Little is known about the impact of child welfare system-level factors on child mortality as an outcome within foster care. Using data from the Adoption and Foster Care Analysis and Reporting System, 2009-2018, we examined the associations between county-level sociodemographic, foster care performance, and judicial reform characteristics with all-cause mortality rates. Results of random effects negative binomial regression analyses showed that higher proportions of younger children (<1 year: IRR = 1.06, 95% CI [1.02, 1.11]; 5-9 years: IRR = 1.05, 95% CI [1.01, 1.09]); children of color (i.e., non-Hispanic Asian: IRR = 1.07, 95% CI [1.01, 1.13]; multiracial: IRR = 1.03, 95% CI [1.01, 1.04]; non-Hispanic Black: IRR = 1.02, 95% CI [1.01, 1.02]; Hispanic: IRR = 1.01, 95% CI [1.01, 1.02]); and male children (IRR = 1.10, 95% CI [1.05, 1.15]) were associated with higher mortality risks at the county level. Current class action lawsuits (IRR = 0.79, 95% CI [0.63, 0.99]) and active consent decrees (IRR = 0.77, 95% CI [0.63, 0.94]) were associated with lower mortality risks. None of the foster care performance characteristics (e.g., foster care entry, placement stability, permanency) were associated with mortality risks. These findings have implications for addressing health disparities and reforming foster care systems through programmatic and policy efforts.

中文翻译：

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与美国寄养儿童全因死亡率相关的儿童福利系统层面的因素，2009-2018 年。

人们对儿童福利系统层面因素对寄养儿童死亡率的影响知之甚少。利用2009-2018年收养和寄养分析和报告系统的数据，我们研究了县级社会人口、寄养绩效和司法改革特征与全因死亡率之间的关联。随机效应负二项回归分析结果显示，年龄较小的儿童比例较高（<1 岁：IRR = 1.06，95% CI [1.02，1.11]；5-9 岁：IRR = 1.05，95% CI [1.01，1.09] ）；有色人种儿童（即非西班牙裔亚裔：IRR = 1.07，95% CI [1.01，1.13]；多种族：IRR = 1.03，95% CI [1.01，1.04]；非西班牙裔黑人：IRR = 1.02，95% CI [1.01, 1.02]；西班牙裔：IRR = 1.01，95% CI [1.01, 1.02]）；男性儿童（IRR = 1.10，95% CI [1.05，1.15]）与县级较高的死亡风险相关。当前的集体诉讼（IRR = 0.79，95% CI [0.63，0.99]）和主动同意令（IRR = 0.77，95% CI [0.63，0.94]）与较低的死亡风险相关。寄养表现特征（例如，寄养进入、安置稳定性、永久性）均与死亡风险无关。这些发现对于通过计划和政策努力解决健康差异和改革寄养制度具有重要意义。