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Background  Child maltreatment leads to enormous adverse short- and long-term health outcomes. The aim of this study is to estimate the burden of disease and the cost of illness attributable to child maltreatment in Japan.    Methods  An incidence-based top-down cost of illness analysis was conducted to estimate medical costs and burden of disease attributable to child maltreatment based on a societal perspective. The assessment included short-term and long-term medical costs and burden of disease measured by Disability-Adjusted Life Years (DALYs) that generates mortality and morbidities, based on several national surveys and systematic review. We considered the main types of child maltreatment as exposure, for which the incidence was obtained from literature review. Based on population attributable fractions (PAFs), burden of disease of physical and mental health consequences attributable to child maltreatment were estimated. Then DALYs were converted into monetary value. The lifetime economic burden was finally estimated by combining with medical costs and subject to sensitivity analysis.    Results  The lifetime disease burden expressed in DALYs was estimated at 1,047,580 DALYs (95% CI 788,388 - 1326,80 DALYs) for the cohort victims in 2016. Based on the incidence according to literature review, the overall lifetime economic burden was 50.24 billion USD, equivalent to 1.3 million times of gross domestic product (GDP) per capita. Among the total economic burden, costs of suffering and pain based on DALYs were accounting for 81.3%. These estimates were 7–8 times of conservative estimates which used incidence data from official reported cases.    Conclusions  This study found that the national lifetime cost was huge and equivalent to 1.3 million GDP per capita, and its burden of disease was approximately equal to that of colon and rectum cancers or stomach cancer. Our findings particularly in terms of revealed the considerable burden of disease in long term and potential effects of the strengthened maternal and child care as the preventive strategy.

The burden of disease and the cost of illness attributable to child maltreatment in Japan: long-term health consequences largely matter