All-Cause and Cause-Specific Mortality in Parents After the Death of a Child in Taiwan: A Population-Based Cohort Study

Objective
Research from Western countries suggests that there is an increase in mortality in parents bereaved by the death of a child. Few studies have investigated this issue in a non-Western context. We explored the impact of the death of a child on parental mortality in Taiwan.

Method
By linking population-based national registers, we followed the 2004–2014 birth cohort (N = 2,083,972) up until 2016. A total of 11,755 child deaths were identified. For each deceased child, four living children matched on age and sex were randomly selected; their parents were the comparison group. We used Cox proportional hazards regression models to compare the mortality risk of bereaved parents with the comparison group up until 2017.

Results
Overall mortality risk was increased in parents who experienced the death of a child; the risk was higher in bereaved mothers (adjusted hazard ratio = 4.91, 95% confidence interval = 3.96–6.09) than fathers (adjusted hazard ratio = 1.82, 95% confidence interval = 1.55–2.13). The risk did not differ according to the sex of the child, but parents whose children died of unexpected causes (i.e., suicide/accidents/violence) were at greater risk than those dying of other causes. Risk was higher when the child was older than 1 year at the time of death than for deaths before age 1 year.

Conclusions
Parents who lost a child were at increased mortality risk in this East Asian population. Special attention should be paid to the health of bereaved parents and explore the pathways leading to their risk.