Cardiovascular disease in individuals with a history of out-of-home care: a Swedish national cohort study

Abstract

Background: Individuals with a history of out-of-home care in childhood experience elevated rates of mortality from all-causes and suicide in adulthood but the relationship with chronic disease is unknown. We examined the association between out-of-home care and cardiovascular disease (CVD) in a large cohort study and, in the women, explored how care is embodied to give rise to CVD. Methods: This is a cohort study generated from linkage of a range of Swedish national registers. Born 1972-1981, 447,516 men (12711 with a care background) and 415,910 women (11926 with a care background) were followed between care graduation at age 18 and up to age 48 years for hospitalisations and death. A subgroup of 377,500 women (87% of the birth cohort) were linked to a maternity database which yielded data on adult cigarette smoking and metabolic risk factors. Results: A maximum of 30 years of health surveillance gave rise to 5519 CVD events (2049 in women). After adjusting for the confounding factors of year of birth and maternal education, men (hazard ratio 1.95 [95% CI 1.68-2.25]) and women (1.80 [1.48-2.18]) with a history of out-of-home care in childhood had around a doubling of CVD risk in adulthood compared with general population controls. Separate presentations of CVD, such as myocardial infarction and stroke, revealed similar magnitudes of association with care. In women who had given birth, adjustment for the mediating variables of adult smoking status (1.41 [1.12-1.78]) and educational performance (1.57 [1.25-1.98]), but not metabolic risk factors (1.98 [1.24-3.15]), led to marked attenuation in CVD risk. Conclusion: In the present study, men and women separated from their family of origin in early life experienced an increased burden of CVD as adults. Results for women suggest that targeting health behaviours, teenage pregnancy, and educational performance in these groups may potentially mitigate risk. These findings add to the array of adverse adult health outcomes seemingly experienced following care graduation.