Association of Childhood Adversity With Morbidity and Mortality in US Adults

Abstract

IMPORTANCE Childhood adversity (CA) is a powerful determinant of long-term physical and mental health that is associated with elevated risk for chronic disease and psychopathology. However, the degree to which CA contributes to mortality as a preventable driver of ill-health and death is unknown.OBJECTIVE To estimate the contribution of CA to health behaviors, including smoking and sedentary behavior, as well as the annual mortality attributable to CA in the US through influences on leading causes of death (eg, cardiovascular disease).EVIDENCE REVIEW For this systematic review, the PsycINFO and MEDLINE databases were searched on November 15, 2019. The databases were searched for publications from inception (1806 for PsycINFO, 1946 for MEDLINE) to November 15, 2019. Meta-analyses of the associations between CA and morbidity outcomes were included. The population attributable fraction (PAF) was calculated from these associations along with the estimated US prevalence of CA. The PAF was then applied to the number of annual deaths associated with each cause of death to estimate the number of deaths that are attributable to CA. Additionally, the PAF was applied to the incidence of health behaviors to derive the number of cases attributable to CA. Exposure to 1 or more experiences of adversity before the age of 18 years was analyzed, including abuse, neglect, family violence, and economic adversity.FINDINGS A total of 19 meta-analyses with 20 654 832 participants were reviewed. Childhood adversity accounted for approximately 439 072 deaths annually in the US, or 15% of the total US mortality in 2019 (2 854 838 deaths), through associations with leading causes of death (including heart disease, cancer, and suicide). In addition, CA was associated with millions of cases of unhealthy behaviors and disease markers, including more than 22 million cases of sexually transmitted infections, 21 million cases of illicit drug use, 19 million cases of elevated inflammation, and more than 10 million cases each of smoking and physical inactivity. The greatest proportion of outcomes attributable to CA were for suicide attempts and sexually transmitted infections, for which adversity accounted for up to 38% and 33%, respectively. CONCLUSIONS AND RELEVANCEThe results of this systematic review suggest that CA is a leading contributor to morbidity and mortality in the US and may be considered a preventable determinant of mortality. The prevention of CA and the intervention on pathways that link these experiences to elevated disease risk should be considered a critical public health priority.

Measuring early life adversity: A dimensional approach

“…Experiences of childhood adversity are common and strongly associated with elevated risk for long-term negative health outcomes, including poor physical health, early mortality, and a wide range of mental health problems, observed even in mid to late life (Dong et al, 2004;Felitti et al, 1998;Grummitt et al, 2021;Rich-Edwards et al, 2012). Findings from observational studies have been supported by randomized control trials that manipulate early environmental experience, documenting causal effects of adversity experiences on mental health, as well as numerous aspects of brain and behavioral development (Humphreys et al, 2015;Muennig et al, 2009;Sheridan et al, 2010;Sheridan et al, 2018).…”

Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting

“…Future studies would benefit from utilizing other informants and objective measures of child behavior. Second, although the inclusion of multiple domains of stressors, using two fairly distinct measures of exposures, is a strength—and adverse exposure counts are increasingly found to be strong predictors of health ( 112 )—our measures did not consider the frequency or severity of the events, or the perceived experiences of distress from these stress exposures—all of which can contribute to the intergenerational effects of toxic stress on child functioning. Third, women retrospectively reported on pSLE when their children were ~8 years old.…”

Systematic Review and Meta-Analysis of the Effect of Adverse Childhood Experiences (ACEs) on Brain-Derived Neurotrophic Factor (BDNF) Levels

“…ACEs are a major contributing factor to early mortality, and exposure to even a single ACE has been found to increase risk of chronic diseases, such as heart, lung, and liver disease, in addition to cancer, type 2 diabetes, obesity, and psychiatric disorders (Deighton, Neville, Pusch, & Dobson, 2018; Godoy et al, 2021; Grummitt et al, 2021), but how ACE exposure directly perturbs diverse physiological systems remains poorly defined (Deighton et al, 2018; Kalmakis & Chandler, 2015; Petruccelli, Davis, & Berman, 2019). ACE-associated increases in inflammatory markers, including C-reactive protein (CRP), Tumor Necrosis Factor-α (TNF-α), and Interleukin-6 (IL-6), have been observed to partially mediate subsequent development of obesity and other chronic conditions (Kylie S Dempster, O’Leary, MacNeil, Hodges, & Wade, 2020).…”