Systematic review of the costs of adverse childhood experiences (ACEs): presenting the evidence on odds ratios and costs.

Background: Adverse childhood experiences (ACEs) are known to cause an array of diseases later in the life course [1]. However, there have been to date no studies that explicitly look at the costs of ACEs to society. Insofar as ACEs have an association with such diseases as cancer it is considered a worthwhile exercise to attempt to put a financial cost on these diseases and to calculate how much of this cost is attributable to ACEs. This is to make the case for investing in early years and linking services across sectors e.g. health, social care, crime and justice etc. so that the balance of spending is shifted towards prevention. Such information is useful for evidence-based policy making.MethodsThis systematic review follows the design, methods and processes of the Campbell and Cochrane Economics Method Group (CCEMG) [2]. The JSTOR, PubMed, Web of Science, Medline, Embase and PsycInfo electronic databases were extensively searched with relevant search terms. ResultsThe review is divided into two parts, the first part looking at odds ratios of the five disease types that link ACEs with these diseases. We then calculate the likelihood of how much of a particular disease is caused by certain ACEs and present these in tables. The second part of the review looks at cost of illness studies for the five highest expenditure disease types in the UK. These are Mental Disorders, Circulatory disorders, cancer, muscoskeletal disorders and genitourinary disorders. The results are presented in a tabular format by taking costs of illness from different studies and presenting them all, converted to GBP and 2020 figures, in an accessible format. The most striking figure in the odds ratios part is the relationship between sexual abuse and psychosis at 15.47 signifying a strong relationship and a suggestion that interventions to reduce psychosis might well benefit from concentrating on tackling sexual abuse. In terms of cost, we see that the lowest costs are those that do not consider indirect costs and only report direct medical expenditure. ConclusionThe information gathered here will serve as the basis to look at the relationship between cost of illness and adverse childhood experiences. The results of this paper will be useful to those who wish to use the odds ratios (after converting into relative risk ratios) to calculate population attributable fractions associated with each ACE so that they are able to calculate the percentage of each disease that is caused by certain ACEs. This percentage can then be applied to the costs gleaned from part 2 of this review to arrive at a cost that can be attributed to certain ACEs.