title: Early mortality and primary causes of death in mothers of children with intellectual disability or autism spectrum disorder: a retrospective cohort study.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Fairthorne
authors.affiliation: Health Department of Western Australia, Perth, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: Hammond
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Bourke
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Jacoby
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology*; D016001:Confidence Intervals; D003710:Demography; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009026:Mortality; D009035:Mothers / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult