Reviewgold2024

The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis

Dhaneesha Navin Sannasgala Senaratne · Bhushan Thakkar · Blair Hamilton Smith · Tim G. Hales · Louise Marryat · Lesley Colvin

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Child Abuse and Trauma Child Welfare and Adoption Chronic Disease Management Strategies

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Abstract Background Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity. Methods We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose–response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528). Results From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose–response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity ( p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies ( I 2 = 76.9%, Cochran Q = 102, p < 0.001). Conclusions This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.

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References

1998Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults 1990Child abuse: Adolescent records vs. adult recall 2003Development and validation of a brief screening version of the Childhood Trauma Questionnaire 2019How to perform a meta-analysis with R: a practical tutorial 2017The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis 1992Methods for Trend Estimation from Summarized Dose-Response Data, with Applications to Meta-Analysis 2016The effects of childhood maltreatment on brain structure, function and connectivity 2019Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis

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