Sibling death in childhood, early adulthood associated with risk for heart disease
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Key takeaways:
- Danish people who experienced the death of a sibling in childhood or early adulthood had greater risk for early-onset CVD.
- CVD risk was higher among bereaved adults who lost a twin or younger sibling.
The death of a sibling from any cause during childhood or early adulthood was associated with increased risks for overall or most type-specific CVDs, data from a Danish cohort show.
“Previous studies have suggested that the loss of a sibling is a highly traumatic event and may be more disruptive than the loss of other family members,” Guoyou Qin, PhD, of Fudan University School of Public Health in Shanghai, and colleagues wrote in the study background. “However, the surviving siblings frequently received inadequate attention, and to our knowledge, there is no existing evidence regarding the impact of sibling death in childhood and early adulthood on the surviving sibling’s subsequent risk of overall and specific CVDs, except two studies from Sweden that reported an association between sibling death in adulthood and an increased risk of mortality from fatal stroke or MI.”
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In a population-based study, Qin and colleagues analyzed data from 2,098,659 adults born in Denmark from 1978 to 2018, with follow-up beginning at age 1 year or on the date of a first sibling’s birth, and ending at the first diagnosis of CVD, death or December 2018 (51.3% men). The primary outcome was early-onset CVD. Researchers estimated HRs for the association between sibling death in the early decades of life and subsequent risk for incident early-onset CVD.
The findings were published in JAMA Network Open.
Within the cohort, the median age at the death of a sibling was 11.48 years.
During a median follow-up of 17.5 years, 1,286 and 76,862 people in the bereaved and nonbereaved groups, respectively, were diagnosed with CVD.
Sibling death in childhood and early adulthood was associated with a 17% increased risk of overall CVD (HR = 1.17; 95% CI, 1.1-1.23). The cumulative incidence among bereaved individuals was 1.96% (95% CI, 1.61-2.34) and the cumulative incidence in nonbereaved individuals at age 41 years was 1.35% (95% CI, 1.34-1.37), for a cumulative incidence difference of 0.61 percentage points (95% CI, 0.24-0.98).
In analyses by type-specific CVD, researchers observed increased risk among bereaved siblings for MI (HR = 1.66; 95% CI, 1.12-2.46), ischemic heart disease (HR = 1.52; 95% CI, 1.22-1.9) and HF (HR = 1.5; 95% CI, 1-2.26), regardless of whether the sibling died of CV or non-CV causes. Researchers also found that CVD risk was greater among bereaved siblings who lost a twin or younger sibling (HR = 1.25; 95% CI, 1.15-1.36) than among bereaved siblings who lost an older sibling (HR = 1.11; 95% CI, 1.03-1.2).
“The risk was the highest shortly after the bereavement, especially for adolescents, but persisted in the long run,” the researchers wrote. “The findings highlight the need for extra attention and both social and mental support to bereaved siblings to reduce CVD risk later in life.”
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