Children facing multiple adversities growing up are more likely to die at a younger age

Imagine a child who has been hospitalized numerous times. Perhaps they were also diagnosed with a mental health condition as a teenager. At the same time, they grew up in a family affected by unemployment, poverty or alcohol abuse.

Some children grow up with challenges affecting their physical or mental health and in families under pressure on multiple fronts. These adversities are difficult in themselves, but they may also have long-term consequences well into adulthood.

Children exposed to multiple, overlapping adversities appear to face an elevated risk of dying prematurely in adulthood compared to other children.

This is a striking figure in a society that prides itself on providing universal access to healthcare.

A new study from the University of Copenhagen shows that children who experience both health-related problems and a high degree of family adversity have more than seven times the risk of dying from the age of 16 and into early adulthood compared with children who grow up with few or no such challenges.

“This is a striking figure in a society that prides itself on providing universal access to healthcare. Yet here we see a group of children who are profoundly disadvantaged and who continue to experience the consequences of health inequality many years later,” says Naja Hulvej Rod, Professor of Epidemiology at the Copenhagen Health Complexity Center and lead author of the study.

Data from more than one million Danes

The study is based on nationwide register data covering 1.2 million people born in Denmark between 1980 and 2001. Researchers followed participants until 2022, or until death or emigration, corresponding to an age range of approximately 16 to 42 years.

The researchers examined adversities across three levels:

• Individual-level adversity: Factors related to birth, such as preterm birth, as well as physical and mental health indicators including psychiatric diagnoses and frequent hospital contacts.
• Family-level adversity: Factors such as poverty, long-term unemployment, serious illness, death, mental illness, and alcohol or substance misuse within the family.
• Neighbourhood-level adversity: Data about the local area where the child grew up, including levels of income, educational attainment and unemployment.

The burden of multiple adversities

The researchers investigated both how different adversities cluster together and how they relate to mortality from age 16 onwards.

They found that children exposed to the highest levels of family adversity were also more likely to experience health-related problems themselves. For example, 26 percent of children in the most disadvantaged group had received a mental health diagnosis during childhood, compared with 7 percent among the least disadvantaged. They were also more likely to grow up in disadvantaged neighbourhoods, (28 percent versus 16 percent).

The study further showed that each of the three forms of adversity was independently associated with an increased risk of death in early adulthood.

However, the researchers observed higher mortality among children who faced both health-related adversity and extensive family adversity. In this group, mortality exceeded what would be expected based on the individual effects of each adversity alone. The group represented 1.4 percent of the study population.

“In some cases, adversities across different aspects of a child’s life appear to reinforce one another and amplify the risk of premature death. This likely reflects a situation in which some children are exposed to multiple interconnected challenges from an early age, making them especially vulnerable,” says Naja Hulvej Rod.

“The excess mortality we observe is likely related both to the adversities we measure and to other factors that are not captured in our data, such as air pollution, bullying or neglect. One interpretation is that the most disadvantaged children are more likely to experience an accumulation of adverse circumstances simultaneously.”

A need for more integrated prevention efforts

According to the researchers, the findings highlight the need to rethink approaches to reducing health inequalities.

“We need to consider the child’s overall life situation and take a broader approach to prevention than focusing on a single illness or a single type of adversity,” says Naja Hulvej Rod.

“If we want to reduce health inequalities, we cannot focus solely on treating problems once they emerge. We also need to become better at identifying children and families facing multiple forms of adversity and ensure that they receive coordinated support across healthcare, social services and other welfare sectors.”