The Multiple Layers of Childhood Adversity and Premature Mortality: Synthesizing Life-course Data on Individual, Family and Neighborhood Adversity in 1.2 million individuals
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Background
Childhood adversity is multi-layered, extending beyond the family to include broader neighborhood contexts, and individual risks such as being born preterm or childhood physical and mental health issues.
Methods
We undertook a population-based study using Danish nationwide register data on multi-layered childhood adversity (individual, family and neighborhood adversity), and premature mortality. Children who were alive and resident in Denmark until their 16th birthday were followed into young adulthood (16-42 years). Individual adversity included perinatal adversity (born preterm or small for gestational age) and mental and physical health service use. Family adversity was determined by categorizing individuals into five distinct groups using group-based multi-trajectory modelling based on 12 adversities. Neighborhood adversity was assessed using home addresses and information on deprivation in small-area zones. We evaluated the individual, interactive, and cumulative associations of these layers with premature mortality using survival analyses.
Findings
1,225,858 individuals born between 1980 and 2001, were followed up until Dec 31, 2022, capturing 7,215 premature deaths. Children facing high family adversity were more likely to have perinatal adversity, use health services, and live in deprived neighborhoods. Each layer separately predicted premature mortality, with for example high physical health service use (HR: 1.58; 95% CI: 1.48; 1.69) and living in a deprived neighborhood (HR: 1.19; 95% CI: 1.13; 1.25) being associated with higher mortality. Cross-layer interactions were most pronounced between family adversity and child mental health or perinatal adversity. The highest mortality risk was observed among those with high family adversity who also experienced individual adversity: HR: 6.48 (95% CI: 5.76; 7.29) compared to those with low adversity across all layers.
Interpretation
The clustering and interaction of childhood adversities across different layers can create highly vulnerable groups from an early age, deepening lifelong health inequalities. This underscores the importance of a comprehensive, multi-layered approach to addressing childhood adversity that targets individual vulnerabilities as well as the broader social environment.
Funding
The project is funded by the European Research Council (consolidator grant no. 101124807).
