Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey

Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England a national survey

ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England....

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Bibliographic Details
Published in:Journal of public health (Oxford, England) Vol. 37; no. 3; pp. 445 - 454
Main Authors: Bellis, M.A., Hughes, K., Leckenby, N., Hardcastle, K.A., Perkins, C., Lowey, H.
Format: Journal Article
Language:English
Published: England Oxford University Press 01-09-2015
Subjects:
Adolescent
Adult
Adult Survivors of Child Abuse - psychology
Adult Survivors of Child Abuse - statistics & numerical data
Adult Survivors of Child Adverse Events - psychology
Adult Survivors of Child Adverse Events - statistics & numerical data
Aged
Cost of Illness
England - epidemiology
Female
Health Surveys
Humans
Male
Middle Aged
Mortality
Proportional Hazards Models
Risk Factors
Surveys and Questionnaires
Wider Determinants
Young Adult
England
morbidity and mortality
children
chronic disease
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Summary:ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England. A nationally representative survey was undertaken (n = 3885, aged 18-69, April-July 2013). Socio-demographically controlled proportional hazards analyses examined the associations between the number of ACE categories (<18 years; e.g. child abuse and family dysfunction such as domestic violence) and cancer, diabetes, stroke, respiratory, liver/digestive and cardiovascular disease. Sibling (n = 6983) mortality was similarly analysed as a measure of premature mortality. Of the total, 46.4% of respondents reported ≥1 and 8.3% ≥4 ACEs. Disease development was strongly associated with increased ACEs (e.g. hazard ratios, HR, 0 versus ≥4 ACEs; cancer, 2.38 (1.48-3.83); diabetes, 2.99 (1.90-4.72); stroke, 5.79 (2.43-13.80, all P < 0.001). Individuals with ≥4 ACEs (versus no ACEs) had a 2.76 times higher rate of developing any disease before age 70 years. Adjusted HR for mortality was strongly linked to ACEs (≥4 versus 0 ACEs; HR, 1.97 (1.39-2.79), P < 0.001). Radically different life-course trajectories are associated with exposure to increased ACEs. Interventions to prevent ACEs are available but rarely implemented at scale. Treating the resulting health costs across the life course is unsustainable.
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ISSN:1741-3842
1741-3850
DOI:10.1093/pubmed/fdu065