Which Adverse Childhood Experiences Increase Premature Death Risk?

Living in poverty, separation from a parent, and parental harshness or neglect are all key adverse childhood experiences (ACEs) that lead to an increased risk for premature death in adulthood, according to new data from the National Institutes of Health and Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The study of nearly 46,000 people found that living in poverty is linked to a 41 percent increased risk for premature death in adulthood. And for every ACE an individual experiences, that risk for premature death compounds, the researchers said.

Adverse childhood experiences “are potentially traumatic events that occur in childhood (0-17 years),” according to the Centers for Disease Control and Prevention. Examples of ACEs include experiences of abuse or neglect, witnessing domestic or community violence, or growing up in a household with substance use or untreated or unstable mental health problems.

ACEs are important social determinants of health (SDOH) that ultimately impact patient health, this latest NIH data shows.

"Our findings and those of previous studies on childhood adverse experiences highlight the need to reduce children's exposure to the types of adversities that many face today, including poverty, poor housing conditions and parental separation,” Jing Yu, PhD, a research fellow in the NICHD Social and Behavioral Sciences Branch who worked on the study, stated publicly.

"These experiences can affect brain development, social and emotional well-being, behavioral development and, as our results suggest, can reduce life expectancy,” Yu continued.

The researchers used data about the offspring of mothers in the NIH’s Collaborative Perinatal Project. Those offspring were born between 1959 and 1966. The researchers then compared death records from between 1979 and 2016 with information about ACEs in the offsprings’ first seven years of life and classified kids into five categories.

Around half (48 percent) of kids went into the low-adversity category, meaning they were unlikely to have experienced any significant ACEs. Four percent fell into the parental harshness or neglect category, 9 percent into the family instability category, 21 percent into the poverty and crowded housing category, and 19 percent into the poverty and parental separation category.

Kids in the poverty and crowded housing category faced a 41 percent higher risk for premature death than kids who were in the low-risk category, the researchers found. Meanwhile, kids in the poverty combined with separation from a parent category were at a 50 percent increased risk for premature death.

Those in the parental harshness and neglect category saw a 16 percent higher risk for premature death, while those who experienced family instability had a 28 percent higher risk.

And these ACEs can compound, the researchers said. Children included in the study could fall into multiple categories (for example, poverty combined with housing instability plus parental harshness and neglect). And when that happened, their risk for premature death increased even further.

Kids who experienced two ACEs had a 27 percent higher risk of early death. For three ACEs, that figure was 29 percent, and for four, it was 45 percent.

The researchers said understanding how and which ACEs impact health outcomes will be key to addressing ACEs upstream.

"Understanding how patterns of early childhood adversity are associated with shortened life expectancy helps us better understand the toll of early experiences on human health and the extent that this toll carries over from childhood through adulthood," the study's senior author, Stephen E. Gilman, ScD, chief of the Social and Behavioral Sciences Branch at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), said in the press release.

Just as healthcare has zeroed in on targeting factors like access to transportation and nutritious food as social determinants of health, the industry must also prioritize interventions that can help mitigate the impacts ACEs have on health and wellness into adulthood.

"In the long run, we hope that results such as ours can inform efforts to develop better interventions that would both reduce exposure to childhood adversity and reduce the health consequences of early adversity among exposed children,” Gilman stated.