Parental overdose, homicide, and suicide linked to increased childhood mortality

Data published in JAMA Network Open have highlighted a significant increase in childhood mortality among children of parents with parental drug overdose, homicide, and suicide vs the general population.¹

Drug overdose, homicide, and suicide are the most common causes of parental death, which has recently reached historically high rates in the United States. Children whose parents have died face significant adverse impacts on their emotional social, and mental well-being.

“[Parental mortality] can reduce their level of protection against harm, thus increasing the risk of early mortality,” wrote investigators.

Comparing mortality rates

The cohort study was conducted to evaluate rates of childhood mortality based on the cause of parental death. Statewide deaths in Michigan from January 2009 to December 2023 were identified from death certificates provided by the Division for Vital Records and Health Statistics at the Michigan Department of Health and Human Services.

Births between 1992 and 2023 were identified from birth certificate records and collated by year of parental death, year of child birth, and parental death cause. The cause of parental death was defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and included homicide, suicide, and drug overdose or drug-related.

Participants included children 17 years or younger whose biological parent died by either homicide, suicide, or drug overdose. The number of bereaved children who died was divided by parental deaths between 2009 and 2023, then multiplied by 10,000 to calculate group-specific mortality rates.

Comparative mortality rates by cause of parental death

There were 32,262 children 17 years or younger enrolled in Medicaid with a parental death linked to homicide, suicide, or drug overdose from 2009 to 2023. Overall, a child mortality rate of 5.22 deaths per 10,000 individuals was reported.

In children whose parents died of homicide, suicide, or drug overdose, this rate was significantly increased, with the greatest rate of 106.10 deaths per 10,000 individuals reported in those whose parents experienced homicide. For suicide and drug overdose deaths, these rates were 66.16 and 36.97 deaths per 10,000 individuals, respectively.

These rates accounted for nearly 150 excess child deaths. According to investigators, this indicates that mortality risk may be reduced among children by preventing parental deaths from homicide, suicide, and drug overdose.

“Early preventive interventions and childhood bereavement services are critical for the growing population of children experiencing parental deaths,” wrote investigators.

Disparities in neonatal care

These concerns arise as rural communities face a disproportionate increase in childhood mortality rates vs their urban counterparts.² Infants need an increased level of childbirth care to reduce the risk of death, which is less often found in rural regions.

In a retrospective cohort study, a rate of higher-level neonatal care for rural birth hospitals of 16.9% was reported as of 2022. In comparison, this rate was 74.4% in urban birth hospitals, highlighting a significantly greater rate.

Additionally, these rates were 14.1% and 64.2%, respectively, in 2010. Unlike rural hospitals, urban hospitals displayed a significant increase in the prevalence of higher-level neonatal care between 2010 and 2022. This highlighted a possible increase in infant mortality rates caused by reduced access to higher-level neonate care in rural hospitals.

References

1. McCabe SE, Kcomt L, Evans-Polce RJ, et al. Childhood mortality by parental cause of death. JAMA Netw Open. 2026;9(3):e262790. doi:10.1001/jamanetworkopen.2026.2790
2. Krewson C. Rural hospitals report reduced access to higher-level neonatal care. Contemporary Pediatrics. February 18, 2026. Accessed March 31, 2026. https://www.contemporarypediatrics.com/view/rural-hospitals-report-reduced-access-to-higher-level-neonatal-care