Parental Divorce in Childhood Linked With Adult Stroke Risk

Experiencing one’s parents’ divorce in childhood is associated with increased risk for stroke in older adults, according to a recent study.

A secondary analysis of public data suggests that parental divorce in childhood may increase stroke risk in older adults by as much as 61%. Though this is not the first time the association has been observed, the study’s authors are sounding the alarm and encouraging clinicians to consider divorce in childhood a potentially important risk factor.

“Surprisingly, parental divorce and stroke have not received a lot of research attention, although I published what I think was the first study looking at this in 2012,” author Esme Fuller-Thomson, PhD, director of the Institute for Life Course and Aging and professor of social work at the University of Toronto, Toronto, Ontario, Canada, told Medscape Medical News. “With 2022 data, we again found that there was an association in both men and women as strong as having diabetes or being male,” she said.

The data were published online on January 22 in PLOS One.

Modifiable Risk Factor?

The researchers conducted a secondary, cross-sectional analysis of US adults who resided in eight states (ie, Arkansas, Florida, Iowa, Nevada, North Dakota, Oregon, South Dakota, and Virginia). Participants were part of the 2022 Behavioral Risk Factor Surveillance System, which was funded by the US Centers for Disease Control and Prevention. For the current analysis, eligible participants were aged > 65 years and had never experienced childhood physical or sexual abuse (two of several adverse childhood experiences [ACEs] associated with negative health outcomes). The primary outcome was a self-reported clinician diagnosis of stroke, and the main exposure was parental divorce or separation before age 18 years.

The final sample consisted of 13,205 older adults without childhood or sexual abuse (57% women), 7.3% of whom reported a stroke diagnosis. Approximately 1 in 7 (13.9%) had experienced parental divorce.

After adjustment for factors traditionally associated with stroke risk (eg, socioeconomic status, social support, health behaviors, body mass index, physical activity, comorbid conditions, and ACEs), there was a significantly increased risk for participants whose parents had divorced compared with participants who did not experience parental divorce (adjusted odds ratio = 1.61, P = .005).

The magnitude of the association was comparable with the magnitude of the associations between diabetes and stroke and between depression and stroke. In the study, participants with diabetes had 1.37 times greater odds of stroke than those without diabetes. Participants with depression had 1.76 times greater odds of stroke than those without depression.

“We can’t say it’s causal, but it is a potential marker that may be important,” Fuller-Thomson told Medscape Medical News.

Mechanisms Are Unclear

Though mechanisms underlying the potential association between parental divorce and stroke among older adults are unclear, the researchers have pointed to the potential of prolonged, postdivorce stress among children whose parents separate, leading to hypothalamic-pituitary-adrenal axis dysregulation and increased cardiovascular disease risk.

“We know that adverse childhood experiences like parental divorce could put someone at higher risk for diabetes, which then places them at higher risk for stroke,” said Ada Tang, PhD, associate dean of the School of Rehabilitation Science at McMaster University in Hamilton, Ontario, Canada. Tang also is part of the MacStroke Canada research team. Although “parental divorce isn’t in the top, highly known, well-established risk factors, you can see how those dotted lines can be made,” she said. Tang was not directly involved in the research.

She added that the findings reinforce the benefits of painting “a fuller, holistic picture” of a patient’s health behaviors and health history. “Stroke is such a complex condition. Patients come in because they’ve experienced a stroke, but it’s not just the moments that the stroke happens.” The patient has a lifelong health and behavioral history that places them at risk.

“We’re just seeing it as a potential marker that might be important,” said Fuller-Thomson. “We’re hoping that clinicians start thinking about this as a factor that has not been on their radar before.”

The study was conducted without outside funding. Fuller-Thomson and Tang reported having no relevant financial relationships.

Liz Scherer is a US-based health/medical journalist who frequently covers Canadian and EU health news and issues.