Editor’s Note: Dr. Elif Ozdogan (she/her) is a second-year resident physician in Pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is interested in quality improvement and computational research and hopes to pursue further training in Transplant Medicine. - Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Adverse childhood experiences (ACEs) have enduring impacts on an individual’s health and wellbeing. For example, separation from parents and primary caregivers is highly stressful, and ACEs often arise during out-of-home care (or foster care). In the US, around 200,000 children enter the foster system every year.
In an article being early released this week in Pediatrics, Anders Hjern, MD, PhD, Bo Vinnerljung, PhD, and Lars Brännström, PhD, from the Karolinska Institute and Stockholm University in Stockholm, Sweden, explore whether exposure to childhood out-of-home care is associated with heightened rates of cardiovascular disease (CVD) in adulthood (10.1542/peds.2023-063174). In order to answer this question, they leverage the national Swedish registry that allows efficient linkage to numerous sources of data (eg, Swedish Child Welfare Intervention Register, Patient Register, Cause of Death Register) with minimal attrition.
The emerging narrative is striking but unsurprising. Children who are removed from their homes face nearly double the risk of CVD and stroke in adulthood, compared to the general population. Similarly, mothers with a childhood history of being removed from their homes are at greater risk of smoking and gestational diabetes during pregnancy.
At a deeper dive, what are the predisposing or alleviating factors in this equation? The authors found that entering out-of-home care after 11 years of age, smoking, and educational challenges contributed to elevated risk. In fact, higher levels of education were protective against the negative impact of out-of-home care.
Despite its robust cohort size (n=881,731) and statistical power, the authors acknowledge limitations to the study, notably the sole reliance on registry-based data without incorporating clinical variables, such as cholesterol levels, that could explain the increased CVD risk and provide clues to preventive measures.
The study concludes with a hopeful note and a call to action. There might be potential in reinforcing school performance and early smoking prevention. Reading this study, we are reminded of the long-term health effects of childhood and the value of interventions designed to alleviate these.
