87
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      research-article
      , Prof, DSc a , b , * , , Prof, PhD a , b , , PhD b , , MRes a , , MD c , , MPH c
      The Lancet. Public Health
      Elsevier, Ltd

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          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.

          Funding

          World Health Organization Regional Office for Europe.

          Related collections

          Most cited references33

          • Record: found
          • Abstract: found
          • Article: not found

          The Lancet Commission on global mental health and sustainable development

          The Lancet, 392(10157), 1553-1598
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Use and misuse of population attributable fractions.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

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

              Adverse childhood experiences (ACEs) are associated with early mortality and morbidity. This study evaluated the association among ACEs, high-risk health behaviors, and comorbid conditions, as well as the independent effect of ACE components.
                Bookmark

                Author and article information

                Contributors
                Journal
                Lancet Public Health
                Lancet Public Health
                The Lancet. Public Health
                Elsevier, Ltd
                2468-2667
                03 September 2019
                October 2019
                03 September 2019
                : 4
                : 10
                : e517-e528
                Affiliations
                [a ]Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, Wrexham, UK
                [b ]College of Human Sciences, Bangor University, Wrexham, UK
                [c ]Violence and Injury Prevention, World Health Organization Regional Office for Europe, Copenhagen, Denmark
                Author notes
                [* ]Correspondence to: Prof Mark A Bellis, Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, Wrexham LL13 7YP, UK m.a.bellis@ 123456bangor.ac.uk
                Article
                S2468-2667(19)30145-8
                10.1016/S2468-2667(19)30145-8
                7098477
                31492648
                28f651eb-e97a-4636-b450-016f58b1f7a4
                © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Categories
                Article

                Comments

                Comment on this article