Background An increasing amount of evidence has emerged in recent years of the association between different aspects of childhood adversity (termed ACEs – Adverse Childhood Experiences – in a great many studies) and increased risks of negative outcomes in later life. Consequently, ACEs have become a policy priority in many quarters. Despite most ACEs being highly socially patterned, there has been very little discussion in the political discourse regarding the role of childhood socio-economic conditions in understanding and addressing them. The aim, therefore, was to investigate what is known about the association between childhood socio-economic position (SEP) and ACEs, including the extent to which the former explains the latter.

Methods Relevant databases (MEDLINE; psycINFO; ProQuest Public Health Database, Cochrane Library) were searched for all papers satisfying four inclusion criteria: (1) measurement of social position in childhood (prior to ACEs measurement); (2) measurement of multiple aspects of childhood adversity; (3) childhood adversity was the outcome; (4) statistical quantification of the relationship between childhood SEP and childhood adversity. Non-English language papers were excluded.

The initial search terms included ACEs, SEP, and their synonyms. A second search additionally included ‘maltreatment’. Papers were independently screened and critically appraised by two authors. Risk of bias was assessed, and overall study quality calculated using a modified version of the Hamilton Tool. Results were synthesised narratively because of the wide variation in definitions of exposures and outcomes.

Results For the ACEs-based search, 2,779 papers were screened, of which 52 were reviewed in full-text. Of these, only six were eligible for qualitative synthesis. The second search (including maltreatment) increased the numbers to: 4,463 papers screened; 166 full texts; 35 included for synthesis. 18 papers were deemed to be ‘high’ quality, five ‘medium’, the rest ‘low’. Meaningful statistical associations were observed between the exposure (childhood SEP) and the outcome (ACEs/maltreatment) in the vast majority of studies, including all bar one of those deemed to be high quality. Low SEP is therefore clearly a determinant of ACEs/maltreatment: the longitudinal nature of many studies means the association is most likely causal.

Conclusion The relationship between childhood SEP and ACEs is clear, but under-researched. More evidence exists in the maltreatment literature. With UK child poverty levels predicted to increase markedly, any policy approach which ignores the socio-economic context to ACEs is flawed. Policy needs to help those currently affected by childhood adversity; but to prevent further adversity, it must also address the key socio-economic drivers.