Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis.
Lancet Public Health
; 6(11): e848-e857, 2021 11.
Article
in English
| MEDLINE | ID: covidwho-1488025
ABSTRACT
BACKGROUND:
Adverse childhood experiences (ACEs) are associated with increased health risks across the life course. We aimed to estimate the annual health and financial burden of ACEs for 28 European countries.METHODS:
In this systematic review and meta-analysis, we searched MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and Education Resources Information Center for quantitative studies (published Jan 1, 1990, to Sept 8, 2020) that reported prevalence of ACEs and risks of health outcomes associated with ACEs. Pooled relative risks were calculated for associations between ACEs and harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular disease, stroke, and respiratory disease. Country-level ACE prevalence was calculated using available data. Country-level population attributable fractions (PAFs) due to ACEs were generated and applied to 2019 estimates of disability-adjusted life-years. Financial costs (US$ in 2019) were estimated using an adapted human capital approach.FINDINGS:
In most countries, interpersonal violence had the largest PAFs due to ACEs (range 14·7-53·5%), followed by harmful alcohol use (15·7-45·0%), illicit drug use (15·2-44·9%), and anxiety (13·9%-44·8%). Harmful alcohol use, smoking, and cancer had the highest ACE-attributable costs in many countries. Total ACE-attributable costs ranged from $0·1 billion (Montenegro) to $129·4 billion (Germany) and were equivalent to between 1·1% (Sweden and Turkey) and 6·0% (Ukraine) of nations' gross domestic products.INTERPRETATION:
Availability of ACE data varies widely between countries and country-level estimates cannot be directly compared. However, findings suggest ACEs are associated with major health and financial costs across European countries. The cost of not investing to prevent ACEs must be recognised, particularly as countries look to recover from the COVID-19 pandemic, which interrupted services and education, and potentially increased risk factors for ACEs.FUNDING:
WHO Regional Office for Europe.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Health Care Costs
/
Adverse Childhood Experiences
Type of study:
Observational study
/
Prognostic study
/
Qualitative research
/
Reviews
/
Systematic review/Meta Analysis
Limits:
Humans
Country/Region as subject:
Europa
Language:
English
Journal:
Lancet Public Health
Year:
2021
Document Type:
Article
Affiliation country:
S2468-2667(21)00232-2
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