Association between adverse childhood experiences and mortality: A systematic review and meta-analysis

Adverse childhood experiences represent a critical public health concern that warrants urgent attention and cannot be overlooked. The evidence regarding the relationship between adverse childhood experiences and mortality has been insufficient and inconsistent. To address this gap, we conducted a systematic review and meta-analysis to explore the association between adverse childhood experiences, including their subtypes, and various mortality outcomes. We systematically searched PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 9 March 2024. Ultimately, 49 studies were included. Among them, 46 studies involving 24,276,424 participants investigated the association between adverse childhood experiences and mortality. The results showed adverse childhood experiences were significantly associated with overall mortality (OR, 1.64; 95% CI, 1.51 to 1.78; P < 0.001), external cause mortality (OR, 1.91; 95% CI, 1.7 to 2.15; P < 0.001), and internal cause mortality (OR, 1.3; 95% CI, 1.17 to 1.44; P < 0.001). Among women and men, the effect sizes were 1.39 (95 %CI, 1.25 to 1.54; P < 0.001) and 1.4 (95 %CI, 1.22 to 1.6; P < 0.001), respectively. Increased mortality risk was also observed for those exposed to maltreatment (OR, 1.95; 95 %CI, 1.65 to 2.3; P < 0.001), household dysfunction (OR, 1.36; 95 %CI, 1.22 to 1.51; P < 0.001), low socioeconomic status (OR, 1.25; 95 %CI, 1.09 to 1.43; P = 0.002), or out-of-home care (OR, 2.87; 95 %CI, 2.12 to 3.9; P < 0.001). Gender differences were not statistically significant, except for minor variations within the low socioeconomic status. This study underscores the profound impact of adverse childhood experiences on mortality risk, highlighting the need for targeted public health interventions and policies.