Death of a Child and the Risk of Stroke
Peer reviewed, Journal article
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Original versionNeurology. 2022, 98 (11), E1104-E1113. 10.1212/WNL.0000000000013263
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.