Mortality Rates Among US Kids in Foster Care Higher Than General Population

By Lisa Rapaport

May 04, 2020

(Reuters Health) - Children in the U.S. foster care system are 42% more likely to die of all causes than their peers in the general population, and this mortality rate gap is widening, a recent study suggests.

Researchers examined data from the Adoption and Foster Care Analysis Reporting System and from the U.S. Centers for Disease Control and Prevention on deaths among foster kids and children in the general population between 2003 and 2016. During this period, mortality rates for children in foster care remained steady (-0.5 annual percent change), while mortality rates for the general population decreased by 2.5% per year.

This widening disparity is likely the result of multiple factors that are more prevalent among children in foster care than in the general population, such as chronic health conditions, said study coauthor Dr. Barbara Chaiyachati, a fellow physician in child abuse pediatrics at the Children's Hospital of Philadelphia.

"Life experiences prior to foster care may also be contributing to increased mortality, such as experiences of emotional or physical trauma or experiences of neglect, including medical neglect," Dr. Chaiyachati said by email. "Challenges within foster care may also be contributing, such as unstable foster care placements - if children are unable to have continuity with a foster parent, that may impact the likelihood that they have continuity with their healthcare providers."

In 8,348,656 person-years for children in foster care, there were 3,485 deaths or 35.4 deaths per 100,000 person-years. That compares with 25.0 deaths per 100,000 person-years for the general population, among 1,036,855,826 person-years, for an incident rate ratio of 1.42.

The study also found racial disparities in mortality rates.

Black or African-American children were more likely to die than kids from other racial and ethnic groups, with 43.8 deaths per 100,000 person-years among youth in foster care and 34.1 deaths per 100,000 person-years for the general population.

American Indian or Alaska native children had 39.7 deaths per 100,000 person-years in the foster care group and 28.7 per 100,000 in the general population.

Asian or Pacific Islander children had 37.5 and 14.6 deaths per 100,000 person-years, respectively, in foster care and general population.

And, white children had 35.3 and 23.6 deaths per 100,000 person-years, respectively, in foster care and general population.

There were also mortality disparities between foster kids and the general population in most age groups, with the exception of 15 to 18 years, researchers report in JAMA Pediatrics.

The highest mortality rate and the biggest disparity was seen among children aged 1 to 4 years old, with 50.7 deaths per 100,000 person-years in foster care, compared with 27.5 per 100,000 in the general population.

One limitation of the study is that it may have underestimated differences in mortality because foster care children are unable to be excluded from data on mortality for all children that is collected by the CDC.

Some mortality differences may be related to baseline health differences between kids in foster care and the general population, particularly in light of the fact that complex medical conditions are one reason that some children may be placed in foster homes, the study team notes.

"It is most likely that abused and neglected children taken into care include a greater proportion of children with serious physical and health challenges," said Deborah Daro, a senior research fellow at Chapin Hall at the University of Chicago who wasn't involved in the study.

"Such challenges may be the result of serious abuse or neglect - physical injuries, including head trauma; nutritional issues; internal injuries - that make them more vulnerable to other infections or illness or reflect developmental delays that make caring for them more challenging," Daro said by email.

The study findings offer fresh evidence that the foster care system needs to do a better job of caring for children in the system, Daro said.

"Foster care should not be a 'holding ground' until child welfare finds a permanent home for these children," Daro added. "From the point of entry until they leave, these children need to have their physical and emotional health needs carefully assessed and adequately addressed."

SOURCE: JAMA Pediatrics, online April 20, 2020.