Hospitalisation patterns among children exposed to childhood adversity: a population-based cohort study of half a million children.

Published on Nov 1, 2021in The Lancet. Public health21.648
· DOI :10.1016/S2468-2667(21)00158-4
Naja Hulvej Rod28
Estimated H-index: 28
(UCPH: University of Copenhagen),
Jessica Bengtsson3
Estimated H-index: 3
(UCPH: University of Copenhagen)
+ 2 AuthorsAndreas Rieckmann7
Estimated H-index: 7
(UCPH: University of Copenhagen)
Sources
Abstract
Summary null Background null Children who are exposed to adversities might be more susceptible to disease development during childhood and in later life due to impaired physiological and mental development. To explore this hypothesis, we assessed hospitalisation patterns through childhood and into adult life among those exposed to different trajectories of adversities during childhood. null Methods null For this population-based cohort study, we used annually updated data from Danish nationwide registers covering more than half a million children (aged 0–15 years) born between 1994 and 2001. Children who were alive and resident in Denmark on their 16th birthday were included in the analysis. Cluster analysis was used to divide children into five distinct trajectories according to their experience of childhood adversities, including poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics. To describe comprehensively the disease patterns experienced by these groups of children, we assessed the associations of each adversity trajectory with hospital admission patterns according to the entire spectrum of disease diagnoses in the International Classification of Diseases 10th edition, from birth to 24 years of age, using survival models. null Findings null 508 168 children born between Jan 1, 1994, and Dec 31, 2001, were followed up until Dec 31, 2018, capturing more than 3·8 million hospital admissions from birth to early adulthood. Hospitalisation rates were consistently higher in all four adversity groups compared with the low adversity group. The high adversity group (14 577 children, 3%), who were exposed to adversities of deprivation, family loss, and negative family dynamics, had a markedly higher rate of hospitalisations across all ages. For example, we observed 243 additional hospital admissions per 1000 person-years (95% CI 238–248) in the high versus low adversity group for those aged 16–24 years. These associations were particularly strong for diagnoses related to injuries, unspecified symptoms, and factors influencing health service contacts (eg, health screening and observation). They also covered a considerable burden of respiratory and infectious diseases, congenital malformations, diseases of the nervous system (especially in early life), mental and behavioural diagnoses, and diagnoses related to pregnancy and childbirth in early adult life. null Interpretation null The close linkage between childhood adversities and poor lifelong health outcomes highlights a need for public health and policy attention on improving the socioeconomic circumstances children are born into to prevent the early emergence of health inequalities. null Funding null None.
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References29
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#1Fabienne El-Khoury (University of Paris)H-Index: 6
#2Andreas Rieckmann (UCPH: University of Copenhagen)H-Index: 7
Last. Naja Hulvej Rod (UCPH: University of Copenhagen)H-Index: 28
view all 5 authors...
Abstract We examine the association between trajectories of childhood adversities and Post-Traumatic Stress Disorder (PTSD) using a register-based Danish cohort. The DANish LIFE Course (DANLIFE) cohort includes and prospectively follows all individuals born in Denmark from 1980. We estimated the rate of PTSD diagnosed from age 16, according to childhood adversity trajectories from age 0 to 16 (n= 1 277 548). Trajectories were previously defined into 5 groups: Low Adversity, Early Life Material D...
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#1Naja Hulvej Rod (UCPH: University of Copenhagen)H-Index: 28
#2Jessica Bengtsson (UCPH: University of Copenhagen)H-Index: 3
Last. Andreas Rieckmann (UCPH: University of Copenhagen)H-Index: 7
view all 8 authors...
Summary Background Childhood is a sensitive period with rapid brain development and physiological growth, and adverse events in childhood might interfere with these processes and have long-lasting effects on health. In this study, we aimed to describe trajectories of adverse childhood experiences and relate these to overall and cause-specific mortality in early adult life. Methods For this population-based cohort study, we used unselected annually updated data from Danish nationwide registers co...
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#1Rebecca E. Lacey (UCL: University College London)H-Index: 14
#2Laura D Howe (UoB: University of Bristol)H-Index: 38
Last. Yvonne Kelly (UCL: University College London)H-Index: 46
view all 5 authors...
Previous research has demonstrated a graded relationship between the number of Adverse Childhood Experiences reported (an ACE score) and child outcomes. However, ACE scores lack specificity and ign...
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#1Arvin Garg (BU: Boston University)H-Index: 20
#2Elena Byhoff (Tufts University)H-Index: 8
Last. Mikayla Gordon Wexler (BU: Boston University)H-Index: 1
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#1Emilie Courtin (Harvard University)H-Index: 14
#2Emily Allchin ('KCL': King's College London)H-Index: 1
Last. Richard Layte (Trinity College, Dublin)H-Index: 45
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Purpose of Review Adverse childhood experiences (ACE) are associated with key risk factors for adult morbidity and mortality. Most interventions to date target proximal risk factors and do not account for the structural determinants shaping the risk of childhood adversity. This review summarizes recent findings regarding the impact of socioeconomic interventions on ACE.
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#1Kaitlyn Petruccelli (Thomas Jefferson University)H-Index: 1
#2Joshua Davis (Penn State Milton S. Hershey Medical Center)H-Index: 13
Last. Tara Berman (Thomas Jefferson University)H-Index: 1
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Abstract Background The Center for Disease Control (CDC) and Kaiser Permanente developed the Adverse Childhood Experiences (ACE) scale to identify negative experiences in childhood. The goal of this study is to systematically review outcomes associated with the ACEs in the CDC-Kaiser ACE scale to understand the diversity of outcomes associated with this scale. Methods The authors conducted a search of English language articles published through September 30, 2016 using OVID Medline®; Ovid Medlin...
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#1Jessica Bengtsson (UCPH: University of Copenhagen)H-Index: 3
#2Nadya Dich (UCPH: University of Copenhagen)H-Index: 10
Last. Naja Hulvej Rod (UCPH: University of Copenhagen)H-Index: 28
view all 4 authors...
Purpose The DANish LIFE course (DANLIFE) cohort is a prospective register-based study set up to investigate the complex life course mechanisms linking childhood adversities to health and well-being in childhood, adolescence and young adulthood including cumulative and synergistic actions and potentially sensitive periods in relation to health outcomes. Participants All children born in Denmark in 1980 or thereafter have successively been included in the cohort totalling more than 2.2 million chi...
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#1Stan Sonu (Emory University)H-Index: 2
#2Sharon PostH-Index: 1
Last. Joe Feinglass (NU: Northwestern University)H-Index: 66
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Abstract This study examined the association of adverse childhood experiences (ACEs) with early-onset chronic conditions. We analyzed data from the 2011–2012 Behavioral Risk Factor Surveillance System (BRFSS), which included 86,968 respondents representing a nine-state adult population of 32 million. ACE questions included physical, emotional, and sexual abuse; substance use, mental illness or incarceration of a household member; domestic violence, and parental separation. Outcomes included chro...
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#1Daniel S. Nagin (CMU: Carnegie Mellon University)H-Index: 106
#2Bobby L. Jones (University of Pittsburgh)H-Index: 25
Last. Richard E. Tremblay (UCD: University College Dublin)H-Index: 134
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Identifying and monitoring multiple disease biomarkers and other clinically important factors affecting the course of a disease, behavior or health status is of great clinical relevance. Yet conventional statistical practice generally falls far short of taking full advantage of the information available in multivariate longitudinal data for tracking the course of the outcome of interest. We demonstrate a method called multi-trajectory modeling that is designed to overcome this limitation. The me...
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