Youth Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020.

Importance: Youth (those aged <18 years) parental death has been associated with negative health outcomes. Understanding the burden of parental death due to drug poisoning (herein, drugs) and firearms is essential for informing interventions. Objective: To estimate the incidence of youth parental death due to drugs, firearms, and all other causes. Design, Setting, and Participants: This cross-sectional observational study was conducted using vital registration, including all US decedents, and census data from January 1990 through December 2020. Data were analyzed from May 30, 2023, to March 28, 2024. Exposures: Parental death due to drug poisoning or firearms. Main Outcomes and Measures: A demographic matrix projection model was used to estimate the number and incidence of youth experiencing parental death, defined as the death of 1 or more parents, per 1000 population aged less than 18 years. Analyses evaluated parental deaths by drugs, firearms, and all other causes from 1999 through 2020 by race and ethnicity. Results: Between 1999 and 2020, there were 931 785 drug poisoning deaths and 736 779 firearm-related deaths with a mean (SD) age of 42.6 (16.3) years. Most deaths occurred among males (73.8%) and White decedents (70.8%) followed by Black (17.5%) and Hispanic (9.5%) decedents. An estimated 759 000 (95% CI, 722 000-800 000) youth experienced parental death due to drugs and an estimated 434 000 (95% CI, 409 000-460 000) youth experienced parental death due to firearms, accounting for 17% of all parental deaths. From 1999 to 2020, the estimated number of youth who experienced parental death increased 345% (95% CI, 334%-361%) due to drugs and 39% (95% CI, 37%-41%) due to firearms compared with 24% (95% CI, 23%-25%) due to all other causes. Black youth experienced a disproportionate burden of parental deaths, based primarily on firearm deaths among fathers. In 2020, drugs and firearms accounted for 23% of all parental deaths, double the proportion in 1999 (12%). Conclusions and Relevance: Results of this modeling study suggest that US youth are at high and increasing risk of experiencing parental death by drugs or firearms. Efforts to stem this problem should prioritize averting drug overdoses and firearm violence, especially among structurally marginalized groups.

Projections of human kinship for all countries.

Demographers have long attempted to project future changes in the size and composition of populations, but have ignored what these processes will mean for the size, composition, and age distribution of family networks. Kinship structures matter because family solidarity-a crucial source of informal care for millions of people around the world-is conditional on kin being alive. Here, we present innovative projections of biological kin for the 1950 to 2100 period and discuss what they imply for the availability of informal care. Overall, we project that the number of living kin for individuals will decline dramatically worldwide. While a 65-yo woman in 1950 could expect to have 41 living kin, a 65-yo woman in 2095 is projected to have just 25 [18.8 to 34.7] relatives (lower and upper 80% projection intervals). This represents a 38% [15 to 54] global decline. The composition of family networks is also expected to change, with the numbers of living grandparents and great-grandparents markedly increasing, and the numbers of cousins, nieces and nephews, and grandchildren declining. Family networks will age considerably, as we project a widening age gap between individuals and their kin due to lower and later fertility and longer lifespans. In Italy, for example, the average age of a grandmother of a 35-yo woman is expected to increase from 77.9 y in 1950 to 87.7 y [87.1 to 88.5] in 2095. The projected changes in kin supply will put pressure on the already stretched institutional systems of social support, as more individuals age with smaller and older family networks.

Estimates from 31 countries show the significant impact of COVID-19 excess mortality on the incidence of family bereavement.

Excess mortality associated with the COVID-19 pandemic has led many to experience the loss of family members, with significant negative outcomes. We quantify the extent to which these population-wide rates of kin loss represent a departure from levels expected in the absence of COVID-19 excess mortality and consider which demographic groups are most likely to be affected. Results for biological kin in 31 countries indicate dramatic increases in excess kin loss associated with excess mortality and follow a generational pattern consistent with COVID-19 mortality risk by age. During periods of high excess mortality, the number of younger individuals losing a grandparent increased by up to 845 per 100,000, or 1.2 times expected levels (for individuals aged 30 to 44 y in the United Kingdom in April 2020), while the number of older individuals losing a sibling increased by up to 511 per 100,000 or 1.15 times (for individuals aged 65 y and over in Poland in November 2020). Our monthly multicountry estimates of excess kin loss complement existing point estimates of the number of individuals bereaved by COVID-19 mortality [Verdery et al., Proc. Natl. Acad. Sci. U.S.A. 117, 17695-17701 (2020); Kidman et al., JAMA Pediatr. 175, 745-746 (2021); Hillis et al., Lancet 398, 391-402 (2021)] and highlight the role of heterogeneous excess mortality in shaping country experiences.

The Demographic Drivers of Grief and Memory After Genocide in Guatemala.

Mortality crises are relatively common demographic events, but we know little about how they affect local populations beyond excess mortality. I argue that using a kinship perspective to study mortality crises provides valuable insights into (1) how excess mortality affects the exposure to kin loss and (2) how family bereavement may contribute to the reproduction of historical memory in the long term. I explore these two processes using a unique genealogical database that records the complete demographic history of Rio Negro, a genocide-affected population in Guatemala, between 1982 and 2015. The analysis shows that deaths from the 1982 genocide were balanced by age, sex, and socioeconomic status. One third of the population were killed, but two thirds were left bereaved (the top 10% most affected individuals lost 30% of their nuclear family relatives and 23% of their extended family relatives). Notably, the proportion of the population related to a victim did not change between 1983 and 2015. The persistence of family bereavement can be interpreted as a prolongation of grief or as a driver of historical memory. These demographic dynamics have implications for the study of historical events beyond mortality crises.

North and South: Naming practices and the hidden dimension of global disparities in knowledge production.

SignificanceContemporary social sciences aim to be diverse and inclusive, but traces of the historical dominance of Western European and North American academic institutions persist in scientific practices. One such practice is the phrasing of article titles. Our analysis shows that articles studying the global North are systematically less likely to mention the name of the country they study in their title compared to articles on the global South. This constitutes, potentially, an unwarranted claim on universality and may lead to lesser recognition of global South studies. Social and behavioral scientists must reflect on the phrasing of their article titles to avoid reproducing harmful relations of intellectual domination which limit inclusivity and constitute a barrier to the generalizability of scientific knowledge.

Representativeness is crucial for inferring demographic processes from online genealogies: Evidence from lifespan dynamics.

Crowdsourced online genealogies have an unprecedented potential to shed light on long-run population dynamics, if analyzed properly. We investigate whether the historical mortality dynamics of males in familinx, a popular genealogical dataset, are representative of the general population, or whether they are closer to those of an elite subpopulation in two territories. The first territory is the German Empire, with a low level of genealogical coverage relative to the total population size, while the second territory is The Netherlands, with a higher level of genealogical coverage relative to the population. We find that, for the period around the turn of the 20th century (for which benchmark national life tables are available), mortality is consistently lower and more homogeneous in familinx than in the general population. For that time period, the mortality levels in familinx resemble those of elites in the German Empire, while they are closer to those in national life tables in The Netherlands. For the period before the 19th century, the mortality levels in familinx mirror those of the elites in both territories. We identify the low coverage of the total population and the oversampling of elites in online genealogies as potential explanations for these findings. Emerging digital data may revolutionize our knowledge of historical demographic dynamics, but only if we understand their potential uses and limitations.

Excess Mortality During the COVID-19 Pandemic in Guatemala.

Objectives. To describe excess mortality during the COVID-19 pandemic in Guatemala during 2020 by week, age, sex, and place of death. Methods. We used mortality data from 2015 to 2020, gathered through the vital registration system of Guatemala. We calculated weekly mortality rates, overall and stratified by age, sex, and place of death. We fitted a generalized additive model to calculate excess deaths, adjusting for seasonality and secular trends and compared excess deaths to the official COVID-19 mortality count. Results. We found an initial decline of 26% in mortality rates during the first weeks of the pandemic in 2020, compared with 2015 to 2019. These declines were sustained through October 2020 for the population younger than 20 years and for deaths in public spaces and returned to normal from July onward in the population aged 20 to 39 years. We found a peak of 73% excess mortality in mid-July, especially in the population aged 40 years or older. We estimated a total of 8036 excess deaths (95% confidence interval = 7935, 8137) in 2020, 46% higher than the official COVID-19 mortality count. Conclusions. The extent of this health crisis is underestimated when COVID-19 confirmed death counts are used. (Am J Public Health. 2021;111(10): 1839-1846. https://doi.org/10.2105/AJPH.2021.306452).

Women's Experience of Child Death Over the Life Course: A Global Demographic Perspective.

The death of a child affects the well-being of parents and families worldwide, but little is known about the scale of this phenomenon. Using a novel methodology from formal demography applied to data from the 2019 Revision of the United Nations World Population Prospects, we provide the first global overview of parental bereavement, its magnitude, prevalence, and distribution over age for the 1950-2000 annual birth cohorts of women. We project that the global burden of parental bereavement will be 1.6 times lower for women born in 2000 than for women born in 1955. Accounting for compositional effects, we anticipate the largest improvements in regions of the Global South, where offspring mortality continues to be a common life event. This study quantifies an unprecedented shift in the timing of parental bereavement from reproductive to retirement ages. Women in the 1985 cohort and subsequent cohorts will be more likely to lose an adult child after age 65 than to lose a young child before age 50, reversing a long-standing global trend. "Child death" will increasingly come to mean the death of adult offspring. We project persisting regional inequalities in offspring mortality and in the availability of children in later life, a particular concern for parents dependent on support from their children after retirement. Nevertheless, our analyses suggest a progressive narrowing of the historical gap between the Global North and South in the near future. These developments have profound implications for demographic theory and highlight the need for policies to support bereaved older parents.

Linking excess mortality to mobility data during the first wave of COVID-19 in England and Wales.

Non-pharmaceutical interventions have been implemented worldwide to curb the spread of COVID-19. However, the effectiveness of such governmental measures in reducing the mortality burden remains a key question of scientific interest and public debate. In this study, we leverage digital mobility data to assess the effects of reduced human mobility on excess mortality, focusing on regional data in England and Wales between February and August 2020. We estimate a robust association between mobility reductions and lower excess mortality, after adjusting for time trends and regional differences in a mixed-effects regression framework and considering a five-week lag between the two measures. We predict that, in the absence of mobility reductions, the number of excess deaths could have more than doubled in England and Wales during this period, especially in the London area. The study is one of the first attempts to quantify the effects of mobility reductions on excess mortality during the COVID-19 pandemic.

Global burden of maternal bereavement: indicators of the cumulative prevalence of child loss.

BACKGROUND: We provide country-level estimates of the cumulative prevalence of mothers bereaved by a child's death in 170 countries and territories. METHODS: We generate indicators of the cumulative prevalence of mothers who have had an infant, under-five-year-old or any-age child ever die by using publicly available survey data in 89 countries and an indirect approach that combines formal kinship models and life-table methods in an additional 81 countries. We label these measures the maternal cumulative prevalence of infant mortality (mIM), under-five mortality (mU5M) and offspring mortality (mOM) and generate prevalence estimates for 20-44-year-old and 45-49-year-old mothers. RESULTS: In several Asian and European countries, the mIM and mU5M are below 10 per 1000 mothers yet exceed 200 per 1000 mothers in several Middle Eastern and African countries. Global inequality in mothers' experience of child loss is enormous: mothers in high-mortality-burden African countries are more than 100 times more likely to have had a child die than mothers in low-mortality-burden Asian and European countries. In more than 20 African countries, the mOM exceeds 500 per 1000 mothers, meaning that it is typical for a surviving 45-49-year-old mother to be bereaved. DISCUSSION: The study reveals enormous global disparities in mothers' experience of child loss and identifies a need for more research on the downstream mental and physical health risks associated with parental bereavement.

Maternal and child access to care and intensity of conflict in the occupied Palestinian territory: a pseudo longitudinal analysis (2000-2014).

BACKGROUND: In the occupied Palestinian territory (oPt), access to maternal and child healthcare (MCH) services are constrained due to the prolonged Israeli military occupation, the Separation Wall, army checkpoints, and restrictions on the movement of people and goods. This study assesses the relationship between conflict intensity and access to Maternal and Child Health care in occupied Palestinian territory (oPt). To the best of our knowledge, the impact of conflict on access to health care has not been measured due to the lack of data. METHODS: We analyse pooled data from household surveys covering a fifteen-year period (2000-2014) of children (n = 16,793) and women (n = 8477) in five regions of the oPt. Conflict intensity was used as a continuous variable defined as the square root of non-combatant conflict mortality taken from monthly death rates of non-combatants by region. We use multilevel logistic models to explain four outputs: child vaccination schedules, antenatal care, caesarean sections, and complications during pregnancy. RESULTS: Locality is important with results showing the negative impact of conflict intensity on access to care, especially in the South West Bank for maternal health services and Central West Bank for vaccination (B - 0.161 p = 0.000 for DPT). Wealth is only significant for DPT vaccinations with poorest (B - 0.098 p = 0.005) and poor (B - 0.148 p = 0.002) individuals less likely to access services. Otherwise conflict does not show a differential effect across socio-economic conditions. CONCLUSIONS: This study shows how locality is the strongest factor when looking at the impact of conflict in the oPt. Preventative services (ANC and vaccinations) are the most affected by conflict. We recommend a greater use of community health care to improve access to maternal and child care when barriers impede access to health facilities during times of conflict.

Maternal and child health outcomes and intensity of conflict in the occupied Palestinian territory in 2000-14: a pseudo longitudinal analysis.

BACKGROUND: Armed conflicts can undermine a country's health-care capacity and disrupt the delivery of basic health services. Yet the public health consequences of war remain difficult to quantify, mainly because adequate data do not exist. We hypothesised that the ongoing conflict in the occupied Palestinian territory (including the restrictions on free movement and the strain on health-care services) have had detrimental effects on maternal and child health outcomes. METHODS: We reconstructed data on delivery by caesarean section and diphtheria, pertussis, and tetanus vaccination with pooled data from Demographic and Health Surveys for 2000-14. We use probit regression for binary outcomes to explain changes in caesarean sections (using data on the last pregnancy of 8700 woman aged 15-45 years) and child vaccination (using 12 600 schedules). All-age mortality of non-combatants was used to measure the intensity of conflict (the explanatory variable). Excess mortality is commonly used as a proxy for conflict intensity in the absence of more detailed data. FINDINGS: There is a general increase in the prevalence of all indicators (less so for caesarean sections, which increased from 10% to 20% between 2002 and 2014). Intensity of conflict is negatively associated with vaccination (ß=-0·2; p<0·0001). A visual examination shows that vaccination is more susceptible to peaks in conflict intensity-prevalence increased from 65% to 80% in the years after the Second Intifada. Boys were more likely than girls to be vaccinated (ß=0·31; p<0·0001). The negative association between conflict intensity and delivery by caesarean section is weaker but significant (ß=-0·04; p=0·007). Education and wealth are not significant predictors for caesarean section. INTERPRETATION: The conflict spares no one: women are affected irrespective of their socioeconomic status. The closer association between vaccination and intensity of conflict might result from their dependency on specialised resources and infrastructure. The slight negative correlation with caesarean delivery during conflict could be due to the difficulty of accessing health centres that provide caesarean section. It is also possible that the rates of planned caesarean section increases during calm periods. The most acute effects occurred when conflict intensity increased or decreased sharply, which suggests that these periods are crucial for health-care provision. FUNDING: Emirates Foundation through the London School of Economics Middle East Centre.