title: Mortality, cancer incidence, and survival in parents after bereavement.
abstract: OBJECTIVE
  The study objective was to investigate whether child loss is related to mortality, cancer incidence, and cancer survival in parents.
  
  
  METHODS
  We used a population-based birth cohort (1964-1976) in Jerusalem and ascertained mortality (average follow-up of 39.1 years) and any cancer (average follow-up of 35.6 years) among parents who lost a child (2838 mothers and 2532 fathers) and among nonbereaved parents (38,212 mothers and 36,433 fathers). We also assessed mortality among parents with cancer. Time-dependent Cox models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Overall mortality rates among bereaved parents were modestly increased when compared with nonbereaved parents (HR = 1.18, 95% CI: 1.05-1.32 in mothers; HR = 1.10, 95% CI: 1.01-1.20 in fathers). Hazard models indicated a significant relationship between bereavement and deaths from coronary heart disease in mothers (HR = 1.90, 95% CI: 1.23-2.95) and circulatory causes in both parents (HR = 1.69; 95% CI: 1.22-2.34 in mothers and HR = 1.25; 95% CI: 1.02-1.54 in fathers). Bereavement was not associated with parental risk of cancer disease and with survival from cancer. The association between bereavement and parental overall mortality was similar in the different parental sociodemographic characteristics. We observed a decrease in HRs for parental mortality associated with bereavement, with increasing time since the death of the child (HRs = 9-10, 0-3 years; HRs = 0.9-1.0, 9+ years; P(heterogeneity) ≤ 3 × 10(-32)). A similar decrease in HRs was observed for parental survival from cancer (HRs = 6.7-8.7, 0-3 years; HRs = 0.9-1.0, 9+ years).
  
  
  CONCLUSIONS
  Our study suggests that child loss was associated with slightly increased risk of all-cause and circulatory mortality in parents but not with incidence of cancer and cancer survival. The considerable increased parental mortality during a short period after child loss support the involvement of pathways related to psychological stress.
authors.affiliation: School of Nursing, Hadassah-Hebrew University, Jerusalem, Israel; School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Limor
authors.initials: L
authors.lastname: Schorr
authors.affiliation: School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Ayala
authors.initials: A
authors.lastname: Burger
authors.affiliation: School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Hagit
authors.initials: H
authors.lastname: Hochner
authors.affiliation: School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Calderon
authors.affiliation: School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Manor
authors.affiliation: School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel. Electronic address: yechielf@ekmd.huji.ac.il.
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Friedlander
authors.affiliation: School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Gabriella M
authors.initials: GM
authors.lastname: Lawrence
authors.affiliation: School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel; Hematology Department, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
mesh_terms: D000328:Adult; D000367:Age Factors; D001601:Bereavement; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Cancer; Mortality; Parental bereavement