The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study

Abstract

ObjectivesThe lifelong health impacts of adverse childhood experiences are increasingly being identified, including earlier and more frequent development of non-communicable disease. Our aim was to examine whether adverse childhood experiences are related to increased use of primary, emergency and in-patient care and at what ages such impact is apparent.MethodsHousehold surveys were undertaken in 2015 with 7414 adults resident in Wales and England using random probability stratified sampling (age range 18–69 years). Nine adverse childhood experiences (covering childhood abuse and household stressors) and three types of health care use in the last 12 months were assessed: number of general practice (GP) visits, emergency department (ED) attendances and nights spent in hospital.ResultsLevels of use increased with increasing numbers of adverse childhood experiences experienced. Compared to those with no adverse childhood experiences, odds (±95% CIs) of frequent GP use (≥6 visits), any ED attendance or any overnight hospital stay were 2.34 (1.88–2.92), 2.32 (1.90–2.83) and 2.67 (2.06–3.47) in those with ≥ 4 adverse childhood experiences. Differences were independent of socio-economic measures of deprivation and other demographics. Higher health care use in those with ≥ 4 adverse childhood experiences (compared with no adverse childhood experiences) was evident at 18–29 years of age and continued through to 50–59 years. Demographically adjusted means for ED attendance rose from 12.2% of 18-29 year olds with no adverse childhood experiences to 28.8% of those with ≥ 4 adverse childhood experiences. At 60–69 years, only overnight hospital stay was significant (9.8% vs. 25.0%).ConclusionsAlong with the acute impacts of adverse childhood experiences on child health, a life course perspective provides a compelling case for investing in safe and nurturing childhoods. Disproportionate health expenditure in later life might be reduced through childhood interventions to prevent adverse childhood experiences.

The Relationship Between Adverse Childhood Experiences and Health Care Use in the Manitoba IBD Cohort Study

“…While previous research suggests that exposure to ACEs is associated with increased healthcare use (Anda et al, 2008;Bellis et al, 2017;Bonomi et al, 2008;Koskenvuo & Koskenvuo, 2015), after consideration of confounding covariates, the various number and types of ACEs were not predictive of increased non-IBD or IBD-related healthcare use in our study.…”

“…Healthcare use in relation to ACEs has been investigated in a number of studies. A recent study that investigated general practice (GP) visits, emergency department (ED) attendance, and nights spent in hospital, observed significantly higher odds of healthcare use with increasing numbers of ACEs (i.e., higher ACE score) (Bellis et al, 2017). A study that included women with a history of both physical and/or sexual abuse during childhood revealed that participants exhibited increased relative rates of mental health, physician, hospital, and pharmacy service use relative to women never exposed to physical and/or sexual abuse (Bonomi et al, 2008).…”

Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences

“…Comparable estimates are not available for exposure to ACEs which include a broader array of childhood stressors including growing up in a household with domestic violence or with family members with depression. However, Bellis et al [11] report that adults with a history of ACEs have significantly higher odds of frequent primary, emergency, and inpatient care relative to those with zero exposure.…”

Adverse Childhood Experiences Run Deep: Toxic Early Life Stress, Telomeres, and Mitochondrial DNA Copy Number, the Biological Markers of Cumulative Stress

“…[2] These initial findings continue to be validated by a growing body of evidence demonstrating ACEs as a risk factor for multiple adverse outcomes, [8] ultimately culminating in premature mortality. [11] When totaling the costs of health care, child welfare services, criminal justice involvement, and productivity losses over the lifespan, the lifetime economic burden of childhood adversity exceeds $124 billion yearly. hhs.gov/sites/default/files/cb/cm2015.pdf 2015 and http://childhealthdata.org/ browse/survey/results?q=4783&r=1 2016; both accessed 1/2018).…”