Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: A national survey

M. A. Bellis*, K. Hughes, N. Leckenby, K. A. Hardcastle, C. Perkins, H. Lowey

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

175 Citations (Scopus)


Background ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England. Methods A nationally representative survey was undertaken (n = 3885, aged 18-69, April-July 2013). Socio-demographically controlled proportional hazards analyses examined the associations between the number of ACE categories (<18 years; e.g. child abuse and family dysfunction such as domestic violence) and cancer, diabetes, stroke, respiratory, liver/digestive and cardiovascular disease. Sibling (n = 6983) mortality was similarly analysed as a measure of premature mortality. Results Of the total, 46.4% of respondents reported ≥1 and 8.3% ≥4 ACEs. Disease development was strongly associated with increased ACEs (e.g. hazard ratios, HR, 0 versus ≥4 ACEs; cancer, 2.38 (1.48-3.83); diabetes, 2.99 (1.90-4.72); stroke, 5.79 (2.43-13.80, all P < 0.001). Individuals with ≥4 ACEs (versus no ACEs) had a 2.76 times higher rate of developing any disease before age 70 years. Adjusted HR for mortality was strongly linked to ACEs (≥4 versus 0 ACEs; HR, 1.97 (1.39-2.79), P < 0.001). Conclusions Radically different life-course trajectories are associated with exposure to increased ACEs. Interventions to prevent ACEs are available but rarely implemented at scale. Treating the resulting health costs across the life course is unsustainable.

Original languageEnglish
Pages (from-to)445-454
Number of pages10
JournalJournal of Public Health
Issue number3
Publication statusPublished - 1 Sep 2015

Bibliographical note

Publisher Copyright:
© The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health.


  • children
  • chronic disease
  • morbidity and mortality


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