Health and financial burden of adverse childhood experiences in England and Wales: a combined primary data study of five surveys

Abstract

ObjectiveTo estimate the health and financial burden of adverse childhood experiences (ACEs) in England and Wales.DesignThe study combined data from five randomly stratified cross-sectional ACE studies. Population attributable fractions (PAFs) were calculated for major health risks and causes of ill health and applied to disability adjusted life years (DALYs), with financial costs estimated using a modified human capital method.SettingHouseholds in England and Wales.Participants15 285 residents aged 18–69.Outcome measuresThe outcome measures were PAFs for single (1 ACE) and multiple (2–3 and ≥4 ACEs) ACE exposure categories for four health risks (smoking, alcohol use, drug use, high body mass index) and nine causes of ill health (cancer, type 2 diabetes, heart disease, respiratory disease, stroke, violence, anxiety, depression, other mental illness); and annual estimated DALYs and financial costs attributable to ACEs.ResultsCumulative relationships were found between ACEs and risks of all outcomes. For health risks, PAFs for ACEs were highest for drug use (Wales 58.8%, England 52.6%), although ACE-attributable smoking had the highest estimated costs (England and Wales, £7.8 billion). For causes of ill health, PAFs for ACEs were highest for violence (Wales 48.9%, England 43.4%) and mental illness (ranging from 29.1% for anxiety in England to 49.7% for other mental illness in Wales). The greatest ACE-attributable costs were for mental illness (anxiety, depression and other mental illness; England and Wales, £11.2 billion) and cancer (£7.9 billion). Across all outcomes, the total annual ACE-attributable cost was estimated at £42.8 billion. The majority of costs related to exposures to multiple rather than a single ACE (ranging from 71.9% for high body mass index to 98.3% for cancer).ConclusionsACEs impose a substantial societal burden in England and Wales. Policies and practices that prevent ACEs, build resilience and develop trauma-informed services are needed to reduce burden of disease and avoidable service use and financial costs across health and other sectors.

Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis

“…13 Two articles presented data from ACE studies using students in multiple countries; 14,15 raw data were available from these student studies and thus each study was included as a separate sample with RRs calculated using generalised linear models. Raw data were also available for five UK studies combined in one article, 12 and here study-level RRs were calculated by the authors when not included in previous estimates. For studies presenting multiple ACEs in more than one category (eg, 2-3 ACEs, ≥4 ACEs), these data were combined to an RR for at least two ACEs using a weighted mean method.…”

“…For example, in California, USA, the annual cost of ACEs across eight health risks and causes has been estimated to exceed $100 billion, 11 while in England and Wales annual costs across 13 health risks and causes of ill health have been estimated at £43 billion. 12 However, to our knowledge no cost estimates are available for other European countries.…”

Perceptions of a short animated film on adverse childhood experiences: a mixed methods evaluation

“… 2–5 Annual costs attributable to ACEs across a range of risk factors and causes of ill health have been estimated to be $1.3 trillion across Europe and North America 6 and £42.8 billion in England and Wales. 7 Internationally, local and national policies are prioritising the prevention and response to ACEs. 8 9 Movements such as ACE-Aware Scotland (UK), the California ACEs Aware Initiative (USA) and Welsh strategy to create ‘ACE aware’ services ( https://www.aceawarewales.com/ ) seek to promote a response to ACEs, including increased ACE awareness.…”

Childhood Emotional Neglect and Adolescent Depression: Assessing the Protective Role of Peer Social Support in a Longitudinal Birth Cohort

“…At least one in five youth in the United States, the United Kingdom, and other developed countries (1)(2)(3) experience childhood adversities such as exposure to abuse, neglect, or other major life stressors, which can considerably impact their socio-emotional, cognitive, and physical development, while simultaneously increasing the long-term risk of mental health difficulties (4,5). In particular, exposure to childhood adversities can more than double the risk of depression in later childhood and adulthood and is also associated with increased suicide rates in adulthood (6)(7)(8).…”