Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey

Abstract

BackgroundACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England.MethodsA nationally representative survey was undertaken (n = 3885, aged 18–69, April–July 2013). Socio-demographically controlled proportional hazards analyses examined the associations between the number of ACE categories (<18 years; e.g. child abuse and family dysfunction such as domestic violence) and cancer, diabetes, stroke, respiratory, liver/digestive and cardiovascular disease. Sibling (n = 6983) mortality was similarly analysed as a measure of premature mortality.ResultsOf the total, 46.4% of respondents reported ≥1 and 8.3% ≥4 ACEs. Disease development was strongly associated with increased ACEs (e.g. hazard ratios, HR, 0 versus ≥4 ACEs; cancer, 2.38 (1.48–3.83); diabetes, 2.99 (1.90–4.72); stroke, 5.79 (2.43–13.80, all P < 0.001). Individuals with ≥4 ACEs (versus no ACEs) had a 2.76 times higher rate of developing any disease before age 70 years. Adjusted HR for mortality was strongly linked to ACEs (≥4 versus 0 ACEs; HR, 1.97 (1.39–2.79), P < 0.001).ConclusionsRadically different life-course trajectories are associated with exposure to increased ACEs. Interventions to prevent ACEs are available but rarely implemented at scale. Treating the resulting health costs across the life course is unsustainable.

Adverse Childhood Experiences and Health in Adulthood in a Rural Population-Based Sample

“…In the current study, ACE score inversely correlated with diagnoses of hypertension, hypercholesterolemia, heart disease, skin cancer, and other cancers, despite previous reports linking these diseases in adulthood to adverse experiences early in life. 24,25,28,[32][33][34][35] There are a number of potential explanations for these findings. For example, participants ≥ 65 years of age were much less likely to report four or more ACEs and many of these conditions increase with age.…”

“…Lack of diagnosis and consequent lack of follow-up care for chronic diseases may contribute to the relationship between ACE score and premature death reported by several others. 22,25,32 Finally, it is worth considering the potential for resilience to adversity in the population, as described further below.…”

Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood

“…2,4,6,14–16,18,25,26 These results are also consistent with the literature in showing that ACEs have a dose–response effect in increasing exposure to risky behaviors and morbidity in adulthood. 2,4,15,18,34–37 For instance, Felitti et al 2 showed a graded relationship between ACE scores and odds of behaviors/conditions, and Chartier and colleagues 34 found respondents who reported four or more adverse experiences in childhood had 172% increased odds of comorbid conditions, compared with those reporting zero. In addition, Gilbert et al 18 reported exposure to more ACEs was associated with greater odds of reporting fair/poor health, frequent mental distress, and disability.…”

Adverse childhood experiences and risk of type 2 diabetes: A systematic review and meta-analysis

“…After the exclusion of duplicate records and studies that did not match the inclusion criteria, 10 articles remained. After assessing the full text of these 10 studies, we excluded three articles [36][37][38] because they lacked the necessary data to be extracted. Finally, 7 studies [21][22][23][24][25][26][27] were included in this meta-analysis with one [26] identified from EMBASE and the rest from PubMed.…”