Wei Dang, Li Jiong, Chen Hua, Fang Fang, Janszky Imre, Ljung Rickard, László Krisztina D
From the Department of Global Public Health (D.W., H.C., I.J., K.D.L.) and Institute of Environmental Medicine (F.F., R.L.), Karolinska Institutet, Stockholm, Sweden; Department of Clinical Medicine/Department of Clinical Epidemiology (J.L.), Aarhus University, Denmark; Department of Public Health and Nursing (I.J.), Norwegian University of Science and Technology, Trondheim, Norway; and Swedish Medical Products Agency (R.L.), Uppsala, Sweden.
Neurology. 2022 Mar 15;98(11):e1104-e1113. doi: 10.1212/WNL.0000000000013263. Epub 2022 Jan 7.
BACKGROUND AND OBJECTIVES: The death of a child is an extreme life event with potentially long-term health consequences. Accumulating evidence suggests that parents who lost a child have increased risks of cardiovascular diseases, including ischemic heart disease and atrial fibrillation. Whether bereaved parents have an increased risk of stroke is unclear and was investigated in this study. METHODS: We conducted a population-based cohort study including parents who had a child born during 1973-2016 or 1973-2014 and recorded in the Danish and the Swedish Medical Birth Registers, respectively. We obtained information on child's death, parent's stroke, and socioeconomic and health-related characteristics through linkage between several population-based registers. We used Poisson regression to examine the association between the death of a child and the risk of stroke. RESULTS: Of the 6,711,955 study participants, 128,744 (1.9%) experienced the death of a child and 141,840 (2.1%) had a stroke during the follow-up. Bereaved parents had an increased risk of stroke; the corresponding incidence rate ratio (95% CI) was 1.23 (1.19-1.27). The association was present for all analyzed categories of causes of child death (cardiovascular, other natural, and unnatural death) and did not differ substantially according to the age of the deceased child, but was stronger if the parent had no or ≥3 than 1-2 live children at the time of the loss. The association was similar for ischemic and hemorrhagic stroke. The risk for hemorrhagic stroke was highest immediately after the death of a child and decreased afterwards. In contrast, there was no clear pattern over time in case of ischemic stroke. DISCUSSION: The death of a child was associated with a modestly increased risk of stroke. The finding that an association was observed in case of unnatural deaths is suggestive of the explanation that bereavement-related stress may contribute to the development of stroke. Although the death of a child often cannot be avoided, an understanding of its health-related consequences may highlight the need for improved support and attention from family members and health care professionals.
背景与目的：儿童死亡是一种极端的生活事件，可能会产生长期的健康后果。越来越多的证据表明，失去孩子的父母患心血管疾病的风险增加，包括缺血性心脏病和心房颤动。失去孩子的父母患中风的风险是否增加尚不清楚，本研究对此进行了调查。 方法：我们进行了一项基于人群的队列研究，研究对象包括在1973 - 2016年或1973 - 2014年期间生育孩子并分别记录在丹麦和瑞典医学出生登记册中的父母。我们通过几个基于人群的登记册之间的关联，获取了有关孩子死亡、父母中风以及社会经济和健康相关特征的信息。我们使用泊松回归来研究孩子死亡与中风风险之间的关联。 结果：在6711955名研究参与者中，128744人（1.9%）经历了孩子死亡，141840人（2.1%）在随访期间发生了中风。失去孩子的父母患中风的风险增加；相应的发病率比（95%置信区间）为1.23（1.19 - 1.27）。在所有分析的儿童死亡原因类别（心血管疾病、其他自然死亡和非自然死亡）中均存在这种关联，并且根据死亡孩子的年龄没有显著差异，但如果父母在孩子死亡时没有或有≥3个而不是1 - 2个存活子女，则关联更强。缺血性中风和出血性中风的关联相似。出血性中风的风险在孩子死亡后立即最高，随后下降。相比之下，缺血性中风的情况没有随时间变化的明显模式。 讨论：孩子死亡与中风风险适度增加有关。在非自然死亡情况下观察到关联这一发现提示，丧亲相关压力可能促成中风的发生这一解释。虽然孩子死亡往往无法避免，但了解其与健康相关的后果可能凸显出家庭成员和医护人员加强支持与关注的必要性。
J Epidemiol Community Health. 2023-5
JAMA Netw Open. 2022-6-1
Neuroepidemiology. 2003
JAMA Netw Open. 2024-1-2
J Epidemiol Community Health. 2023-5
Zotero 插件