Relative and combined contributions of adverse childhood experiences and self-reported child poverty to health and economic outcomes in adults – a retrospective study in a UK region

Background: Adverse childhood experiences (ACEs) and childhood poverty (CP) are linked to long-term harms, including poor health, lower educational attainment, and economic instability. However, few studies have examined their independent and combined effects on life course health and prosperity as well as their contributions to intergenerational cycles of poverty and abuse. This study analyses these associations using a large regional survey in northwest England. Methods: A cross-sectional household survey was conducted across five local authority/administrative areas (November 2023–April 2024) using a stratified quota sample by age, sex and deprivation. Analysis used a sample of 5,330 adults ≥ 18 years old. Along with retrospective questions on nine ACE types and CP measured on a Likert scale (categorised into tertiles), the survey measured self-reported health (chronic health condition, mental well-being and overall health) and self-assessed economic (household income, employment status) outcomes. Statistical analyses included chi-squared tests and logistic regression modelling. Results: ACE count was significantly related to CP. Increases in category of self-reported CP were associated with 43.7% of 4 + ACEs and 20.5% of 2–3 ACEs reports. ACE count and CP both showed independent dose response relationships with all three health measures. Adjusted prevalence of lower health rose from 20.6% (no ACEs, wealthiest CP tertile) to 45.2% (4 + ACEs, poorest CP tertile). Membership of the poorest CP tertile with no ACEs, or of the wealthiest tertile with 4 + ACEs showed intermediate values (34.6% and 28.9% respectively). Economic outcomes (low income, unemployed/long-term sick) showed similar independent and additive relationships with ACEs and CP. Percentage unemployed/long-term sick rose in the wealthiest CP tertile from 3.8% (0 ACEs) to 5.9% (4 + ACEs) and in the poorest tertile from 8.0% to 12.2% respectively. Conclusions: Our findings support ACEs being widespread across all socio-economic backgrounds but being more frequent in poorer childhoods. Both ACEs and CP appear independently associated with poorer life course health outcomes with exposure to ACEs adding to the risks from CP. Exposure to ACEs and CP are also associated with poorer economic outcomes in adulthood. Therefore, these childhood experiences in one generation may also increase the risk of CP and ACEs in the children they raise. Targeted interventions and policies are already available that can mitigate the impacts of ACEs and CP, improving health, economic stability and productivity and thus, reducing public service costs and increasing prosperity.