Orphanhood and caregiver death among children in the United States due to all-cause mortality 2000-2021: A Modeling Study (preprint)

Importance: Deaths of parents and grandparent caregivers linked to social and health crises threaten child wellbeing due to losses of nurturance, financial support, physical safety, family stability, and care. Little is known about the full burden of all-causes and leading cause-specific orphanhood and caregiver death beyond estimates from select causes. Objective: To estimate 2000-2021 prevalence and incidence trends of all-cause orphanhood and caregiver death among children <18, by cause, age, race/ethnicity, and state. Data Sources: National Center for Health Statistics (NCHS) birth, death, race/ethnicity, and population data to estimate fertility rates and identify causes of death; 1983-1998 ICD-9 causes-of-death harmonized to ICD-10 classifications; 1999-2021 ICD-10 causes-of-death; CDC WONDER for state-specific estimates; and American Community Survey for grandparent population estimates. Data extraction and synthesis: We extracted U.S. population-level death, birth, population size, race, and ethnicity data from NCHS and attributed to each deceased individual the average number of children left behind according to subgroup-specific fertility rates in the previous 0-17 years. We examined prevalence and incidence of orphanhood by leading causes-of-death, including COVID-19, the leading 5 causes-of-death for 1983-2021, and additional leading causes for ages 15-44. We extended these to obtain state-level outcome estimates. Main outcome measures: National incidence and prevalence of orphanhood and caregiver death from 2000-2021, with orphanhood by year, parental cause-of-death and sex, child age, race/ethnicity, and state. Results: From 2000-2021, orphanhood and custodial/co-residing grandparent caregiver loss annual incidence and prevalence trends increased 49.2% and 8.3%, respectively. By 2021, 2.9 million children (4% of all children) had experienced prevalent orphanhood and caregiver death. Populations disproportionately affected by orphanhood included 5.0% of all adolescents; 6.5%, 4.8%, and 3.9% respectively of non-Hispanic American Indian/Alaska Native, non-Hispanic Black, and non-Hispanic White children; and children in New Mexico and Southern and Eastern States. Parental death due to drug overdose during 2020-2021 surpassed COVID-19 as the leading cause of incident and prevalent orphanhood during the COVID-19 pandemic. Conclusions and Relevance: Policies, programs, and practices aimed at orphanhood prevention, identification, and linkage to services and support of nearly 3 million bereaved children are needed, foremost prioritizing rapidly increasing overdose-linked orphanhood.

10.4 Million Children Affected by COVID-19-associated Orphanhood and Caregiver Death: An Imperative for Action (preprint)

The new WHO estimates for COVID-19 excess deaths allow us to generate supdated and more accurate models of COVID-19 associated orphanhood and caregiver loss. Using methodology established in prior studies, we combine age-specific fertility and excess death estimates from January 2020 to May 2022. We find 10.4 million children have lost a parent or caregiver due to COVID-associated excess deaths, and 7.5 million children have experienced COVID-associated orphanhood. Without supportive intervention, caregiver loss can bring severe risks of poverty, school dropout, sexual exploitation, and mental health distress. It is essential that evidence-based care for these children is integrated into all national response plans as a caring action to protect children from immediate and long-term harms of COVID-19.

Under the Radar: Global Minimum Estimates for COVID-19-Associated Orphanhood and Deaths Among Caregivers During 2020 (preprint)

Background: The global COVID-19 pandemic and response has focused on prevention, detection, and response. Beyond morbidity and mortality of those infected, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, delayed development, and institutionalization. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation.Methods: We use mortality and fertility data to model rates of COVID-19-associated orphanhood and caregiver deaths for 18 countries in Africa, Asia, Europe, and the Americas, and extrapolate global estimates of COVID-associated deaths of parents and grandparent caregivers.Results: We estimate that globally, >1 million children were orphaned or lost a caregiver due to COVID-19-associated deaths during March–December 2020. Countries with higher rates of caregiver deaths included Peru, South Africa, Mexico, Russian Federation, Colombia, Brazil, Islamic Republic of Iran, Argentina, U.S.A., and Spain (range, 1·1–9·8/1000). For most countries, numbers of children orphaned were greater than deaths among those aged 15–44 years; 2–5 times more children had deceased fathers than deceased mothers.Conclusions: Orphanhood and caregiver deaths are a shadow pandemic resulting from COVID-19-associated deaths: we find that over one million children worldwide have lost a parent or caregiver in just ten months. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families nurture children bereft of caregivers and promote their recovery. Strengthening family-based care can help ensure that institutionalization of these children is avoided. These data demonstrate the need for an additional pillar of our response: prevent, detect, respond, and care for children.Funding: UK Research and Innovation (Global Challenges Research Fund (GCR), Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, U.S. National Institutes of Health, Imperial College.Declaration of Interests: Dr. Donnelly reports grants from UK Medical Research Council and grants from NIHR during the conduct of the study. Dr. Cluver reports grants from UK Research and Innovation (UKRI) Global Challenges Research Fund, during the conduct of the study. All other authors report nothing to disclose.Ethics: We used modeled aggregate data and publicly available de-identified survey metadata.