Abstract
Importance: Most studies report associations between adverse childhood experiences (ACEs) and a single health outcome. It is therefore difficult to assess impacts holistically. Examining a broad range of health outcomes may help inform targeting of interventions.
Objective: To quantify the modelled impact of ACEs across several adult health outcomes within a single study (outcome-wide approach).
Design: Secondary analysis (conducted September-October 2024) of a longitudinal birth cohort, The National Child Development Study, using doubly-robust estimation. Risk differences were estimated between pseudo-populations (exposure to ACEs set at 100% v 0%) with adjustment made for confounders (at birth) using inverse probability weights.
Setting: UK population-based cohort, 1958 to 2008.
Participants: 17,638 people born during one week in 1958; 53% participated at age 50.
Exposures: 14 ACEs from data collected through childhood (7, 11, and 16 years) and retrospectively (23, 33, and 44 years).
Main Outcomes and Measures: Eleven outcomes (with prevalence ≥ 5%) self-reported at age 50: severe pain, mental ill-health, asthma/bronchitis, hayfever/rhinitis, back problems, hearing problems, eyesight problems, hypertension, migraine, skin problems, and gastrointestinal problems.
Results: Data for 16,321 participants were analysed: 49.0% female, 98.8% white ethnic group. ACEs were associated with several (but not all) health outcomes. Severe pain and mental ill-health displayed the largest risk differences. In males, the risk of severe pain was 8.7% in the exposed vs 4.9% unexposed (risk difference 3.8; 95% CI 2.2, 5.4)), and that of mental ill-health was 10.5% vs 6.7% (difference 3.9; 95% CI 2.2, 5.6). In females, the risks were 11.2% vs 7.5% (difference 3.7; 85% CI 1.7, 5.7) and 19.1% vs 12.6% (difference 6.5; 95% CI 4.1, 8.9) respectively. Experiencing ≥4 ACEs increased these risks. Migraine, hayfever/rhinitis, eyesight problems, or skin conditions were not related. Abuse, neglect, and family conflict demonstrated the most wide-ranging associations.
Conclusions and Relevance: In this cohort study of ACEs and health conditions at age 50, we confirmed associations between several but not all outcomes. While ‘broad spectrum’ interventions remain important to ameliorate the impact of ACEs, a targeted approach, considering types of ACE, could address specific vulnerabilities – particularly mental ill-health and severe pain.
Objective: To quantify the modelled impact of ACEs across several adult health outcomes within a single study (outcome-wide approach).
Design: Secondary analysis (conducted September-October 2024) of a longitudinal birth cohort, The National Child Development Study, using doubly-robust estimation. Risk differences were estimated between pseudo-populations (exposure to ACEs set at 100% v 0%) with adjustment made for confounders (at birth) using inverse probability weights.
Setting: UK population-based cohort, 1958 to 2008.
Participants: 17,638 people born during one week in 1958; 53% participated at age 50.
Exposures: 14 ACEs from data collected through childhood (7, 11, and 16 years) and retrospectively (23, 33, and 44 years).
Main Outcomes and Measures: Eleven outcomes (with prevalence ≥ 5%) self-reported at age 50: severe pain, mental ill-health, asthma/bronchitis, hayfever/rhinitis, back problems, hearing problems, eyesight problems, hypertension, migraine, skin problems, and gastrointestinal problems.
Results: Data for 16,321 participants were analysed: 49.0% female, 98.8% white ethnic group. ACEs were associated with several (but not all) health outcomes. Severe pain and mental ill-health displayed the largest risk differences. In males, the risk of severe pain was 8.7% in the exposed vs 4.9% unexposed (risk difference 3.8; 95% CI 2.2, 5.4)), and that of mental ill-health was 10.5% vs 6.7% (difference 3.9; 95% CI 2.2, 5.6). In females, the risks were 11.2% vs 7.5% (difference 3.7; 85% CI 1.7, 5.7) and 19.1% vs 12.6% (difference 6.5; 95% CI 4.1, 8.9) respectively. Experiencing ≥4 ACEs increased these risks. Migraine, hayfever/rhinitis, eyesight problems, or skin conditions were not related. Abuse, neglect, and family conflict demonstrated the most wide-ranging associations.
Conclusions and Relevance: In this cohort study of ACEs and health conditions at age 50, we confirmed associations between several but not all outcomes. While ‘broad spectrum’ interventions remain important to ameliorate the impact of ACEs, a targeted approach, considering types of ACE, could address specific vulnerabilities – particularly mental ill-health and severe pain.
| Original language | English |
|---|---|
| Journal | JAMA Network Open |
| DOIs | |
| Publication status | Accepted/In press - 11 Jun 2025 |
Bibliographical note
For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission. This study was only possible due to the commitment and enthusiasm of the NCDS participants: their time and contribution is gratefully acknowledged.We thank Jisha Babu (University of Aberdeen) for her work involved in administration in relation to access to data as part of this programme of work.
Data Availability Statement
Most data from the NCDS is freely available through the UK Data Service (https://ukdataservice.ac.uk). A general analysis plan covering all the cohorts analysed as part of CAPE is available on the OSF: www.osf.io/shdy3. Stata code for the analyses in the final manuscript will be shared on the OSF projects site.Funding
The authors submitted this work on behalf of the Consortium Against Pain inEquality (CAPE) investigators and Chronic Pain Advisory Group (known as the CAPE consortium). The CAPE consortium was part of the Advanced Pain Discovery Platform, which was funded by UKRI, Versus Arthritis, and Eli Lilly. Grant Reference MR/W002566/1. Funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The Economic and Social Research Council funds the Centre for Longitudinal Studies (CLS) Resource Centre (ES/W013142/1) which provides core support for the CLS cohort studies (including the NCDS). While the CLS Resource Centre makes these data available, CLS does not bear any responsibility for the analysis or interpretation of these data by researchers.
| Funders | Funder number |
|---|---|
| UK Research and Innovation | MR/W002566/1, ES/W013142/1 |