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Meta-Analysis
. 2024 Aug 15;22(1):315.
doi: 10.1186/s12916-024-03505-w.

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

Dhaneesha N S Senaratne  1 , Bhushan Thakkar  2 , Blair H Smith  2 , Tim G Hales  3 , Louise Marryat  4 , Lesley A Colvin  2
Affiliations
Meta-Analysis

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

Dhaneesha N S Senaratne et al. BMC Med. .

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 (I2 = 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.

Keywords: Adverse childhood experiences; Childhood adversity; Chronic disease; Long-term conditions; Multimorbidity.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of selection of studies into the systematic review and meta-analysis. Flow chart of selection of studies into the systematic review and meta-analysis. ACE, adverse childhood experience; MM, multimorbidity; DRMA, dose–response meta-analysis
Fig. 2
Fig. 2
Meta-analysis of prevalence of exposure to ≥ 1 adverse childhood experiences. Meta-analysis of prevalence of exposure to ≥ 1 adverse childhood experience. ACE, adverse childhood experience; CI, confidence interval
Fig. 3
Fig. 3
Meta-analysis of prevalence of multimorbidity. Meta-analysis of prevalence of multimorbidity. CI, confidence interval; LTC, long-term condition; MM, multimorbidity
Fig. 4
Fig. 4
Dose–response meta-analysis of the relationship between adverse childhood experiences and multimorbidity. Dose–response meta-analysis of the relationship between adverse childhood experiences and multimorbidity. Solid black line represents the estimated relationship; dotted black lines represent the 95% confidence intervals for this estimate. ACE, adverse childhood experience
See this image and copyright information in PMC

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