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Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis
Open accessAbstract
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.
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Stendardo, M., Renzi, C., Pallavi, R., Roda, N., Gambino, V., Casciaro, F., Persico, G., & Giorgio, M. (2022) · Cancer Reports · doi:10.1002/cnr2.1625 · Cited by 1
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Importancia de incorporar la perspectiva del trauma en los servicios de salud mental infanto-juvenil
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Prevalence of Adverse Childhood Experiences in OmanPreprint
Alazri, Z., Sawafi, A. A., Jaju, S., & Mohammad, A. Q. (2023) · Research Square · doi:10.21203/rs.3.rs-3354496/v1 · Cited by 1
Introduction to the Special Section on Innovations in Trauma-Informed Health Care
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“, 2012) that in turn can lead to alcohol-related problems such as early alcohol drinking initiation, alcohol binging, and problem alcohol use (lifetime) (Bellis et al., 2019; Benjet et al., 2016; Erdozain et al., 2015; Hughes et al., 2019, 2017).”
BackgroundHenry, M. A. (2021) · Brock University Digital Repository (Brock University)
Introducing Trauma-and Resiliency-Informed Care in a Residential Treatment Setting
Quach, C. (2021) · doi:10.22371/07.2021.052
“Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis.”
BackgroundInfluentialKoo, A., Irwin, J., Sturgis, M. R., Schwartz, A., Hasnain, M., Davis, E., & Stillerman, A. (2021) · medRxiv · doi:10.1101/2021.09.02.21263054
“4 Decades of robust basic science, public health and social science research reveal that childhood experiences, both positive and negative, shape our trajectory of health or illness across the lifespan.(1-5) Insufficiently buffered childhood adversity and trauma, arising from experiences ranging from the individual (a…”
BackgroundPrimary Care Screening for Adverse Childhood Experiences (ACEs) in the Adult Population
Plisco, C. (2021) · IRL - University of Missouri, St. Louis (University of Missouri–St. Louis)
Servant Leadership: It Really is Trauma-Informed
Mahon, D. (2022) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80382-429-120221003 · Cited by 1
Mefford, L. C. (2022) · Nursing Science Quarterly · doi:10.1177/08943184211070595
“Systematic literature reviews, as exemplified by Bellis et al. (2019), provide abundant evidence to confirm these initial research findings.”
BackgroundMinors at risk: adverse childhood experiences and youth offending
Pomares, A. G. (2022) · Tesis Doctorals en Xarxa (Consorci de Serveis Universitaris de Catalunya) · doi:10.6035/14109.2022.534524
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Editorial: Childhood Adversity and Life-Course Consequences
Cui, N., Zlotnick, C., Li, Y., & Golfenshtein, N. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.967180
“Childhood adversity is common in different sociocultural contexts and related to adverse outcomes throughout the life course (Caspi et al., 2017; Hughes et al., 2017, 2021; Bellis et al., 2019).”
BackgroundAdverse childhood experiences and yoga: An integrative approach for healing
Taghavi, I., & Kia‐Keating, M. (2021) · PsycEXTRA Dataset · doi:10.1037/e505462022-001
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Metadata
- Authors
- Bellis, M. A., Hughes, K., Ford, K., Ramos Rodriguez, G., Sethi, D., & Passmore, J.
- Affiliations
- Bangor University (GB)
- World Health Organization Regional Office for Europe (DK)
- Corresponding author
- Bellis, Mark A
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 4
- Issue
- 10
- Pages
- e517-e528
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC7098477
- OpenAlex
- W2971937136
- Cited by
- 1,032
- References
- 51
- Citations by year
- 2026: 132 · 2025: 178 · 2024: 216 · 2023: 161 · 2022: 167 · 2021: 118 · 2020: 57 · 2019: 2
- FWCI
- 13.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bangor University Research Portal (Bangor University) (publishedVersion, other-oa)
- Liverpool John Moores University (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Sociology and Political Science › Child Welfare and Adoption
- Social Sciences › Health › Intimate Partner and Family Violence
- Keywords
- adverse childhood experiences, life course health, population attributable fraction, disability-adjusted life years, health care costs, alcohol consumption, illicit drug use, smoking, obesity, cancer, diabetes mellitus, cardiovascular disease, respiratory diseases, anxiety, depression, health disparities
- MeSH terms
- Adult Survivors of Child Adverse Events, Adverse Childhood Experiences, Costs and Cost Analysis, Europe, Health Status, Humans, North America
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