Home > Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis.

Bellis, Mark A and Hughes, Karen and Ford, Kat and Ramos Rodriguez, Gabriela and Sethi, Dinesh and Passmore, Jonathon . (2019) Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. The Lancet, Public Health, Early online https://doi.org/10.1016/S2468-2667(19)30145-8•

URL: https://www.thelancet.com/journals/lanpub/article/...


Background: An increasing number of studies are identifying associations between adverse childhood experiences (ACEs) and ill health throughout the life course. We aimed to calculate the proportions of major risk factors for and causes of ill health that are attributable to one or multiple types of ACE and the associated financial costs.

Methods: In this systematic review and meta-analysis, we searched for studies in which risk data in individuals with ACEs were compared with these data in those without ACEs. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and the Education Resources Information Center) for quantitative studies published between Jan 1, 1990, and July 11, 2018, that reported risks of health-related behaviours and causes of ill health in adults that were associated with cumulative measures of ACEs (ie, number of ACEs). We included studies in adults in populations that did not have a high risk of ACEs, that had sample sizes of at least 1000 people, and that provided ACE prevalence data. We calculated the pooled RR for risk factors (harmful alcohol use, illicit drug use, smoking, and obesity) and causes of ill health (cancer, diabetes, cardiovascular disease, respiratory disease, anxiety, and depression) associated with ACEs. RRs were used to estimate the population-attributable fractions (PAFs) of risk attributable to ACEs and the disability-adjusted life-years (DALYs) and financial costs associated with ACEs. This study was prospectively registered in PROSPERO (CRD42018090356).

Findings: Of 4387 unique articles found following our initial search, after review of the titles (and abstracts, when the title was relevant), we assessed 880 (20%) full-text articles. We considered 221 (25%) full-text articles for inclusion, of which 23 (10%) articles met all selection criteria for our meta-analysis. We found a pooled prevalence of 23·5% of individuals (95% CI 18·7–28·5) with one ACE and 18·7% (14·7–23·2) with two or more ACEs in Europe (from ten studies) and of 23·4% of individuals (22·0–24·8) with one ACE and 35·0% (31·6–38·4) with two or more ACEs in north America (from nine studies). Illicit drug use had the highest PAFs associated with ACEs of all the risk factors assessed in both regions (34·1% in Europe; 41·1% in north America). In both regions, PAFs of causes of ill health were highest for mental illness outcomes: ACEs were attributed to about 30% of cases of anxiety and 40% of cases of depression in north America and more than a quarter of both conditions in Europe. Costs of cardiovascular disease attributable to ACEs were substantially higher than for most other causes of ill health because of higher DALYs for this condition. Total annual costs attributable to ACEs were estimated to be US$581 billion in Europe and $748 billion in north America. More than 75% of these costs arose in individuals with two or more ACEs.

Interpretation: Millions of adults across Europe and north America live with a legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of 3 million DALYs or $105 billion. Programmes to prevent ACEs and moderate their effects are available. Rebalancing expenditure towards ensuring safe and nurturing childhoods would be economically beneficial and relieve pressures on health-care systems.

Item Type:Evidence resource
Drug Type:Alcohol
Intervention Type:AOD disorder harm reduction
Date:September 2019
Volume:Early online
EndNote:View
Subjects:A Substance use, abuse, and dependence > Prevalence > Substance use behaviour
A Substance use, abuse, and dependence > Prevalence > Substance use behaviour > Alcohol consumption
A Substance use, abuse, and dependence > Effects and consequences
B Substances > Alcohol
G Health and disease > State of health > Physical health
G Health and disease > State of health > Mental health
J Health care, prevention and rehabilitation > Risk and protective factors > Risk factors
J Health care, prevention and rehabilitation > Health care economics
L Social psychology and related concepts > Marital relations > Family and kinship > Family relations > Family role
L Social psychology and related concepts > Quality of life
L Social psychology and related concepts > Economic availability or accessibility
MP-MR Policy, planning, economics, work and social services > Economic aspects of substance use (cost / pricing)
T Demographic characteristics > Child
T Demographic characteristics > Adolescent / youth (teenager / young person)
VA Geographic area > United States
VA Geographic area > Europe

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