Mortality outcomes of care experienced children (CHiCS): a population-wide cohort study

Abstract Background There is little evidence in the UK on the mortality of those with care experience. Many studies lack the power to examine mortality outcomes of children who are still in, or have recently left, care. Research conducted elsewhere suggest that deaths are increased among those with care experience. Children's Health in Care in Scotland (CHiCS) is a population-wide study linking administrative data on social care to deaths. We compared mortality outcomes of care experienced children (CEC) with children in the general population (CGP). Methods Data were linked for all publicly funded school-aged children in Scotland on the 2009 Pupil Census. The CEC cohort (n=13 831) comprised children included in the 2009–10 Children Looked After Statistics return whereas children in the CGP cohort (n=649 771) had no care experience. All children were followed up for 7 years (Aug 1, 2009 to July 31, 2016). Poisson regression models, adjusted for age, sex, and area deprivation measure, were used to compare mortality between the CEC and GCP cohorts. Findings There were 78 CEC and 746 CGP deaths over the period. 53 (68%) of the 78 CEC deaths were due to external causes versus 309 (41%) of the 746 CGP deaths. The leading cause of death for CEC was suicide; accidents were the leading cause for CGP. In the unadjusted model, the mortality rate from any cause was 4·92 (95% CI 3·87–6·17) times as high for CEC versus CGP. After controlling for age, sex, and area deprivation, the rate was 4·19 (3·21–5·39). Interpretation Mortality rates were considerably higher for CEC than CGP, and CEC were more likely to die from external causes (eg, suicide). The increased risk of death could not be explained by accounting for age, sex, or area deprivation. The Scottish Government have recognised the need for evidence on the health of CEC to implement changes to the care system. Our findings highlight the need for CEC to access appropriate health services, including those that support mental and emotional wellbeing. One limitation of the study is the exclusion of children not of school age or those who are educated in independent schools or at home. Funding Economic and Social Research Council, Medical Research Council, the Scottish Government Chief Scientist Office, and the Urban Big Data Centre.