Adverse Childhood Experiences and Premature Parent Death Among US Urban Youth and Young Adults

Background: It is well documented that direct exposure to adverse childhood experiences (ACEs) elevates premature mortality risk in a dose-response manner. ACEs include stressful experiences before the age of 18 years old, including abuse, neglect, and household dysfunction (e.g., parental incarceration). However, comparatively little research has examined the impact or relevance of an individual's history of ACEs for the risk of premature mortality among family members. Furthermore, methodological limitations in the few studies examining this relationship have highlighted the need for prospective, longitudinal research. We build on existing evidence by examining the relationship between ACEs from infancy to late childhood (1-10 years) and parent death during adolescence (11-19 years) and young adulthood (20-26 years).

Methods: Data and sample: We used longitudinal data from Waves II-VII (Ages Y1, Y3, Y5, Y9, Y15, and Y22 years) in the Future of Families and Child Wellbeing Study (FFCWS) (N=2,578). The FFCWS began in 1998-2000 and is largely composed of unmarried, low-income, and racially minoritized families from 20 US cities.

Measures: Our primary outcomes were parent death reported in 1) Wave Y15 (i.e., death occurred between Waves Y9-Y15), 2) Wave Y22 (i.e., death occurred between Waves Y15-Y22), and 3) combined Waves Y15-Y22 (i.e., death occurred between Waves Y9-Y22). Parent deaths reported in Waves I-V (Y1-Y9) were excluded. We included ten ACEs aligned with prior study conceptualizations measured in Waves Y1, Y3, Y5, and Y9. We operationalized ACEs categorically (1 (low), 2-3 (moderate), or 4+ (high)) and individually as dummy variables. We controlled for young adult current age, biological sex, race and ethnicity, baseline household income, baseline maternal age, baseline maternal education, and baseline parent marital status.

Analysis: We estimated stepwise logistic regression models to assess the odds of biological parent death during adolescence and young adulthood by categorical and individual ACEs exposure, net social covariates.

Results: Multivariate logistic regression models suggested high ACEs exposure was associated with 68% higher odds of parent death reported in Wave Y22 (OR=1.14; 95% CI: 1.16–2.44), 31% higher odds reported in combined Waves Y15-Y22 (OR=1.31; 95% CI: 1.03–1.67), and no significant difference in Wave Y15 (OR=1.10; 95% CI: 0.83–1.48), relative to those without ACE exposure. Adjusted ancillary analyses found higher odds of parent death at Wave Y22 for parental incarceration (OR=2.17, 95% CI 1.40–3.37), parental substance abuse (OR=1.59, 95% CI 1.11–2.29), parental mental illness (OR=1.54, 95% CI 1.06–2.23), and material hardship (OR=1.05, 95% CI 1.02–1.09) compared to those without respective ACE exposures.

Conclusions: The longitudinal perspective allowed the effects of ACEs on parental mortality to unfold over time, with the most pronounced associations in young adulthood. Results suggest individuals' ACEs reporting may serve as an early risk marker of premature parent death among US young adults in urban areas. Long-term follow-up of children who experienced ACEs is critical given their elevated risk of parent death during the transition to adulthood. Service coordination must be reenvisioned for those facing the “double jeopardy” of parental death following ACEs during a time when care is often disrupted and siloed.