FROM PLAYGROUND TO PAYOR: THE HIDDEN ECONOMIC BURDEN OF CHILDHOOD ADVERSITY ON CARDIOMETABOLIC DISEASE AND ALL-CAUSE MORTALITY
Author(s)
Xiao Liu, PhD1, Shengwei Luo, PhD2, Wai-kit Ming, MBA, MPH, PhD, MD3, Chen Zhang, Master4, Nanqin Peng, PhD5, Yunting Zeng, Bachelor6, Ruihao Zhang, PhD7, Dezhi Long, PhD7, Weizhen Liang, High School Diploma8.
1¹ Duke-NUS Medical School ² Sun Yat-sen University, Singapore & Guangzhou（China）, Singapore, 2¹ City University of Hong Kong ² National University of Singapore³ Peking University, Hongkong & Singapore & Beijing, China, 3City University of Hong Kong, Hong Kong, China, 4¹ Cornell University ² University of Nottingham Ningbo, Ithaca & Ningbo（China）, NY, USA, 5¹ Shanghai Jiao Tong University ² Nanchang University, Shanghai & Nanchang, China, 6Fujian University of Traditional Chinese Medicine, Fuzhou, China, 7Southern Medical University, Guangzhou, China, 8¹BASIS International School Guangzhou ² Sun Yat-Sen University, Guangzhou, China.
1¹ Duke-NUS Medical School ² Sun Yat-sen University, Singapore & Guangzhou（China）, Singapore, 2¹ City University of Hong Kong ² National University of Singapore³ Peking University, Hongkong & Singapore & Beijing, China, 3City University of Hong Kong, Hong Kong, China, 4¹ Cornell University ² University of Nottingham Ningbo, Ithaca & Ningbo（China）, NY, USA, 5¹ Shanghai Jiao Tong University ² Nanchang University, Shanghai & Nanchang, China, 6Fujian University of Traditional Chinese Medicine, Fuzhou, China, 7Southern Medical University, Guangzhou, China, 8¹BASIS International School Guangzhou ² Sun Yat-Sen University, Guangzhou, China.
OBJECTIVES: One in two adults globally reports childhood adversity (CA), yet its economic consequences are not reflected in health system decision-making. We estimated its population-level burden on cardiovascular disease (CVD), metabolic disease, and all-cause mortality across developed and developing economies and modeled economic implications under counterfactual CA reduction scenarios.
METHODS: We conducted a systematic review and dose-response meta-analysis of 25 cohort studies (N=1,727,018) identified in PubMed, Embase, and Cochrane Library through November 2025. Pooled relative risks were estimated using random-effects models. Population attributable fractions were calculated, integrating disability-adjusted life years from the Global Burden of Disease 2021 study and monetizing outcomes via GDP per capita across seven countries (six high-income: Canada, Finland, Ireland, Sweden, UK, USA; one upper-middle-income: China). Generalized impact fraction modeling estimated economic gains under WHO “25 by 25” childhood adversity reduction scenarios (5%-100%).
RESULTS: CA was associated with increased risk of cardiovascular disease events (RR 1.29, 95% CI 1.19-1.39), metabolic diseases (RR 1.24, 95% CI 1.09-1.42), and all-cause mortality (RR 1.22, 95% CI 1.08-1.38), with a dose-response relationship for CVD. CA accounted for 4.69% of CVD events, 8.31% of metabolic diseases, and 9.85% of all-cause mortality, corresponding to per-capita economic losses of $50.26, $13.64, and $808.17, respectively. Although relative risks were similar across countries, economic burden varied substantially due to GDP differences between high-income and upper-middle-income settings. A 25% reduction in CA exposure (WHO “25 by 25” target) would yield per-capita savings of $12.57 (CVD), $3.41 (metabolic diseases), and $202.04 (mortality).
CONCLUSIONS: Childhood adversity generates a substantial and largely hidden economic burden that is not captured in routine health system decision-making. These findings support the relevance of early-life prevention within noncommunicable disease strategies and suggest potential economic benefits under WHO-aligned prevention targets, particularly in resource-limited settings.
METHODS: We conducted a systematic review and dose-response meta-analysis of 25 cohort studies (N=1,727,018) identified in PubMed, Embase, and Cochrane Library through November 2025. Pooled relative risks were estimated using random-effects models. Population attributable fractions were calculated, integrating disability-adjusted life years from the Global Burden of Disease 2021 study and monetizing outcomes via GDP per capita across seven countries (six high-income: Canada, Finland, Ireland, Sweden, UK, USA; one upper-middle-income: China). Generalized impact fraction modeling estimated economic gains under WHO “25 by 25” childhood adversity reduction scenarios (5%-100%).
RESULTS: CA was associated with increased risk of cardiovascular disease events (RR 1.29, 95% CI 1.19-1.39), metabolic diseases (RR 1.24, 95% CI 1.09-1.42), and all-cause mortality (RR 1.22, 95% CI 1.08-1.38), with a dose-response relationship for CVD. CA accounted for 4.69% of CVD events, 8.31% of metabolic diseases, and 9.85% of all-cause mortality, corresponding to per-capita economic losses of $50.26, $13.64, and $808.17, respectively. Although relative risks were similar across countries, economic burden varied substantially due to GDP differences between high-income and upper-middle-income settings. A 25% reduction in CA exposure (WHO “25 by 25” target) would yield per-capita savings of $12.57 (CVD), $3.41 (metabolic diseases), and $202.04 (mortality).
CONCLUSIONS: Childhood adversity generates a substantial and largely hidden economic burden that is not captured in routine health system decision-making. These findings support the relevance of early-life prevention within noncommunicable disease strategies and suggest potential economic benefits under WHO-aligned prevention targets, particularly in resource-limited settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO144
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Geriatrics, Injury & Trauma, Mental Health (including addiction)