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Excess mortality in children living in one-parent families in Belgium

Excess mortality in children living in one-parent families in Belgium. October 21 – Océane Van Cleemput & Bruno Masquelier. Single parenthood , unmarried couple and other unconventional households forms have become increasingly common in recent years .

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Excess mortality in children living in one-parent families in Belgium

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  1. Excessmortality in children living in one-parent families in Belgium October 21 – Océane Van Cleemput & Bruno Masquelier

  2. Single parenthood, unmarried couple and otherunconventionalhouseholdsforms have becomeincreasinglycommon in recentyears. • Still, the impact of family structure on childhealth has received no proper attention in Belgium. • In other high-income countries, familyfactorsseem to play a crucial role in shapinghealthdisparities in childhood: • Growing up in a single-parent familyexposes to excessrisk of mortality, mental diseases and riskybehaviours • This negativeeffectisobserved in case of transitions in the family composition (Remes et al. 2011) and also in single-parent familieswithoutany transition (Ostberg 1997). Introduction

  3. Severalcategories of explanationmechanisms: • 1) Socioeconomicdeprivation • Single-parent familiesusually have fewerresourcesthanmarried or cohabiting couples; • In Belgium: The majority of lone-parent familiesare composed of single mother (84%) who are more likely to live in poor or basic comforthousing and are lesslikely to beownerottheirdwelling (Census, 2001); • Higherhouseholdincomeprovidesbetter protection against the hazards of life (Lerman 2002, Weitoft 2003); • Difficult to capture specificeffect of the household structure, irrespective of the economic situation • mixed results in the literature. Threeexplanationmechanisms

  4. 2) Contextualeffects • The characteristicsof the area couldexert an influence on childmortality, beyondindividualcharacteristics; • Onlystudied for adultmortality (Cubbin et al. 2000, Kendrick et al. 2005) • 3) Parenting • Childhood injuries, accidents and riskybehaviours are far more commonamong single and blendedfamilies; • May reflectdifferences in parental supervision and parentingbehaviours (Siegel 1996, Roberts 1995, Thomson 1994); • Family stress • Time and money allocated to the child are constrained, leading to lack of supervision and higherrisk of accidents (Tanskanen 2017). Threeexplanationmechanisms

  5. To highlight the impact of family structure on the childsurvival chances and explore the potentialmechanismsinvolved • Do differences in family types introducesignificant variations in the risks of dyingamongchildaged 0-4 in Belgium in 2001?; • Do thesedifferencesremainaftercontrolling for socioeconomiccharacteristics?; • Does the magnitude of the relationshipbetweenfamily type and mortalityvary by gender?; • Does the magnitude of the relationshipbetweenfamily type and mortalityvary by cause of death?. Research questions

  6. Data: • Register data and deathcertificateslinked to census records; • Population of interest: all childrenaged 0-4 in the 2001 census; • Information on causes of death come from the deathcertificates; • Socio-economiccharacteristicsprovided by the census: • Professional activity and educationallevel of the head of the household • Region of residence Data and Methods

  7. Method: • Poisson regression • Register data allowsevent-historyanalysis: • Person-period file • Childrenfollowed up to theirfifthbirthday • Childrenwhomigrated out of Belgium are keptuntiltheirmigration • The exposure time isintroducedafter a logarithmic transformation as an offset variable • The coefficients of the model, once exponentiated, are directlyinterpretable as rate ratios. Data and Methods

  8. H1: Excessmortalityamongchildrenunder 5 living in single-parent familiesissignificant and large (IRR >= 1.4); H2: Thesedifferencesremainaftercontrolling for socioeconomiccharacteristics; H3: Rejected. No significant interaction betweenfamily configuration and children’sgenderfound; H4: Excessmortality of children living in single-parent familiesincreaseswhenconsideringonly violent deaths. Results

  9. Excessmortalityamongchildrenunder 5 living in single-parent familieswasparticularlypronounced for violent deaths. • Due to less parental supervision? Or lesssafehousing? • To test for differences in supervision according to family composition, weconducted chi-square tests. • No association wasfoundbetween place, type and day of the week in which the deathoccurred and the family composition. • Limitations: • Limited sample • Census data do not provide information on maternaleducation • Family structure >< Familydynamics. Discussion

  10. A longer time periodwillbecovered in future work: • Analysisstartingfrom the 1991 censusuntil last updates of the dataset; • Open cohortwithchildrenenteringthroughbirth or in-migration; • Investigating changes in rate ratios over time. • A biggersample to compare differences in all-cause and externalmortality • Identifyingfamily transitions through longitudinal methods: • Family structure and socio-economiccharacteristicsbeing update as the childrengrow up; • Provides duration, number and type of family transition; • Arrondissements, maternaleducation, characteristics of the householdwillbeadded in the models; Future research

  11. Cubbin, C., LeClere, F.B., Smith, G.S., 2000. Socioeconomic status and the occurrence of fatal and nonfatal injury in the United States. Am J Public Health 90, 70–77. • Deboosere, P., Lesthaeghe, R., Surkyn, J., Willaert, D., Boulanger, P.-M., Lambert, A., Lohlé-Tart, L., 2009. Monographie 4: Ménages et famillesenBelgique - Enquête Socio-économique 2001 - Monographies (No. 4). Direction généraleStatistique et Information économique. • Kendrick, D., Mulvaney, C., Burton, P., Watson, M., 2005. Relationships between child, family and neighbourhood characteristics and childhood injury: A cohort study. Social Science & Medicine 61, 1905–1915. https://doi.org/10.1016/j.socscimed.2005.04.003 • Lerman, R.I., 2002. Marriage and the Economic Well-Being of Families with Children: A Review of the Literature (Text). • Östberg, V., 1997. The social patterning of child mortality: the importance of social class, gender, family structure, immigrant status and population density. Sociology of Health & Illness 19, 415–435. https://doi.org/10.1111/j.1467-9566.1997.tb00411.x • Remes, H., Martikainen, P., Valkonen, T., 2011. The effects of family type on child mortality. Eur J Public Health 21, 688–693. https://doi.org/10.1093/eurpub/ckq159 • Roberts, I., Pless, B., 1995. For Debate: Social policy as a cause of childhood accidents: the children of lone mothers. BMJ 311, 925–928. https://doi.org/10.1136/bmj.311.7010.925 • Siegel, C.D., Graves, P., Maloney, K., Norris, J.M., Calonge, B.N., Lezotte, D., 1996. Mortality from intentional and unintentional injury among infants of young mothers in Colorado, 1986 to 1992. Arch PediatrAdolesc Med 150, 1077–1083. • Tanskanen, A.O., Danielsbacka, M., 2017. Association Between Grandparental Co-Residence and Early Childhood Injury in the UK. Child Indicators Research 10, 825–837. https://doi.org/10.1007/s12187-016-9411-1 • Thompson, R.G., Lizardi, D., Keyes, K.M., Hasin, D.S., 2008. Childhood or adolescent parental divorce/separation, parental history of alcohol problems, and offspring lifetime alcohol dependence. Drug and Alcohol Dependence 98, 264–269. https://doi.org/10.1016/j.drugalcdep.2008.06.011 • Weitoft, G.R., Hjern, A., Haglund, B., Rosén, M., 2003. Mortality, severe morbidity, and injury in children living with single parents in Sweden: a population-based study. The Lancet 361, 289–295. https://doi.org/10.1016/S0140-6736(03)12324-0 References

  12. Thankyou for your attention! oceane.vancleemput@uclouvain.be

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