Parental Death and Premature Mortality in Individuals with Out-of-Home Care Experience in Sweden: A Nationwide Cohort Study

Experiences of out-of-home care (placement in foster-family care or residential care) and parental death in childhood are known risk factors for premature all-cause mortality. However, it remains unclear whether parental death during placement moderates the association between out-of-home care and mortality, particularly when considering the timing and duration of placement. Longitudinal register data from 10 Swedish birth cohorts (<i>n</i> = 948,483) were analyzed. Around 2.5% (<i>n</i> = 23,628) had out-of-home care experience during ages 0-19. Sex-specific Cox proportional hazard regression models assessed associations between experience of out-of-home care (categorized by timing and duration), parental death, and premature all-cause mortality (ages 20-47). Both men and women with out-of-home care experience displayed increased risk of premature all-cause mortality, as did those who experienced parental death before age 20. However, statistical interaction analyses revealed no moderating effect of parental death on the association between placement and premature all-cause mortality. Compared to non-placed individuals, parental death during placement in out-of-home care did not further increase the risk of premature mortality across placement groups. Possible reasons include strong attachments within the out-of-home care setting or reduced stress towards biological parents. Further research is needed to explore the complex dynamics of parental loss within out-of-home care populations.