Childhood forecasting of a small segment of the population with large economic burden

Abstract

Policymakers are interested in early-years interventions to ameliorate childhood risks. They hope for improved adult outcomes in the long run that bring a return on investment. The size of the return that can be expected partly depends on how strongly childhood risks forecast adult outcomes, but there is disagreement about whether childhood determines adulthood. We integrated multiple nationwide administrative databases and electronic medical records with the four-decade-long Dunedin birth cohort study to test child-to-adult prediction in a different way, using a population-segmentation approach. A segment comprising 22% of the cohort accounted for 36% of the cohort’s injury insurance claims; 40% of excess obese kilograms; 54% of cigarettes smoked; 57% of hospital nights; 66% of welfare benefits; 77% of fatherless child-rearing; 78% of prescription fills; and 81% of criminal convictions. Childhood risks, including poor brain health at three years of age, predicted this segment with large effect sizes. Early-years interventions that are effective for this population segment could yield very large returns on investment.

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Figure 1: Measuring the concentration of economic-burden outcomes in a birth cohort.
Figure 2: The aggregation of adult economic-burden outcomes.
Figure 3: Predicting the probability of economic-burden outcomes.
Figure 4: The big footprint of multiple-high-cost users.

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Acknowledgements

We thank Dunedin Study members, their families and Dunedin Study founder Phil Silva. This research received support from US National Institute on Aging (NIA) grants AG032282, AG048895, AG049789, UK Medical Research Council (MRC) grant MR/K00381X and ESRC grant ES/M010309/1. The Dunedin Study was supported by the New Zealand Health Research Council and New Zealand Ministry of Business, Innovation and Employment (MBIE). Additional support was provided by the Jacobs Foundation and the Avielle Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank D. Reiss, J. Heckman and his seminar members, and the New Zealand agencies that offered guidance and assistance to the Dunedin Study. We also thank Z. van der Merwe (ACC), C. Lewis (Ministry of Health), M. Wilson and R. Ota (Ministry of Social Development), the Otago Police District Commander, P. Stevenson, J. Curren and the Dunedin Police. The Otago University Ethics Committee, Duke University and King’s College London provided ethical approval for the Dunedin Study. Participants gave written consent before data were collected.

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A.C., R.P. and T.E.M. designed the research, and A.C., R.M.H. and T.E.M. wrote the manuscript. A.C., S.H., S.R., R.P. and T.E.M. collected the data, and it was analysed by A.C., R.M.H. and H.H. All authors reviewed drafts, provided critical feedback and approved the final manuscript.

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Correspondence to Avshalom Caspi.

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The authors declare no competing interests.

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Supplementary Methods, Supplementary Data Analyses, Supplementary Tables 1–4, Supplementary Figure 1. (PDF 1029 kb)

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Caspi, A., Houts, R., Belsky, D. et al. Childhood forecasting of a small segment of the population with large economic burden. Nat Hum Behav 1, 0005 (2017). https://doi.org/10.1038/s41562-016-0005

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