title: Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  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. Adjusted HR for mortality was strongly linked to ACEs (≥4 versus 0 ACEs; HR, 1.97 (1.39-2.79), P < 0.001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK Public Health Wales, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Bellis
authors.affiliation: Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors.forename: K
authors.initials: K
authors.lastname: Hughes
authors.affiliation: Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors.forename: N
authors.initials: N
authors.lastname: Leckenby
authors.affiliation: Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors.forename: K A
authors.initials: KA
authors.lastname: Hardcastle
authors.affiliation: Knowledge and Intelligence Team (North West), Public Health England, 15-21 Webster Street, Liverpool L3 2ET, UK.
authors.forename: C
authors.initials: C
authors.lastname: Perkins
authors.affiliation: Blackburn with Darwin Borough Council, Specialist Public Health Directorate, 10 Duke Street, Blackburn BB2 1DH, UK.
authors.forename: H
authors.initials: H
authors.lastname: Lowey
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology / Q000706:statistics & numerical data*; D000368:Aged; D017281:Cost of Illness; D004739:England / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: children; chronic disease; morbidity and mortality