Mortality outcomes of children and young people who have spent time in care: evidence from Children’s Health in Care in Scotland, a population-wide administrative data cohort study

Objective: Individuals who spend time in care during childhood/adolescence face a higher risk of premature mortality compared with those who have not been in care. However, it is unclear whether this risk applies to both external causes of death (eg, accident or suicide) and internal causes (eg, disease), as well as the role of potential confounders. Design: A descriptive, population-wide cohort study linking administrative data on state school pupils in Scotland with social care records and vital event data for children and young people with (n=12 367) and without (n=6 49 711) experience of care. Outcome: Premature mortality between 2010 and 2016. Analysis: Poisson regression, with robust SEs, was used to calculate mortality rate ratios, adjusting for confounders age group, sex, area deprivation, disability, and sociodemographic characteristics at birth. Results: Of 745 deaths, 58 were among those with care experience. Of these, 66% were due to external causes, compared with 43% in those without care experience. The unadjusted mortality rate was 4.5 (95% CI 2.6 to 7.7) times as high for those with care experience. After adjusting for confounders, the rate ratio (RR) was 3.0 (95% CI 2.0 to 4.4). Adjusting for confounders did not account for differences in external causes; RR 6.5 (95% CI 4.5 to 9.5), but did account for differences in internal causes; RR 1.4 (95% CI 0.9 to 2.3). Conclusions: Individuals with care experience have higher premature mortality rates, particularly from external causes, compared with those without care experience, a difference not fully accounted for by the confounders considered here. Further research is needed to explore factors contributing to excess external deaths in this population.