COVID-19–Associated Orphanhood and Caregiver Death in the United States

Abstract

We found marked variation by race and ethnicity, overall and within US states, in risks of COVID-19-associated orphanhood and death of grandparent caregivers among children.What's Known on this Subject: Caregiver death increases risks of short-term trauma and lifelong adverse consequences for children. One microsimulation research letter estimated parental deaths in the US to Feb 2021. A global study aggregated COVID-associated orphanhood and coresident caregiver deaths across 21 countries. What this Study Adds:We report overall and US state-specific findings, disaggregated by race/ethnicity, for COVID-19-associated orphanhood and death of grandparent caregivers. High rates of orphanhood, marked disparities, and state-specific differences show the overlooked burden among children at greatest risk, in states most affected. Authors' Contributions:Dr. Hillis guided the conceptualization and investigation, wrote the first draft of the Article, guided the writing, and led the reviews and revisions of the manuscript.Drs. Unwin and Ratmann contributed to the conceptualization or design of the work; the interpretation of the data; guided and performed the statistical analyses, verified the underlying data, led writing of the methods section, prepared all visualizations, and performed all analyses for and contributed to the Supplementary Material.Dr. Blenkinsop performed the statistical analyses, verified the underlying data, led writing of the methods section, prepared all visualizations, and performed all analyses for and wrote the Supplementary Material.Drs. Flaxman and Donnelly contributed to the conceptualization and the formal analyses, and reviewed and revised the manuscript critically for important intellectual content.

Urgently Needed: Equity Tools to Navigate Demographic Gale-Force Wind Gusts

“…Bernstein and Achenbach report there were 93,000 drug overdose deaths in 2020, representing a 30% increase over the 2019 death toll, bringing the total to more than 900,000 overdose deaths since the United States drug epidemic began in the late 1990s [11]. Further, an estimated 144,000 children's lives have been upended by the death of either a primary (122,000) or secondary (22,000) caregiver [21].…”

COVID-19 as America’s Stress Test

“…Prolonged grief disorder, defined by persistent symptoms and effects a year after a loss, can affect 5 to 10 percent of persons who lose a close family member or friend (Courage 2021). An estimate in JAMA Pediatrics for the pandemic period up to June 2021 indicates that more than 140,000 children have lost at least one parent or grandparent caregiver due to COVID (Kidman et al 2021;Hillis et. al.…”

“…These mortality effects cut across all age groups, but where COVID is concentrated in particular communities it can result in a significant aftermath of psychological, physical, and, in some cases, economic loss. Again, the consequences of death and bereavement are believed to also have a racial and ethnic component, with the disproportionate deaths in minority communities translating to disparate mental health consequences for minority children and families (Hillis et al 2021; Substance Abuse and Mental Health Services Administration 2021).…”

Hidden Pain: Children Who Lost a Parent or Caregiver to COVID-19 and What the Nation Can Do to Help Them

“…Among these 760,000 deaths are parents, custodial grandparents, or other caregivers on whom children and adolescents relied for financial, emotional, and developmental support. [3][4][5][6][7] A high priority for policymakers is estimating the number of children made acutely vulnerable because their caregiver died from COVID-19. The impacts of losing one or both parents-defined by the United Nations as "orphanhood" for anyone under the age of 18-are well documented.…”