Abstract
BackgroundACE (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.MethodsA 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.ResultsOf 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).ConclusionsRadically 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.
Highlights
Ethnicity was associated with adverse childhood experiences (ACEs) count, with Asian ethnicity associated with lowest ACE counts primarily through lower parental separation rates (Table 1)
There were no significant differences between birth cohort in levels of verbal, physical and sexual abuse experienced as children, greater levels of parental separation, incarceration and household drug and alcohol abuse were reported by those born in 1969 or later
ACE counts were positively associated with deprivation (Table 1) and, like other studies,[29,30,31] deprivation was associated with premature mortality (Table 3)
Summary
Health strategies are increasingly recognizing the link between early childhood experiences and health outcomes across the life course.[1,2] The importance of early life experiences is so pronounced that in Europe, the World Health Organization’s (WHO) review of social determinants and health states that ‘The highest priority is for countries to ensure a good start to life for every child’.3 Poor quality childhoods are often associated with societal level factors such as deprivation and inequities.[4,5,6,7] there is increasing evidence that specific childhood experiences increase the risk of individuals adopting health-harming behaviours and developing chronic ill health in later life.[8,9,10] A well-defined set of adverse childhood experiences (ACEs) linked to poorM.A. Poor quality childhoods are often associated with societal level factors such as deprivation and inequities.[4,5,6,7] there is increasing evidence that specific childhood experiences increase the risk of individuals adopting health-harming behaviours and developing chronic ill health in later life.[8,9,10] A well-defined set of adverse childhood experiences (ACEs) linked to poor. Results 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.
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