Association of childhood out-of-home care status with all-cause mortality up to 42-years later






The adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples.


Data on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971–2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings.


Adults who had been in care at any census (maximum of two) had an adjusted all-cause mortality hazard ratio 1.62 (95% CI 1.43, 1.86) times higher than adults who had never been in care. The excess mortality was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes. Mortality risk was elevated if the LS member was initially assessed in 1981 or 2001, compared to 1971. There was no significant variation in mortality risk for those in care by age or gender. The main findings were consistent irrespective of choice of comparison group (whole population, disadvantaged population), care placement (residential, non-residential) and age at death (all ages, adulthood only).


In this large, nationally representative study of dependent children resident in England and Wales, those who had been in care during childhood had a higher risk of mortality long after they had left care on average, mainly from unnatural causes. No differences by age or gender were found. Children in care have not benefitted from the general decline in mortality risk over time.



Reference:  Murray, E.T., Lacey, R., Maughan, B., Sacker, A. (2020). Association of childhood out-of-home care status with all-cause mortality up to 42-years later: Office of National Statistics Longitudinal Study. BMC Public Health 20, 735 (2020).




The adverse lifelong consequences of being looked after as a child are well recognised. However, systematic evidence on outcomes for looked-after children beyond the early adult years is currently very limited.

This study begins to fill that gap by exploring the long-term consequences of being cared for in institutional or family settings, using data from the Office of National Statistics Longitudinal Study (ONS LS). ONS LS contains linked census and life events data for a 1% sample of the population of England and Wales. Members of the study can be identified who were children at the time of each decennial census and living in: residential care, as an unrelated member of an individual household, as a biological or adopted child in a parental household, and as a child in a relative’s household.

This study was supported & funded by the Nuffield Foundation




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