Orphanhood and caregiver death among children in the United States by all-cause mortality, 2000-2021

Deaths of parents and grandparent caregivers threaten child wellbeing due to losses of care, financial support, safety, and family stability, but are relatively unrecognised as a public health crisis. We used cause-specific vital statistics deaths registrations in a modelling approach to estimate the full magnitude of orphanhood incidence and prevalence among United States (U.S.) children aged 0-17 years between 2000-2021 by cause, child age and race & ethnicity, sex of deceased parent, and state, and also accounted for grandparent caregiver loss using population survey data. In 2021, we estimate 2.91 million children (4.2% of children) had in their lifetime experienced prevalent orphanhood and caregiver death combined, with incidence increasing by 49.5% and prevalence by 7.9% since 2000. Populations disproportionately affected by orphanhood included 5.2% of all adolescents; 6.4% and 4.7% respectively of non-Hispanic American Indian/Alaska Native, and non-Hispanic Black children; and children in southern and eastern states. In 2021, drug overdose was the leading cause of orphanhood among non-Hispanic white children, but not among minoritised subgroups. Effective policies and programs to support nearly 3 million bereaved children are needed to reduce the acute and long-term negative effects of orphanhood.