Yu Yongfu, Liew Zeyan, Cnattingius Sven, Olsen Jørn, Vestergaard Mogens, Fu Bo, Parner Erik Thorlund, Qin Guoyou, Zhao Naiqing, Li Jiong
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles.
JAMA Pediatr. 2017 Jun 1;171(6):538-545. doi: 10.1001/jamapediatrics.2017.0197.
The death of a close relative is associated with an increased mortality risk among the bereaved, but much less is known about the potential association of the death of a sibling in childhood with mortality in this population.
To examine the association between sibling death in childhood and subsequent mortality risk.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study of 5 005 029 participants evaluated linked national registers in Denmark (January 1, 1973, through December 31, 2009) and Sweden (January 1, 1973, through December 31, 2008). A total of 2 060 354 Danish and 2 944 675 Swedish children who survived the first 6 months of their life were included. We excluded 14 children who died of the same external cause as their siblings within 30 days. Data were analyzed from November 2, 2015, through October 14, 2016.
Participants were classified as exposed if a sibling died in childhood (age <18 years).
Poisson regression was used to estimate mortality rate ratio (MRR) with the exposure as a time-varying variable.
Among the 55 818 participants who experienced sibling death in childhood (51.5% male and 48.5% female; median age at loss, 7.0 [interquartile range, 3.3-12.1] years), all-cause mortality risk was increased by 71% (MRR, 1.71; 95% CI, 1.57-1.87) during the follow-up of 37 years. The excess mortality risk was observed for groups with specific causes of death, and the higher MRRs were found when the sibling pairs died of the same cause (death due to disease [MRR, 2.16; 95% CI, 1.87-2.49]; death due to external cause [MRR, 1.91; 95% CI, 1.54-2.37]). The increased mortality risk after sibling death was seen across the follow-up period, regardless of the age at bereavement and the type of death among bereaved siblings, but the magnitude of association was stronger during the first year after sibling death (MRR, 2.51; 95% CI, 1.79-3.54). Higher MRRs were found among sibling pairs with the same sex (MRR, 1.92; 95% CI, 1.70-2.18) and close age (MRR, 1.94; 95% CI, 1.58-2.37).
Bereavement in childhood because of the death of a sibling was associated with an increased risk for mortality in the short and long term. Health care professionals should be aware of individuals' vulnerability due to sibling death, especially for sibling pairs of close age or the same sex. Social and health care support may help to minimize the potential adverse effects on the bereaved sibling.
近亲死亡与 bereaved 人群的死亡风险增加相关，但对于童年时期兄弟姐妹死亡与该人群死亡率之间的潜在关联知之甚少。
研究童年时期兄弟姐妹死亡与随后的死亡风险之间的关联。
设计、背景和参与者：这项基于人群的队列研究纳入了丹麦（1973年1月1日至2009年12月31日）和瑞典（1973年1月1日至2008年12月31日）的5005029名参与者，评估了相关的国家登记册。共有2060354名丹麦儿童和2944675名瑞典儿童度过了生命的前6个月并被纳入研究。我们排除了14名在30天内死于与兄弟姐妹相同外部原因的儿童。数据于2015年11月2日至2016年10月14日进行分析。
如果兄弟姐妹在童年时期（年龄<18岁）死亡，参与者被分类为暴露组。
使用泊松回归以暴露作为时间变化变量来估计死亡率比（MRR）。
在童年时期经历兄弟姐妹死亡的55818名参与者中（男性占51.5%，女性占48.5%；失去兄弟姐妹时的中位年龄为7.0岁[四分位间距，3.3 - 12.1岁]），在37年的随访期间，全因死亡风险增加了71%（MRR，1.71；95%置信区间，1.57 - 1.87）。在特定死因组中观察到额外的死亡风险，当兄弟姐妹对死于相同原因时发现更高的MRR（疾病导致的死亡[MRR，2.16；95%置信区间，1.87 - 2.49]；外部原因导致的死亡[MRR，1.91；95%置信区间，1.54 - 2.37]）。无论失去兄弟姐妹时的年龄以及失去的兄弟姐妹的死亡类型如何，在整个随访期间都观察到兄弟姐妹死亡后死亡风险增加，但在兄弟姐妹死亡后的第一年关联程度更强（MRR，2.51；95%置信区间，1.79 - 3.54）。在同性别的兄弟姐妹对（MRR，1.92；95%置信区间，1.70 - 2.18）和年龄相近的兄弟姐妹对（MRR，1.94；95%置信区间，1.58 - 2.37）中发现了更高的MRR。
童年时期因兄弟姐妹死亡而经历的 bereavement 与短期和长期的死亡风险增加相关。医疗保健专业人员应意识到因兄弟姐妹死亡导致的个体脆弱性，特别是对于年龄相近或同性别的兄弟姐妹对。社会和医疗保健支持可能有助于将对失去兄弟姐妹的人的潜在不利影响降至最低。
