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Death of a Parent and the Risk of Ischemic Heart Disease and Stroke in Denmark and Sweden

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Hua Chen, Karolinska Institutet
  • ,
  • Jiong Li
  • Dang Wei, Karolinska Institutet
  • ,
  • Mikael Rostila, Stockholm University
  • ,
  • Imre Janszky, Karolinska Institutet, Norwegian University of Science and Technology
  • ,
  • Yvonne Forsell, Karolinska Institutet, Stockholm County Council
  • ,
  • Tomas Hemmingsson, Stockholm University, Karolinska Institutet
  • ,
  • Krisztina D. László, Karolinska Institutet

Importance: Increasing evidence suggests that parental death is associated with unhealthy behaviors and mental ill-health. Knowledge regarding the link between parental death and the risk of ischemic heart disease (IHD) and stroke remains limited. Objectives: To investigate whether parental death is associated with an increased risk of IHD and stroke and whether these associations differ by the characteristics of the loss. Design, Setting, and Participants: This population-based cohort study, involving linkages between several nationwide registers, included 3766918 individuals born between 1973 and 1998 in Denmark and between 1973 and 1996 in Sweden. Participants were followed up until 2016 in Denmark and 2014 in Sweden. Data were analyzed from December 2019 to May 2021. Exposures: Death of a parent. Main Outcomes and Measures: Diagnosis with or death due to IHD or stroke. Poisson regression was used to analyze the associations between parental death and IHD and stroke risk. Results: Altogether, 48.8% of the participants were women, and 42.7% were from Denmark. A total of 523496 individuals lost a parent during the study period (median age at loss, 25 years; IQR, 17-32 years). Parental death was associated with a 41% increased risk of IHD (incidence rate ratio [IRR], 1.41; 95% CI, 1.33-1.51) and a 30% increased risk of stroke [IRR, 1.30; 95% CI, 1.21-1.38). The associations were observed not only if the parent died because of cardiovascular or other natural causes but also in cases of unnatural deaths. The associations were stronger when both parents had died (IHD: IRR, 1.87; 95% CI, 1.59-2.21; stroke: IRR, 1.64; 95% CI, 1.35-1.98) than when 1 parent had died (IHD: IRR, 1.37; 95% CI, 1.28-1.47; stroke: IRR, 1.27; 95% CI, 1.19-1.36) but did not differ substantially by the offspring's age at loss or the deceased parents' sex. The risk of acute myocardial infarction was highest in the first 3 months after loss. Conclusions and Relevance: In this cohort study, parental death in the first decades of life was associated with an increased risk of IHD and stroke. The associations were observed not only in cases of parental cardiovascular and other natural deaths but also in cases of unnatural deaths. Family members and health professionals may need to pay attention to the cardiovascular disease risk among parentally bereaved individuals..

TidsskriftJAMA network open
StatusUdgivet - 22 jun. 2022

Bibliografisk note

Funding Information:
Conflict of Interest Disclosures: Dr Forsell reported receiving grants from Karolinska Institutet during the conduct of the study. Dr László reported receiving grants from Forte during the conduct of the study and grants from the Class Groschinsky Foundation outside the submitted work. No other disclosures were reported.

Funding Information:
Funding/Support: The study was supported by the Swedish Council for Working Life and Social Research (2015-00837), the Karolinska Institutet’s Research Foundation (2018-01547, 2018-01924, and 2020-01600), the China Scholarship Council (201700260296 and 201700260276). Dr Li is supported by grants from the Independent Research Fund Denmark (DFF-6110-00019B and DFF 9039-00010B), the National Natural Science Foundation of China (82073570), the Nordic Cancer Union (R275-A15770), the Karen Elise Jensens Fond (2016), the Novo Nordisk Foundation (NNF18OC0052029). Dr László is supported by the Heart and Lung Foundation (20180306).

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