Child maltreatment and premature mortality in the United States: Heterogeneity by gender and maltreatment subtypes

This study investigated the relationship between child maltreatment and premature mortality in early to mid-adulthood. Potential heterogeneities by gender and maltreatment subtypes were also examined. This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), including 20,654 participants, of whom 678 died during follow-up. Child maltreatment was assessed using a combination of self-reports from Wave I (grades 7-12) and retrospective reports of pre-sixth grade experiences from Wave III (ages 18-26). Vital status was ascertained using the Mortality Outcomes Surveillance System, which links Add Health study participants to the National Death Index with follow-up through December 2023, as the cohort reached their 40s. Maltreatment subtypes were classified into emotional, physical, sexual abuse, as well as emotional and physical neglect. Cox proportional hazards models were employed, and gender differences were assessed through subgroup and interaction analyses. Exposure to multiple forms of maltreatment is significantly associated with higher risks of all-cause mortality, even after adjusting for individual- and family-level characteristics (HR = 1.397, 95% CI = 1.134–1.722). This association was evident among males (HR = 1.765, 95% CI = 1.362–2.289), with no significant relationship observed among females. Among males, experiencing emotional and physical neglect emerged as the most pronounced risk factors for all-cause mortality compared to other subtypes. The findings underscore the need for a life-course continuum of supportive interventions for maltreatment victims, particularly males, designed to remain responsive to the contexts of individual cases.