Table 1.
Summary of included studies
| Region | Country | Study type | Population | Sample size (n) | Age range (years) | ACEs measured (n) |
ACE prevalence |
Outcomes |
Quality assessment |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | 1 | ≥2 | Sampling* | Bias† | ACE‡ | Response§ | Decliners¶ | Participants‖ | Analysis** | |||||||||
| Anda et al (2006)17 | NAm | USA | C | HMO | 17 337 | ≥19 | 8 | 36% | 26% | 38% | ABCDEF | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Bellis et al (2014)18 | Eur | UK | CS | General | 1500 | 18–70 | 11 | 53% | 19% | 28% | ABCDJ | 1 | 0 | 1 | 1 | 0 | 1 | 1 |
| Bellis et al (2014)19 | Eur | Various | CS | Students | 10 696 | 18–25 | 10 | 47% | 25% | 28% | ABC | 0 | 0 | 1 | 1 | 0 | 1 | 1 |
| Björkenstam et al (2017)20 | Eur | Sweden | C | General | 478 141 | 24–28 | 8 | 69% | 22% | 10% | F | 1 | 0 | 1 | NA | NA | 1 | 1 |
| Cunningham et al (2014)21 | NAm | USA | CS | General | 45 561 | ≥18 | 8 | 37% | 23% | 40% | J | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| Dahl et al (2017)22 | Eur | Denmark | C | General | 978 647 | 19–34 | 9 | 48% | 34% | 18% | F | 1 | 0 | 1 | NA | NA | 0 | 0 |
| Dong et al (2004)23 | NAm | USA | C | HMO | 17 337 | ≥19 | 10 | 36% | 26% | 38% | H | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Downey et al (2017)24 | NAm | USA | CS | General | 6361 | ≥18 | 8 | 46% | 23% | 31% | ACDFGHIJ | 1 | 1 | 1 | 0 | 0 | 1 | 1 |
| Felitti et al (1998)25 | NAm | USA | C | HMO | 8506 | 19–92 | 7 | 48% | 25% | 27% | GIJ | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Ford et al (2011)26 | NAm | USA | CS | General | 25 809 | ≥18 | 8 | 41% | 22% | 37% | C | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| Ford et al (2016)27 | Eur | UK | CS | General | 5454 | 18–69 | 9 | 56% | 18% | 26% | ABCDGHIJ | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| Friedman et al (2015)28 | NAm | USA | C | General | 3996 | 30–84 | 27†† | 52% | 28% | 20% | DHI | 1 | 0 | 0 | 0 | 0 | 1 | 0 |
| Hughes et al (2018)29 | Eur | UK | CS | General | 2497 | 18–69 | 11 | 50% | 19% | 31% | EF | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| Kelly-Irving et al (2013)30 | Eur | UK | C | General | 6138 | 50 | 6 | 75% | 20% | 6% | G | 1 | 0 | 1 | 1 | 0 | 1 | 1 |
| McCrory et al (2015)31 | Eur | Ireland | CS | General | 6408 | ≥50 | 4 | 66% | 26% | 8% | GHIJ | 1 | 0 | 1 | 1 | 1 | 1 | 1 |
| Poole et al (2017)32 | NAm | Canada | CS | Primary care | 4006 | 18–92 | 10 | 31% | 24% | 46% | F | 0 | 0 | 1 | 0 | 0 | 1 | 1 |
| Wade et al (2016)33 | NAm | USA | CS | General | 1784 | ≥18 | 9‡‡ | 33% | 21% | 47% | CDFHIJ | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Wainwright et al (2007)34 | Eur | UK | C | Primary care | 20 888 | 41–80 | 8 | 51% | 30% | 19% | J | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| Warne et al (2017)35 | NAm | USA | CS | General | 7594 | ≥18 | 10 | 48% | 23% | 29% | ACEF | 1 | 0 | 1 | 0 | 0 | 1 | 0 |
| Ye and Reyes-Salvail (2014)36 | NAm | USA | CS | General | 5928 | ≥18 | 8 | 42% | 22% | 36% | ACEFHIJ | 1 | 1 | 1 | 1 | 0 | 1 | 0 |
| Bellis et al (2014)3 | Eur | UK | CS | General | 3885 | 18–69 | 9 | 52% | 23% | 25% | ABC | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| Campbell et al (2016)4 | NAm | USA | CS | General | 48 526 | ≥18 | 11 | 45% | 21% | 34% | ACDFHI | 1 | 1 | 1 | 0 | 0 | 1 | 1 |
| Bellis et al (2015)5 | Eur | UK | CS | General | 3885 | 18–69 | 9 | 54% | 23% | 24% | GHIJ | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
Outcomes: A indicates harmful alcohol use, B indicates illicit drug use, C indicates smoking, D indicates obesity, E indicates anxiety, F indicates depression, G indicates cancer, H indicates cardiovascular disease, I indicates diabetes, and J indicates respiratory disease. Quality assessment: 1 indicates the study met the criteria and 0 indicates the study did not meet the criteria, or this element was not reported. ACE=Adverse childhood experience. C=cohort study. CS=cross-sectional study. Eur=Europe. HMO=health maintenance organisation. NAm=north America. NA=not applicable.
Study used a nationally representative or whole population sample.
Sample was not considered to have additional bias beyond that common to retrospective ACE studies.
Validated or well described ACE measurement tool used.
Response rate of at least 50%; however, methods of calculating response rates varied between studies, so rating is based on available data.
Information was provided on individuals who chose not to participate in the study.
A demographic description of sample was provided.
Analysis controlled for key demographics, including a socioeconomic measure.
Of all possible adverse events, only those occurring before age 18 years were included.
Study measured an additional five ACEs, but relevant analyses were restricted to nine ACEs.