Employment, health visits, mental health, and mortality in parents with a chronically ill child: a Danish nationwide population-based cohort study

Chronic diseases in children can impact their parents; this may be overlooked in a clinical setting. Our aim was to investigate associations of chronic diseases in children with their parents’ employment, health care utilization, mental health, and mortality. In a matched cohort study using nationwide and population-based data in Denmark, we included parents to children (< 18 years) with acute disseminated encephalomyelitis, multiple sclerosis, type 1 diabetes, inflammatory bowel disease, and rheumatoid arthritis/juvenile idiopathic arthritis during 2008–2015. The reference group was parents to unaffected children. Outcomes were parental employment (early retirement, cash benefits, income), health care utilization (e.g., general practitioner, or hospital visits), mental health (visits to psychiatry/psychology clinics, antidepressant drug redemptions), and mortality. We included 13,769 parents with a chronically ill child and 138,606 control parents. Annual income was unaffected for two-parent families after the child’s disease onset, but two-parent families had increased hazard of early retirement of 25% (95% CI = 1.01–1.54; p = 0.04). Parents with a chronically ill child had (a) increased rate of antidepressant drug redemptions or psychology/psychiatry visits (hazard ratio 1.37; 95% CI = 1.28–1.46 at 1-year follow-up); (b) increased health care utilization, with an increased marginal mean in primary care of 1% (95% CI = 1.00–1.02; p = 0.005), hospital-affiliated visits of 19% (95% CI = 1.14–1.24; p < 0.0001), and hospital admissions of 14% (95% CI = 1.09–1.20; p < 0.0001); and (c) 69% increased mortality hazard (95% CI = 1.30–2.18; p < 0.0001) in parents younger than 50 years with no comorbidities, albeit small in absolute numbers.