Health Care Utilization, Productivity Losses, and Burden of Adverse Childhood Experiences in Singapore: Findings From a National Survey

Objective: There is poor understanding on health care utilization, productivity losses, and burden of adverse childhood experiences (ACEs) in multiethnic Asian populations. Part of this research gap stems from the limited epidemiological data on neglect, emotional abuse, bullying, and dysfunctional home environments. This study estimated health care utilization, productivity losses, and burden of ACEs (at least one exposure and multiple exposures) in Singapore. Method: A total of 4,441 adult residents were recruited via door-to-door surveys in a nationally representative study in Singapore. All participants were assessed for ACEs, health care utilization, productivity losses, chronic physical disorders, and mental disorders on structured interviews. Approximation formulas were applied to calculate the estimated cost of ACEs in Singapore. Results: ACEs were prevalent (63.9%) in the Singapore population. Individuals exposed to >= 3 ACEs (13.1%) utilized more direct medical care (e.g., primary care doctor and accident and emergency visits) and experienced greater productivity losses than those without ACEs (36.1%). The adjusted excess costs associated with ACEs per person were estimated to be S$767.40 (at least one ACE; 63.9%) and S$2167.84 (>= 3 ACEs; 13.1%). The adjusted incremental costs of ACEs in the Singapore population were estimated to be S$1.18 billion (at least one ACE) and S$680 million (>= 3 ACEs) per year. Conclusions: The health and economic burden of ACEs is substantial in Singapore. Our results highlight the importance of investing in novel, population-based ACEs interventions, and the potential return on investment through preventive care and alleviation of the health care burden. Clinical Impact Statement This epidemiological study found that adverse childhood experiences (ACEs) are prevalent and associated with significant health and economic burden in Singapore. Understudied ACEs in Asia, such as emotional adversities (e.g., emotional abuse and neglect) and parental separation/death were prevalent and contributed to the high costs. While these ACEs do not inflict physical injuries, they have pernicious health consequences. Novel assessment tools and interventions are required to accurately identify and effectively treat these types of ACEs. Investment in strategic research that support these endeavors is likely to yield favorable returns on investment through preventive care and alleviation of the health care burden.