Early-life death of a sibling and primary care utilisation during middle age: a population-wide cohort study.

Background: The death of a family member has been linked to higher mortality for those grieving. However, much less is known about different types of health problems of the surviving sibling during middle age.

Methods: Individual-level register data on all Norwegian residents born between 1969 and 1979 were linked to cause-specific primary care utilisation between 2015 and 2019. Incidence rate ratios (IRRs) of different types of health conditions in mid-life (age 36-50) were calculated, comparing individuals who experienced the death of a sibling during childhood or early adulthood (age 0-29) and those who did not.

Results: The study included 556 593 participants (mean (SD) age in 2017, 43.3 (3.15) years; 273 491 women (49.1%)). The death of a sibling was positively associated with all-cause primary care utilisation (IRR=1.11; 95% CI, 1.08 to 1.13). The highest cause-specific estimates were found for psychological (IR=1.17; 95% CI, 1.11 to 1.23) and cardiovascular (IRR=1.14; 95% CI, 1.05 to 1.23) health problems. Suicide was the cause of death with the strongest association with all-cause primary care (IRR=1.16; 95% CI, 1.09 to 1.23). When examining the intersection of type-specific health problems and causes of death, the highest estimate was found for psychological problems and sibling suicide (IRR=1.53, 95% CI, 1.32 to 1.77).

Conclusion: Early-life sibling death was associated with more health problems several decades after the trauma. The persistence of these associations suggests that these problems are substantial, and at least partly caused by the trauma. More needs to be learnt interventions that could mitigate these adverse effects.