Adverse childhood experiences and premature mortality through mid-adulthood: A five-decade prospective study

Background Adverse childhood experiences (ACEs) can have lasting effects on adult health and survival. In this study, we aimed to examine how the cumulative number and clustering patterns of ACEs were related to premature mortality. Methods Participants (N=46 129; 45% White, 48% Black; 49 cent 5% females) were offspring (born in 1959-1966) of participants enrolled in the Collaborative Perinatal Project (CPP). We conducted latent class analysis to examine the clustering patterns of ACEs assessed between children's birth and age seven. We also calculated the cumulative ACE scores of 13 individual ACEs. Cox regression models were used to examine the associations of ACE clusters and scores with risk of premature mortality from adolescence to mid-adulthood. Findings At the start of the follow-up for mortality in 1979, participants were 12-20 years old (Mean=15 center dot 99 years), and within the 38-year follow-up through 2016, 3 344 deaths were observed among the 46 129 CPP offspring. Five latent classes of ACEs were identified. Compared to children with Low Adversity (48% of the sample), children in Family Instability (9%, HR=1 center dot 28, 95%CI 1 center dot 07-1 center dot 53), Poverty & Crowded Housing (21%, HR=1 center dot 41, 95%CI 1 center dot 24-1 center dot 62), and Poverty & Parental Separation (19%, HR=1 center dot 50, 95%CI 1 center dot 33-1 center dot 68) classes had higher hazards of premature mortality. In addition, children with 2 (HR=1 center dot 27, 95%CI 1 center dot 14-1 center dot 41), 3 (HR=1 cent 29, 95%CI 1 center dot 15-1 center dot 45), and 4+ (HR=1 center dot 45, 95%CI 1 center dot 30-1 center dot 61) ACEs had higher hazards of mortality than those with no ACE. The clusters of Poverty & Crowded Housing (HR=1 center dot 28, 95%CI 1 center dot 10-1 center dot 49) and Poverty & Parental Separation (HR=1 cent 23, 95%CI 1 center dot 02-1 center dot 48) remained associated with higher risk of premature mortality, beyond the cumulative risk of higher number of ACEs (HR=1 center dot 05, 95%CI 1 center dot 01-1 center dot 08). Interpretation About half of the CPP cohort experienced early life adversities that clustered into four distinct patterns, which were associated with different risk of premature mortality. It is important to deepen our understanding of how specific clusters of childhood adversities affect health and premature mortality to better inform approaches to prevention and interventions. Copyright Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/)