Villaveces Andrés, Chen Yu, Tucker Sydney, Blenkinsop Alexandra, Cluver Lucie, Sherr Lorraine, Losby Jan L, Graves Linden, Noonan Rita, Annor Francis, Kojey-Merle Victor, Wang Douhan, Massetti Greta, Rawlings Laura, Nelson Charles A, Unwin H Juliette T, Flaxman Seth, Hillis Susan, Ratmann Oliver
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Department of Mathematics, Imperial College London, London, UK.
Nat Med. 2025 Feb;31(2):672-683. doi: 10.1038/s41591-024-03343-6. Epub 2025 Jan 10.
Deaths of parents and grandparent caregivers threaten child well-being owing to losses of care, financial support, safety and family stability, but are relatively unrecognized as a public health crisis. Here we used cause-specific vital statistics death registrations in a modeling approach to estimate the full magnitude of orphanhood incidence and prevalence among US children aged 0-17 years between 2000 and 2021 by cause, child age, race and ethnicity, sex of deceased parent and state, and also accounted for grandparent caregiver loss using population survey data. In 2021, we estimate that 2.91 million children (4.2% of children) had in their lifetime experienced prevalent orphanhood and caregiver death combined, with incidence increasing by 49.5% and prevalence by 7.9% since 2000. Populations disproportionately affected by orphanhood included 5.2% of all adolescents; 6.4% and 4.7%, respectively, of non-Hispanic American Indian or Alaska Native, and non-Hispanic Black children; and children in southern and eastern states. In 2021, drug overdose was the leading cause of orphanhood among non-Hispanic white children, but not among minoritized subgroups. Effective policies and programs to support nearly three million bereaved children are needed to reduce the acute and long-term negative effects of orphanhood.
父母及祖父母照料者的死亡会威胁儿童的幸福，因为这会导致照料缺失、经济支持丧失、安全保障受损以及家庭稳定性遭到破坏，但这一情况相对未被视作公共卫生危机。在此，我们采用一种建模方法，利用特定死因的人口动态统计死亡登记数据，按死因、儿童年龄、种族和族裔、已故父母性别及所在州，估算2000年至2021年间美国0至17岁儿童中孤儿身份发生率和患病率的全貌，同时还利用人口调查数据考量了祖父母照料者的离世情况。2021年，我们估计有291万儿童（占儿童总数的4.2%）一生中经历过孤儿身份和照料者死亡的双重情况，自2000年以来，发生率增长了49.5%，患病率增长了7.9%。受孤儿身份影响尤为严重的人群包括所有青少年中的5.2%；非西班牙裔美国印第安人或阿拉斯加原住民儿童及非西班牙裔黑人儿童分别占比6.4%和4.7%；以及南部和东部各州的儿童。2021年，药物过量是非西班牙裔白人儿童中导致孤儿身份的主要原因，但在少数族裔亚组中并非如此。需要制定有效的政策和项目来支持近300万失去亲人的儿童，以减少孤儿身份带来的急性和长期负面影响。
