependent differences add another level of potential complexity,” Chaiyachati said.

During the study period, mortality rates among children in foster care remained steady, whereas mortality rates of children in the general population decreased by 2.5%, according to the study. – by Ken Downey Jr.

Disclosures: Chaiyachati reports that her employer receives compensation for her expert witness court testimony. Please see the study for all other authors’ relevant financial disclosures.