Hospitalization of Children in Foster Homes: A Canadian Cohort Study

In Canada, approximately 4% to 7% of children live in a foster home during their childhood. This study reports on hospitalizations of children in foster homes, with the hypothesis that rates of hospitalization are higher for children with foster home experience compared to all other children.

We used linked Canadian Census records and health administrative databases. All children <18 years old were included in all provinces and territories except for Quebec. Our exposure was being identified as a "foster child" on Census Day 2011. Our primary outcome was hospitalizations between 2011 and 2017. Survey weights were applied to obtain a sample size representative of the Canadian population.

Our study represented weighted N = 31 595 (unweighted N = 5796) children in foster homes compared to weighted N = 5 317 346 (unweighted N = 1 062 694) children not in a foster home. Indigenous First Nations children were in foster homes at a rate of 50.49 per 1000, compared to 3.28 per 1000 white children (ratio 15.4, 95% CI, 9.27-25.43). Children with foster home experience were more likely to be hospitalized compared to those without (283 per 1000 vs 140 per 1000, relative rate 1.94, 95% CI, 1.69-2.22). The top causes of hospitalization for young adults with foster home experience were mental health, substance use, and complications of reproductive health.

Children and young adults with foster home experience have acute health needs that last into their adult years and would benefit from early and accessible mental health and reproductive health services.