Adverse childhood experiences and premature all-cause mortality
Open accessAbstract
Events causing stress responses during sensitive periods of rapid neurological development in childhood may be early determinants of all-cause premature mortality. Using a British birth cohort study of individuals born in 1958, the relationship between adverse childhood experiences (ACE) and mortality ≤50 year was examined for men (n = 7,816) and women (n = 7,405) separately. ACE were measured using prospectively collected reports from parents and the school: no adversities (70 %); one adversity (22 %), two or more adversities (8 %). A Cox regression model was carried out controlling for early life variables and for characteristics at 23 years. In men the risk of death was 57 % higher among those who had experienced 2+ ACE compared to those with none (HR 1.57, 95 % CI 1.13, 2.18, p = 0.007). In women, a graded relationship was observed between ACE and mortality, the risk increasing as ACE accumulated. Women with one ACE had a 66 % increased risk of death (HR 1.66, 95 % CI 1.19, 2.33, p = 0.003) and those with ≥2 ACE had an 80 % increased risk (HR 1.80, 95 % CI 1.10, 2.95, p = 0.020) versus those with no ACE. Given the small impact of adult life style factors on the association between ACE and premature mortality, biological embedding during sensitive periods in early development is a plausible explanatory mechanism.
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Early adversity is associated with higher risk of type 2 diabetes, obesity, ischemic heart disease, cancers, depression, addictions, premature mortality, unemployment, and lower educational attainment.
“Outcomes associated with early adversity include higher risk of type 2 diabetes, obesity, ischemic heart disease, cancers, depression, addictions, and premature mortality, as well as social outcomes including unemployment and lower educational attainment [1–8].”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [8]
The Discussion (page unavailable) reports that childhood adversity was associated with increased premature mortality in the study cohort. The paper does not establish the full list of outcomes attributed to it: it measures education, depressive symptoms, and BMI as potential mediators rather than reporting them as consequences of adversity, and it does not report associations with the other specified diseases, addictions, or unemployment. (LLM, conf=0.90)
Experimental — accuracy not yet measuredAdverse childhood experiences predict poorer long-term outcomes across health and social domains.
“Epidemiological studies have demonstrated that adverse childhood experiences, namely exposures such as neglect, abuse, caregiver mental illness, and family or community violence, predict poorer long-term outcomes across health and social domains.”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [8]
The Conclusion (page unavailable) identifies adverse childhood experiences as risk factors for long-term health and premature mortality. The Methods include neglect and household mental illness among the adversities considered, but the study defines its exposures primarily as intrafamilial; it does not establish community violence as an exposure or poorer social outcomes as a finding. Education and social class are considered as possible mediators, not outcomes. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAdverse psychosocial exposures in early life are associated with increased lifetime risk of adverse outcomes including diabetes, heart disease, cancers, and psychiatric illnesses.
“Adverse psychosocial exposures in early life, namely experiences such as child maltreatment, caregiver stress or depression, and domestic or community violence, have been associated in epidemiological studies with increased lifetime risk of adverse outcomes, including diabetes, heart disease, cancers, and psychiatric illnesses.”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [8]
The Introduction and Conclusion link adverse childhood experiences and early-life stress to later poor health, and the Discussion says studies have found higher morbidity with accumulated adversity. But the paper does not establish the claimed associations with each listed illness—diabetes, heart disease, cancer, and psychiatric illness—or address all the exposure examples, particularly community violence. (LLM, conf=0.85)
Experimental — accuracy not yet measuredExposure to stress has a greater detrimental effect on developmental outcomes on a dose-equivalent basis, and if exposure occurs in the first 2-3 years of life.
“In addition, the ACE literature indicates that exposure to stress has a greater detrimental effect of developmental outcomes on a doseequivalent basis, and if exposure to stress occurs in the first 2 -3 years of life (e.g.Shonkoff et al., 2012;Kelly-Irving et al., 2013).”
From The effects of paternal depression on child and adolescent outcomes: A systematic review (2016) · cites this paper as Kelly-Irving et al., 2013
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References 39 · Cited by 338
- Authors
- Kelly-Irving, M., Lepage, B., Dedieu, D., Bartley, M., Blane, D., Grosclaude, P., Lang, T., & Delpierre, C.
- Affiliations
- Université Toulouse III - Paul Sabatier (FR)
- University College London (GB)
- Imperial College London (GB)
- Venue
- European Journal of Epidemiology
- Published
- 2013-07-26
- Volume
- 28
- Issue
- 9
- Pages
- 721-734
- ISSN
- 0393-2990 (ISSN-L)
- 1573-7284
- PMC
- PMC3787798
- OpenAlex
- W2109438093
- Cited by
- 338
- References
- 39
- Citations by year
- 2026: 19 · 2025: 16 · 2024: 16 · 2023: 31 · 2022: 49 · 2021: 31 · 2020: 61 · 2019: 29 · 2018: 16 · 2017: 17 · 2016: 19 · 2015: 19 · 2014: 12 · 2013: 2
- FWCI
- 19.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Journal of Epidemiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Ligue Contre le Cancer
- Institut National Du Cancer
- Economic and Social Research Council (ES/J019119/1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- adverse childhood experiences, premature mortality, all-cause mortality, childhood adversity, sex differences, biological embedding, sensitive periods of development, childhood stress, 1958 British birth cohort
- MeSH terms
- Adolescent, Adult, Child, Child Abuse, Female, United Kingdom, Humans, Life Change Events, Male, Middle Aged, Prospective Studies, Risk Factors, Social Environment, Stress, Psychological, Multivariate Analysis, Proportional Hazards Models, Child of Impaired Parents, Young Adult, Mortality, Premature
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