{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:57:51Z","timestamp":1780545471549,"version":"3.54.1"},"posted":{"date-parts":[[2024,1,27]]},"group-title":"Epidemiology","reference-count":46,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected physical and mental health problems in adulthood, however, their risk of cardiovascular disease (CVD) is uncertain. Accordingly, we pooled published and unpublished results from cohort studies of childhood care and adult CVD.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used two approaches to identifying relevant data on childhood care and adult CVD (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the aim of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews of the impact of childhood state care on related adult health outcomes. All included studies were required to have prospective measurement of state care in childhood and a follow-up of CVD events in adulthood as the primary outcome (incident coronary heart disease and\/or stroke). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>\n                    Thirteen studies (2 published, 11 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Relative to the unexposed, individuals with a care placement during childhood had a 50% greater risk of CVD in adulthood (summary rate ratio after basic adjustment [95% confidence interval]: 1.50 [1.22, 1.84]); range of study-specific estimates: 1.28 to 2.06;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    = 69%, p = 0.001). This association was attenuated but persisted after multivariable adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.28 [1.10, 1.50]). There was a suggestion of a stronger state care-CVD association in women.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>Our findings show that individuals with experience of state care in childhood have a moderately raised risk of CVD in adulthood. For timely prevention, clinicians and policy makers should be aware that people with a care history may need additional attention in risk factor management.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Research in context<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Evidence before this study<\/jats:title>\n                    <jats:p>There is growing evidence that individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected physical and mental ill-health in adulthood, however, their risk of cardiovascular disease (CVD) events is uncertain. A search of electronic databases to November 2023 yielded only 2 relevant published studies and these had discordant findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Added value of this study<\/jats:title>\n                    <jats:p>By scrutinising retrieved reviews of the impact of childhood state care on broadly related adult health outcomes, we identified studies with the potential to examine the association between childhood care and adult CVD events. Investigators from 7 provided these previously unpublished results and, on aggregating them alongside updated analyses from the 2 published studies, we found that, relative to their unexposed peers, adults with experience of state care earlier in life had a 50% greater risk of CVD. There was evidence that this relationship was partially mediating by socioeconomic status in adulthood, and there was a suggestion of a stronger state care\u2013CVD association in women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications of all the available evidence<\/jats:title>\n                    <jats:p>This meta-analysis suggests that, alongside the array of well-document unfavourable social, behavioural, and health outcomes in adulthood, children experiencing state care may additionally have a higher burden of later CVD. For timely prevention, clinicians and policy makers should be aware that people with a care history may need additional attention in risk factor management.<\/jats:p>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.1101\/2024.01.26.24301814","type":"posted-content","created":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T12:30:11Z","timestamp":1706358611000},"source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular Disease Events in Adults with a History of State Care in Childhood: Pooling of Unpublished Results from 9 Cohort Studies"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1822-5753","authenticated-orcid":false,"given":"G. David","family":"Batty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4699-5627","authenticated-orcid":false,"given":"Mika","family":"Kivim\u00e4ki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ylva B","family":"Almquist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan G.","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel S","family":"Gnanamanickam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8726-7992","authenticated-orcid":false,"given":"Mark","family":"Hamer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Jackisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee-Soon","family":"Juon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Keski-S\u00e4ntti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaiquan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuija M.","family":"Mikkola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Murray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Sacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Segal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Frank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2024013007201191000_2024.01.26.24301814v1.1","doi-asserted-by":"publisher","DOI":"10.1161\/hc4601.099487"},{"key":"2024013007201191000_2024.01.26.24301814v1.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199302253280804"},{"key":"2024013007201191000_2024.01.26.24301814v1.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007063430103"},{"key":"2024013007201191000_2024.01.26.24301814v1.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.966465"},{"issue":"5","key":"2024013007201191000_2024.01.26.24301814v1.5","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1001\/jamacardio.2020.0140","article-title":"Cardiovascular Health Trajectories From Childhood Through Middle Age and Their Association With Subclinical Atherosclerosis","volume":"5","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"8","key":"2024013007201191000_2024.01.26.24301814v1.6","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1038\/s41569-021-00647-9","article-title":"Prevention of atherosclerosis from childhood","volume":"19","year":"2022","journal-title":"Nat Rev Cardiol"},{"key":"2024013007201191000_2024.01.26.24301814v1.7","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.486"},{"key":"2024013007201191000_2024.01.26.24301814v1.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa072515"},{"key":"2024013007201191000_2024.01.26.24301814v1.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1503840"},{"key":"2024013007201191000_2024.01.26.24301814v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.06.047"},{"key":"2024013007201191000_2024.01.26.24301814v1.11","doi-asserted-by":"publisher","DOI":"10.1136\/jech.55.5.334"},{"key":"2024013007201191000_2024.01.26.24301814v1.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2109191"},{"key":"2024013007201191000_2024.01.26.24301814v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.07.045"},{"key":"2024013007201191000_2024.01.26.24301814v1.14","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e3282ffb17e"},{"key":"2024013007201191000_2024.01.26.24301814v1.15","doi-asserted-by":"crossref","unstructured":"Batty GD , Kivimaki M . Adverse childhood experiences and adult health: the need for stronger study designs to evaluate impact. J Epidemiol Community Health 2021.","DOI":"10.1136\/jech-2020-215870"},{"key":"2024013007201191000_2024.01.26.24301814v1.16","doi-asserted-by":"crossref","unstructured":"Xie TH , de Mestral C , Batty GD . Association of public care in childhood with social, criminal, cognitive, and health outcomes in middle-age: six decades of follow-up of members of the 1958 Birth Cohort Study. medRxiv 2020.","DOI":"10.1101\/2020.03.03.20030718"},{"key":"2024013007201191000_2024.01.26.24301814v1.17","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.childyouth.2015.09.017","article-title":"Tobacco use among foster youth: Evidence of health disparities","volume":"58","year":"2015","journal-title":"Children and Youth Services Review"},{"key":"2024013007201191000_2024.01.26.24301814v1.18","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1311"},{"key":"2024013007201191000_2024.01.26.24301814v1.19","unstructured":"Batty GD , Hamer M. Public care during childhood and biomedical risk factors in middle-age: the 1970 birth cohort study. Am J Epidemiol In press."},{"issue":"6","key":"2024013007201191000_2024.01.26.24301814v1.20","doi-asserted-by":"crossref","first-page":"e504","DOI":"10.1016\/S2468-2667(22)00081-0","article-title":"State care in childhood and adult mortality: a systematic review and meta-analysis of prospective cohort studies","volume":"7","year":"2022","journal-title":"Lancet Public Health"},{"key":"2024013007201191000_2024.01.26.24301814v1.21","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e31825b3d76"},{"key":"2024013007201191000_2024.01.26.24301814v1.22","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2022-219851"},{"key":"2024013007201191000_2024.01.26.24301814v1.23","doi-asserted-by":"crossref","first-page":"106084","DOI":"10.1016\/j.psyneuen.2023.106084","article-title":"Parent-child separation and cardiometabolic outcomes and risk factors in adulthood: A systematic review","volume":"152","year":"2023","journal-title":"Psychoneuroendocrinology"},{"key":"2024013007201191000_2024.01.26.24301814v1.24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"2024013007201191000_2024.01.26.24301814v1.25","doi-asserted-by":"crossref","unstructured":"Jensen HAR , Lau CJ , Davidsen M , Ekholm O , Christensen AI . Agreement between self-reported diseases from health surveys and national health registry data: a Danish nationwide study. J Epidemiol Community Health 2022.","DOI":"10.1136\/jech-2022-219944"},{"key":"2024013007201191000_2024.01.26.24301814v1.26","unstructured":"Wells G , Shea B , O\u2019Connell D , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses https:\/\/www.ohri.ca\/\/programs\/clinical_epidemiology\/oxford.asp (accessed 13 October 2022)."},{"key":"2024013007201191000_2024.01.26.24301814v1.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1972.tb00899.x"},{"key":"2024013007201191000_2024.01.26.24301814v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"issue":"4","key":"2024013007201191000_2024.01.26.24301814v1.29","first-page":"843","article-title":"Mortality in a child welfare population: implications for policy","volume":"74","year":"1995","journal-title":"Child welfare"},{"key":"2024013007201191000_2024.01.26.24301814v1.30","doi-asserted-by":"publisher","DOI":"10.1111\/1468-2397.00169"},{"key":"2024013007201191000_2024.01.26.24301814v1.31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7306.207"},{"key":"2024013007201191000_2024.01.26.24301814v1.32","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2003.014282"},{"issue":"3","key":"2024013007201191000_2024.01.26.24301814v1.33","doi-asserted-by":"crossref","first-page":"548","DOI":"10.2105\/AJPH.2013.301228","article-title":"Early life conditions of overall and cause-specific mortality among inner-city African Americans","volume":"104","year":"2014","journal-title":"Am J Public Health"},{"key":"2024013007201191000_2024.01.26.24301814v1.34","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.301939"},{"key":"2024013007201191000_2024.01.26.24301814v1.35","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-08867-3"},{"key":"2024013007201191000_2024.01.26.24301814v1.36","doi-asserted-by":"crossref","first-page":"104145","DOI":"10.1016\/j.chiabu.2019.104145","article-title":"Lifetime risk of child protection system involvement in South Australia for Aboriginal and non-Aboriginal children, 1986-2017 using linked administrative data","volume":"97","year":"2019","journal-title":"Child Abuse Negl"},{"issue":"1","key":"2024013007201191000_2024.01.26.24301814v1.37","doi-asserted-by":"crossref","first-page":"e214324","DOI":"10.1001\/jamapediatrics.2021.4324","article-title":"Long-term Health and Social Outcomes in Children and Adolescents Placed in Out-of-Home Care","volume":"176","year":"2022","journal-title":"JAMA Pediatr"},{"issue":"1","key":"2024013007201191000_2024.01.26.24301814v1.38","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1186\/s12889-019-6752-y","article-title":"Do trajectories of economic, work- and health-related disadvantages explain child welfare clients\u2019 increased mortality risk? A prospective cohort study","volume":"19","year":"2019","journal-title":"BMC Public Health"},{"issue":"4","key":"2024013007201191000_2024.01.26.24301814v1.39","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/14623730.2007.9721845","article-title":"Age and gender effects on resilience in children and adolescents","volume":"9","year":"2007","journal-title":"International Journal of mental health promotion"},{"key":"2024013007201191000_2024.01.26.24301814v1.40","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.chiabu.2015.10.020","article-title":"Changes in first entry to out-of-home care from 1992 to 2012 among children in England","volume":"51","year":"2016","journal-title":"Child Abuse Negl"},{"key":"2024013007201191000_2024.01.26.24301814v1.41","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(98)00017-8"},{"key":"2024013007201191000_2024.01.26.24301814v1.42","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(17)30118-4"},{"key":"2024013007201191000_2024.01.26.24301814v1.43","doi-asserted-by":"crossref","unstructured":"Baldwin JR , Reuben A , Newbury JB , Danese A . Agreement Between Prospective and Retrospective Measures of Childhood Maltreatment: A Systematic Review and Meta-analysis. JAMA Psychiatry 2019.","DOI":"10.1001\/jamapsychiatry.2019.0097"},{"key":"2024013007201191000_2024.01.26.24301814v1.44","doi-asserted-by":"publisher","DOI":"10.14301\/llcs.v5i1.232"},{"key":"2024013007201191000_2024.01.26.24301814v1.45","doi-asserted-by":"crossref","unstructured":"Kauhanen L , Lakka HM , Lynch JW , Kauhanen J . Social disadvantages in childhood and risk of all-cause death and cardiovascular disease in later life: a comparison of historical and retrospective childhood information. Int J Epidemiol 2006.","DOI":"10.1093\/ije\/dyl046"},{"key":"2024013007201191000_2024.01.26.24301814v1.46","doi-asserted-by":"crossref","unstructured":"de Mestral C , Bell S , Hamer M , Batty GD . Out-of-home care in childhood and biomedical risk factors in middle-age: National birth cohort study. Am J Hum Biol 2019: e23343.","DOI":"10.1002\/ajhb.23343"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2024.01.26.24301814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T19:49:45Z","timestamp":1768506585000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2024.01.26.24301814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,27]]},"references-count":46,"URL":"https:\/\/doi.org\/10.1101\/2024.01.26.24301814","relation":{},"subject":[],"published":{"date-parts":[[2024,1,27]]},"subtype":"preprint"}}