Abstract
IMPORTANCE: Most studies have reported associations between adverse childhood experiences (ACEs) and a single health outcome. It is therefore difficult to assess impacts holistically. Examining a broad range of health outcomes may help inform the targeting of interventions. OBJECTIVE: To quantify the modeled association of ACEs with several adult health outcomes within a single study. DESIGN, SETTING, AND PARTICIPANTS: This cohort study using an outcome-wide approach was a secondary analysis of the National Child Development Study, a longitudinal birth cohort of people across the UK born during 1 week in 1958. Data from the follow-up survey at age 50 years were used. The data analysis was conducted between September and October 2024. EXPOSURES: Fourteen ACEs from data collected throughout childhood (age 7, 11, and 16 years) and retrospectively (age 23, 33, and 44 years). MAIN OUTCOMES AND MEASURES: Eleven outcomes (with prevalence ≥5%) self-reported at age 50 years were examined using doubly robust estimation and included severe pain, poor mental health, asthma or bronchitis, hay fever or rhinitis, back problems, hearing problems, eyesight problems, hypertension, migraine, skin problems, and gastrointestinal problems. Risk differences were estimated between pseudopopulations (exposure to ACEs set at 100% vs 0%) with adjustment made for confounders at birth using inverse probability weights. RESULTS: From a total of 17 638 people initially included in the birth cohort, 53% participated at age 50 years. Data for 16 321 participants (51.0% men) were analyzed. Adverse childhood experiences were associated with several health outcomes, with the largest risk differences (comparing exposed vs unexposed pseudopopulations) observed for severe pain and poor mental health. In men, the risk of severe pain was 8.70% vs 4.88%, respectively (risk difference, 3.82%; 95% CI, 2.23%-5.42%), and of poor mental health, 10.53% vs 6.68%, respectively (risk difference, 3.85%; 95% CI, 2.16%-5.85%). In women, the risks were 11.22% vs 7.53% (risk difference, 3.69%; 95% CI, 1.71%-5.67%) and 19.10% vs 12.59% (risk difference, 6.50%; 95% CI, 4.13%-8.88%), respectively. Experiencing 4 or more ACEs increased these risks. Migraine, hay fever or rhinitis, eyesight problems, and skin problems showed no association with ACEs. Abuse, neglect, and family conflict showed the most wide-ranging associations. CONCLUSIONS AND RELEVANCE: In this cohort study of ACEs and health conditions at age 50 years, the findings suggest that while broad-spectrum interventions remain important to ameliorate the influence of ACEs, a targeted approach that considers the types of ACEs may address specific vulnerabilities, particularly poor mental health and severe pain.