DOI: 10.3310/nihropenres.14455.1 ISSN: 2633-4402

Early Years Risk Factors with long-term economic consequences across key life domains: a systematic umbrella review

Evdoxia Gkaintatzi, Richard Cookson, Ruth Blackburn, Aase Villadsen, Jeongeun Park, Shrathinth Venkatesh, Rosana Pacella, Antonia Dixey, Claire Monks, Ieva Skarda, Priya Shah, Paul McCrone
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Background The first period of life shapes later life chances, but the economic consequences accumulate across later childhood, adolescence and adulthood and fall across several policy sectors. Existing reviews typically address one risk factor at a time, or focus on a restricted outcome domain, leaving the relevant evidence scattered. This umbrella review collates review-level evidence on how early childhood exposures affect later economic outcomes. Methods The review was registered on Open Science Framework (https://osf.io/szpx5/overview). Medline, APA PsycArticles, APA PsycINFO, CINAHL Plus with Full Text, Education Research Complete & Psychology and Behavioural Sciences Collection databases were searched in November 2025. Systematic, rapid, scoping, narrative and umbrella reviews were eligible if they examined early childhood exposures and later outcomes with measurable consequences for education, employment, income, criminal justice involvement, quality of life, wellbeing or service costs. Reviews reporting only health status outcomes, and those focused on low- and middle-income countries, were excluded. Two authors screened and extracted independently, and quality was appraised. Findings were synthesised narratively. Results Seventy-two reviews were included, published between 2001 and 2025 and increasingly since 2021. Adverse childhood experiences and related adversity were the most frequently examined exposures, followed by childhood physical health conditions, birth and perinatal factors, and neurodevelopmental and behavioural difficulties. Early years risk factors were consistently associated with poorer later education and employment, lower income and greater criminal justice involvement. Evidence on quality of life was mixed, and service use and costs were seldom reported. Few reviews addressed publication bias. Conclusion Difficulties experienced in the early years have consequences across several later life domains and public sectors. The evidence is most consistent for education and criminal justice involvement, and thinner for quality of life, service use and costs. Reviews rarely address correlations between risk factors or the pathways connecting them to later outcomes. Modelling these pathways and evaluating interventions to address early years risks are priorities. Limitations of the review were the inclusion of studies that covered a wide range of age groups and the exclusion of health outcomes.

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