Quantifying the health and financial burden of adverse childhood experiences in Wales, England and English regions in 2023: a pooled analysis of 10 population surveys.

چکیده اصلی

OBJECTIVES: To update estimates of the health and financial burden of adverse childhood experiences (ACEs) in England and Wales and generate estimates for English regions. DESIGN: Population attributable fractions (PAFs) for ACEs were calculated for risks and causes of ill-health using data from 10 randomly stratified cross-sectional ACE studies. PAFs were applied to disability-adjusted life years (DALYs) for England, Wales and English regions for 2023, with financial costs estimated using UK statistical life year values (societal willingness to pay). SETTING: Households in England and Wales. PARTICIPANTS: 28 449 residents aged ≥18 years. OUTCOME MEASURES: PAFs for ACE exposure categories (1 ACE, 2-3 ACEs and ≥4 ACEs) for four health risks (smoking, high alcohol use, drug use and high body mass index (BMI)) and seven causes of ill health (violence, mental illness, cancer, type 2 diabetes, heart disease, respiratory disease and stroke). Annual estimated DALYs and financial costs attributable to ACEs. RESULTS: Relative risks for all outcomes increased with ACEs, with risk ratios for ≥4 ACEs ranging from 1.063 (95% CI 1.000 to 1.129, p=0.048) for high BMI to 9.147 (95% CI 7.062 to 11.847, p<0.001) for drug use. For health risks, PAFs for ACEs were highest for drug use (Wales 60.3% and England 56.7%), while ACE-attributable costs were highest for smoking (Wales £1.8 billion and England £22.7 billion). For causes of ill health, PAFs for ACEs were highest for violence (Wales 49.2% and England 46.2%), and costs were highest for mental illness (Wales £1.8 billion and England £37.8 billion). Across all outcomes (accounting for duplication by excluding DALYs for causes linked to the four health risks), total ACE-attributable costs were £7.8 billion for Wales and £115.6 billion for England; costs for English regions ranged from £6.3 billion (North East England) to £18.0 billion (South East England). CONCLUSIONS: Findings highlight the substantial financial burden of ACEs across England and Wales and provide important information to inform regional activity. There is an urgent and economically justified need for action to prevent ACEs and support those affected by them to reduce the health and economic burden of poor-quality childhoods.

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