Scientists have found a link between several adverse factors and early mortality.

The conditions in which a person grows up may be related to his health after many years. A study involving more than 1.2 million people showed that a combination of health problems, family problems and an unfavorable environment is associated with a particularly high risk of death at a young age. About how different difficulties of childhood can overlap each other and affect health in the future — in the material of Izvestia.

More than 1.2 million people — and several decades of observations

The study was published in the scientific journal The Lancet Regional Health — Europe (LRH). Scientists from the University of Copenhagen analyzed the national registries of Denmark, which included data on 1,235,519 people born from 1980 to 2001. Participants were tracked until the end of 2022, death or emigration. Thus, the follow-up period ranged from about 16 to 42 years of age. During this time, 7,320 deaths were recorded.

The researchers assessed unfavorable circumstances not only within the family. They considered three levels at the same time: the individual characteristics and state of health of the child, the situation in the family and the conditions in the area of residence.

What scientists considered unfavorable conditions

On an individual level, the researchers took into account circumstances related to birth, as well as physical and mental health. In particular, the analysis included premature birth, psychiatric diagnoses, and frequent medical treatment.

The family level included a wider range of circumstances: poverty, long-term unemployment, serious illnesses and death of loved ones, mental disorders, as well as alcohol or substance use in the family. The third level concerned the area where the child grew up. The scientists took into account the financial situation of the territory, the level of income and education of the population, and the prevalence of unemployment.

This approach made it possible to consider the unfavorable circumstances of children not as separate events, but as a set of factors that can simultaneously be present in the life of one person.

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Family difficulties were often combined with the problems of the child himself

Children who belonged to the groups with the highest level of family problems were more likely to face their own health problems. For example, 26% of participants from the most disadvantaged group were diagnosed with a mental disorder in childhood. Among the children who were exposed to the least amount of such effects, this figure was 7%.

The living environment also differed. In the most disadvantaged group, 28% of children grew up in areas with unfavorable socio-economic conditions. There were 16% of such participants in the group with a minimal level of disadvantage.

Thus, various difficulties were not distributed independently of each other: children who faced serious family problems more often had health problems at the same time and lived in a less prosperous environment.

Each level of distress was associated with an increased risk of death.

When the researchers analyzed the three levels of adverse conditions separately, each of them was associated with an increased risk of death in early adulthood. The connection with the child's own health was particularly noticeable. Participants with the highest frequency of seeking help for physical problems had more than twice the risk of death compared to people in the group with the lowest burden on the healthcare system.

For those who grew up in a disadvantaged area, the connection was significantly weaker, but it also persisted: an increased risk was observed even after taking into account other circumstances. This is important for interpreting the results — the study does not reduce subsequent risks solely to family income or place of residence. The authors found several independent levels of adverse effects.

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When problems add up, the risk becomes even higher.

The most pronounced association was found in people who, in childhood, simultaneously faced serious family difficulties and adverse circumstances related to their own health.

In this group, the risk of death from the age of 16 and into early adulthood was 7.16 times higher than among participants with a low level of adverse factors. At the same time, the most vulnerable group was small: it included 1.4% of the study participants.

The researchers found that when the factors were combined, the mortality rate was higher than what would have been expected if the effects of each type of distress simply added up independently of each other.

The most vulnerable children were a small group

The researchers separately note that we are not talking about the majority of people who experienced any difficulties in childhood. The most pronounced combination of factors was typical only for a small part of the participants. At the same time, it was her isolation that proved important for understanding the results. If we consider the adverse circumstances one at a time, there is a link with subsequent mortality, but the highest rate was observed when they were combined.

The authors believe that such an analysis helps to see groups in which several types of vulnerability intersect already in childhood. This differs from the approach in which each problem is considered separately, for example, only the child's health status or only the financial situation of the family.

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The study did not take into account all the circumstances of childhood

There are limitations to the job. The researchers acknowledge that the data used does not reflect all the conditions in which the participants may have grown up. In particular, the analysis did not include circumstances such as air pollution, bullying, or neglect of the child's needs. Therefore, the detected increased mortality may be related not only to those factors that could be measured using national registries.

In addition, the nature of the study suggests statistical links between adverse childhood conditions and mortality, but does not in itself prove that a particular factor directly caused death.

The authors called for taking into account the entire situation around the child

The researchers believe that the results point to the need for a more comprehensive approach to reducing health inequalities. In their opinion, when dealing with risks, it is important to take into account not one problem, but a set of circumstances: the child's health status, the family situation, and the socio-economic conditions of the environment.

The authors also consider it important to identify children and families who are simultaneously facing several types of disadvantage, and to ensure interaction between medical, social and other support services.

However, the study does not mean that difficult childhood circumstances inevitably lead to premature death. His main conclusion is that the combination of several types of disadvantage can form particularly vulnerable groups, for whom the link with subsequent mortality is much stronger.