Abstract

We present findings from a study to estimate the economic costs of adverse childhood experiences (ACEs, e.g. child abuse, neglect, exposure to domestic violence). By utilising international literature on the prevalence of ACEs and their association with increased risk of major health conditions we calculate ACE-attributable fractions for major health conditions and convert these into financial costs for countries using a DALY/GDP based model.

Following our recent systematic review and meta-analysis on the health consequences of multiple ACEs, we expanded search criteria to allow calculations of relative risks of key health conditions (e.g. cardiovascular disease, diabetes, mental health disorders, cancers) in adulthood associated with exposure to no, one and two or more ACEs. Searches have retrieved over 3 800 unique studies of which more than 800 have been reviewed to identify data for inclusion in the analysis. From studies that meet the criteria, the most reliable estimates have been extracted for prevalence and health outcome risk estimates. We developed a model to calculate proportionate attributable fractions for each outcome based on retrieved estimates and subsequently estimate the DALYs lost. We use established health economics methods to convert DALYs into annual financial costs to countries.

Results of the systematic review and attributable fractions for major health conditions identify that substantive proportions of each major non-communicable disease and other health condition are related to exposure to ACEs in childhood. Such relationships are consistent across a number of countries and suggest high financial costs to countries resulting from a legacy of ACEs. There is a strong and cost effective case for policy changes that invest more in safe and nurturing childhoods in order to reduce long term ill health and overall costs to the public purse.