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Hughes, K, Ford, K, Kadel, R, Sharp, CA and Bellis, MA (2020) Health and financial burden of adverse childhood experiences in England and Wales: a combined primary data study of five surveys. BMJ Open, 10 (6). ISSN 2044-6055
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Health and financial burden of adverse childhood experiences in England and Wales a combined primary data study of five surv.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. Download (331kB) | Preview |
Abstract
Objective To estimate the health and financial burden of adverse childhood experiences (ACEs) in England and Wales. Design The study combined data from five randomly stratified cross-sectional ACE studies. Population attributable fractions (PAFs) were calculated for major health risks and causes of ill health and applied to disability adjusted life years (DALYs), with financial costs estimated using a modified human capital method. Setting Households in England and Wales. Participants 15 285 residents aged 18-69. Outcome measures The outcome measures were PAFs for single (1 ACE) and multiple (2-3 and ≥4 ACEs) ACE exposure categories for four health risks (smoking, alcohol use, drug use, high body mass index) and nine causes of ill health (cancer, type 2 diabetes, heart disease, respiratory disease, stroke, violence, anxiety, depression, other mental illness); and annual estimated DALYs and financial costs attributable to ACEs. Results Cumulative relationships were found between ACEs and risks of all outcomes. For health risks, PAFs for ACEs were highest for drug use (Wales 58.8%, England 52.6%), although ACE-attributable smoking had the highest estimated costs (England and Wales, £7.8 billion). For causes of ill health, PAFs for ACEs were highest for violence (Wales 48.9%, England 43.4%) and mental illness (ranging from 29.1% for anxiety in England to 49.7% for other mental illness in Wales). The greatest ACE-attributable costs were for mental illness (anxiety, depression and other mental illness; England and Wales, £11.2 billion) and cancer (£7.9 billion). Across all outcomes, the total annual ACE-attributable cost was estimated at £42.8 billion. The majority of costs related to exposures to multiple rather than a single ACE (ranging from 71.9% for high body mass index to 98.3% for cancer). Conclusions ACEs impose a substantial societal burden in England and Wales. Policies and practices that prevent ACEs, build resilience and develop trauma-informed services are needed to reduce burden of disease and avoidable service use and financial costs across health and other sectors.
| Item Type: | Article |
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| Uncontrolled Keywords: | Humans; Obesity; Substance-Related Disorders; Cross-Sectional Studies; Alcohol Drinking; Smoking; Adolescent; Adult; Aged; Middle Aged; Health Care Costs; State Medicine; England; Wales; Female; Male; Young Adult; Surveys and Questionnaires; Adult Survivors of Child Adverse Events; Adverse Childhood Experiences; epidemiology; health economics; public health; Adolescent; Adult; Adult Survivors of Child Adverse Events; Adverse Childhood Experiences; Aged; Alcohol Drinking; Cross-Sectional Studies; England; Female; Health Care Costs; Humans; Male; Middle Aged; Obesity; Smoking; State Medicine; Substance-Related Disorders; Surveys and Questionnaires; Wales; Young Adult; 1103 Clinical Sciences; 1117 Public Health and Health Services; 1199 Other Medical and Health Sciences |
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Divisions: | Public Health Institute |
| Publisher: | BMJ |
| SWORD Depositor: | A Symplectic |
| Date Deposited: | 21 Dec 2022 11:12 |
| Last Modified: | 21 Dec 2022 11:12 |
| DOI or ID number: | 10.1136/bmjopen-2019-036374 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/18465 |
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