Early mortality and primary causes of death in mothers of children with ID or ASD: a retrospective cohort study

INTRODUCTION: Mothers of children with intellectual disability or autism spectrum disorder (ASD) have poorer health than other mothers. Yet no research has explored whether this poorer health is reflected in mortality rates or whether certain causes of death are more likely. We aimed to calculate the hazard ratios for death and for the primary causes of death in mothers of children with intellectual disability or ASD compared to other mothers. METHODS: The study population comprised all mothers of live-born children in Western Australia from 1983-2005. We accessed state-wide databases which enabled us to link socio-demographic details, birth dates, diagnoses of intellectual disability or ASD in the children and dates and causes of death for all mothers who had died prior to 2011. Using Cox Regression with death by any cause and death by each of the three primary causes as the event of interest, we calculated hazard ratios for death for mothers of children intellectual disability or ASD compared to other mothers. RESULTS AND DISCUSSION: During the study period, mothers of children with intellectual disability or ASD had more than twice the risk of death. Mothers of children with intellectual disability were 40% more likely to die of cancer; 150% more likely to die of cardiovascular disease and nearly 200% more likely to die from misadventure than other mothers. Due to small numbers, only hazard ratios for cancer were calculated for mothers of children with ASD. These mothers were about 50% more likely to die from cancer than other mothers. Possible causes and implications of our results are discussed. CONCLUSION: Similar studies, pooling data from registries elsewhere, would improve our understanding of factors increasing the mortality of mothers of children with intellectual disability or ASD. This would allow the implementation of informed services and interventions to improve these mothers' longevity

The relationship between maternal race-ethnicity, immigrant status and country of birth and the risk of having a child with autism spectrum disorder in Western Australia

ABSTRACT Background The risk of autism spectrum disorder (ASD) varies by maternal race-ethnicity, immigrant status and birth region. Women from Asia and East Africa have had higher rates of ASD with ID in their children. We aimed to investigate the odds of ASD with ID in children born in Western Australia (WA) according to maternal race-ethnicity,country of birth and immigrant status. Methods We linked state registries and examined the odds of ASD with ID in children born in WA from 1994-2005, by maternal race-ethnicity, country of birth and immigrant status. Results Compared to Caucasian non-immigrant women immigrant women were 40% less likely, to have a child with ASD with ID. Women of Asian race-ethnicity from Central and South Asia were slightly more likely than Caucasian non-immigrant women to have a child with ASD with ID but children of women of Asian race-ethnicity from other parts of Asia had about half the odds of having ASD with ID. Black women from East Africa had more than three and a half times the odds of ASD with ID in their children. Conclusions  Our results suggest an interaction effect between race-ethnicity, immigrant status and birth region, with Black East African women having highest odds of a child with ASD with ID. Research is implicated on specific risk and protective factors for ASD with ID in the children of immigrant women

Early mortality from external causes in Aboriginal mothers: a retrospective cohort study

ABSTRACT Background Maternal loss can have a deep-rooted impact on families. Whilst a disproportionate number of Aboriginal women die from potentially preventable causes, no research has investigated mortality in Aboriginal mothers. We aimed to examine the elevated mortality risk in Aboriginal mothers with a focus on external cause. Methods We linked data from four state administrative datasets to identify all women who had a child from 1983-2010 in Western Australia and ascertained their Aboriginality, socio-demographic details, and dates and causes of death of all mothers who had died prior to 2011. For Aboriginal mothers and compared to other mothers, we calculated the hazard ratios (HRs) for death by any external cause and each of the sub-categories of accident, suicide and homicide and the corresponding age of their youngest child. Results and discussion Compared to non-Aboriginal mothers and after adjustment, Aboriginal mothers were more likely to die from external cause [HR=4.61(95% CI: 3.7, 5.7)], accident [HR=4.74(95% CI: 3.2, 7.0)], suicide [HR=2.48(95% CI: 1.5, 4.0)] or homicide [HR=11.72(95% CI: 6.5, 21.0)]. For mothers experiencing death, the median age of the youngest child was 4.8 years. Aboriginal mothers are much more likely to die from external causes than non-Aboriginal mothers with the scale of difference ranging from 2.5 times for suicide, to more than eleven times for homicide. Comparisons with the extant literature suggest that the magnitude of ethnic disparities in mortality from external causes is greater among mothers than the female population overall, identifying Aboriginal mothers as a particularly at-risk group in both relative and absolute terms. Conclusion During the study period, Aboriginal mothers were more likely to die than other mothers and they usually left young children. Our increased adjusted HRs were only partly explained by socio-demographic circumstances. Further research is required to fully examine the risk factors associated with these potentially preventable deaths and to enable the development of informed health promotion to increase the life chances of Aboriginal mothers and their children

Mothers of children with autism have different rates of cancer according to the presence of intellectual disability in their child

ABSTRACT Background Autism Spectrum Disorder (ASD) and Intellectual Disability (ID) are neurodevelopmental disorders with a strong genetic component. Increasing research attention has focused on whether the genetic factors that convey susceptibility for these conditions, also influence the risk for other health conditions, such as cancer. Aims We compared hospital admissions and treatment/services for cancer in mothers of ASD probands to other mothers. Methods Using West Australian databases, we calculated the hazard ratios (HRs) of hospitalisations for cancer in case and comparator mothers. Results In the multivariate model and compared to mothers of children with no ASD or ID, mothers of children with ASD without ID were more likely to have had an admission associated with a cancer diagnosis [HR=1.33(95% CI: 1.1, 1.7)] or a treatment or service associated with cancer [HR=1.54(95% CI: 1.1, 2.2)]. Furthermore, these HRs were significantly greater (p-values < 0.00005) than the corresponding HRs for mothers of children with ASD with ID [HR=1.05(95% CI: 0.8, 1.3) and HR= 0.97(95% CI: 0.7, 1.4)]. Conclusions We suggest that genes increasing the risk of autism without ID and cancer have common pathways and that the genetic basis of ASD with ID differs from ASD without ID

Early mortality from external causes in Aboriginal mothers: a retrospective cohort study

Background: Maternal loss can have a deep-rooted impact on families. Whilst a disproportionate number of Aboriginal women die from potentially preventable causes, no research has investigated mortality in Aboriginal mothers. We aimed to examine the elevated mortality risk in Aboriginal mothers with a focus on external causes. Methods: We linked data from four state administrative datasets to identify all women who had a child from 1983 to 2010 in Western Australia and ascertained their Aboriginality, socio-demographic details, and their dates and causes of death prior to 2011. Comparing Aboriginal mothers with other mothers, we estimated the hazard ratios (HRs) for death by any external cause and each of the sub-categories of accident, suicide, and homicide, and the corresponding age of their youngest child. Results: Compared to non-Aboriginal mothers and after adjustment for parity, socio-economic status and remoteness, Aboriginal mothers were more likely to die from accidents [HR = 6.43 (95 % CI: 4.9, 8.4)], suicide [HR = 3.46 (95 % CI: 2.2, 5.4)], homicide [HR = 17.46 (95 % CI: 10.4, 29.2)] or any external cause [HR = 6.61 (95 % CI: 5.4, 8.1)]. For mothers experiencing death, the median age of their youngest child was 4.8 years. Conclusion: During the study period, Aboriginal mothers were much more likely to die than other mothers and they usually left more and younger children. These increased rates were only partly explained by socio-demographic circumstances. Further research is required to examine the risk factors associated with these potentially preventable deaths and to enable the development of informed health promotion to increase the life chances of Aboriginal mothers and their children.Medicine, Faculty ofOther UBCNon UBCPediatrics, Department ofReviewedFacult

Demographic and psychiatric characteristics of the study population by number and percentage of maternal group.

<p>ID, intellectual disability; ASD, autism spectrum disorder; Mild ID, Mild or moderate intellectual disability; Severe ID, Severe or profound intellectual disability; Down, Down syndrome.</p><p>Demographic and psychiatric characteristics of the study population by number and percentage of maternal group.</p

Kaplan-Meier survival rates of mothers according to the existence of a psychiatric disorder and the disability status of the index child.

<p>Kaplan-Meier survival rates of mothers according to the existence of a psychiatric disorder and the disability status of the index child.</p

Comparison group, composite and core case groups.

<p>Comparison group, composite and core case groups.</p