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research
The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis
Authors
Carlos Abanto
Adamu Addissie
+118 more
Oluwadamilola Adebayo
Yerzhan Adilbekov
Bibigul Adilbekova
Temitope Ajagbe
Zauresh Akhmetzhanova
Rufus O Akinyemi
Albert Akpalu
Sebastián Ameriso
Silva Andonova
Paulo Andrade Lotufo
Thierry Armel
Moiz Bakhiet
Miguel Barboza
Hamidon Basri
Philip Bath
Richard Beare
Olamide Bello
Dániel Bereczki
Simone Beretta
Aaron Berkowitz
Antonio Bernabé-Ortiz
Julie Bernhardt
Guna Berzina
Mher Bisharyan
Pascal Bovet
Michael Brainin
Hrvoje Budincevic
Dominique Cadilhac
Valeria Caso
Christopher Chen
Jerome Chin
Kamil Chwojnicki
Adriana Conforto
Marco D'Amelio
Kristine Danielyan
Stephen Davis
Vida Demarin
Robert Dempsey
Adoukonou Diana Aguiar de Sousa
Martin Dichigans
Klara Dokova
Geoffrey Donnan
Mitchell S Elkind
Foloruso Emmanuel Awoniyi
Matthias Endres
Valery L Feigin
Semaw Ferede Abera
Urs Fischer
Seana L Gall
Fortuné Gankpé
Andrés Gaye Saavedra
Artyom Gil
Maurice Giroud
Elena Gnedovskaya
Vladimir Hachinski
Melanie Hafdi
Randah Hamadeh
Graeme Hankey
Mirjam Heldner
Etedal Ahmed Ibrahim
Norlinah Mohamed Ibrahim
Kamarul Imran Musa
Manabu Inoue
Marie Ishida
Sungju Jee
Jiann-Shing Jeng
Walter D Johnson
Yogesh Kalkonde
Saltanat Kamenova
Zhe Kang Law
Bartosz Karaszewski
Peter Kelly
Taskeen Khan
Stefan Kiechl
T Kolapo Kolapo Hamzat
Aida Kondybayeva
Michael Kravchenko
Rita V Krishnamurthi
Jera Kruja
Janika Kõrv
Mongkol Lakkhanaloet
Peter Langhorne
Pablo M Lavados
Abisola Lawal
Maria Lazo-Porras
Dmytro Lebedynets
Tsong-Hai Lee
Thomas Leung
David S Liebeskind
Patrice Lindsay
Patricio López-Jaramillo
Julia Machline-Carrion
Ajay Mahal
Akintomiwa Makanjuola
Hugh Stephen Markus
Juan Manuel Marquez-Romerom
Sheila Martins
Marco Medina
Sabina Medukhanova
Man Mohan Mehndiratta
Alexandr Merkin
Robert Mikulik
Erkin Mirrakhimov
Stephanie Mohl
Miguel Moscoso-Porras
Sean Murphy
Annabel Müller-Stierlin
Bo Norrving
Amos Olufemi Adeleye
Mayowa O Owolabi
Jeyaraj Pandian
Hoang T Phan
Thanh G Phan
Greg Roth
Vitor Tedim Cruz
Amanda G Thrift
Joseph Yaria
Jhon Álvarez Ahlgren
Publication date
1 January 2017
Publisher
'Elsevier BV'
Doi
Cite
Abstract
Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens
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