Adverse childhood experiences and adverse health outcomes in adulthood – do relationships differ by gender?

Background: Adverse childhood experiences (ACE) have been found to be associated with negative health outcomes in clinical studies and population-based surveys. These studies have not examined potential effect modification of this association by gender. Objectives: To examine if the association between ACEs and negative physical and mental health outcomes varies by gender among adults in California. Methods: We used a representative sample of adults from the California Behavioral Risk Factor Surveillance System 2008 and 2009 to estimate the prevalence of ACEs by gender. For men and women, we calculated odds ratios of poor health, obesity, depression, diabetes, myocardial infarction, and asthma with ACEs using an ACE count variable: 0, 1, 2, 3, or 4 or greater, and adjusted for demographic and socioeconomic factors. Results: Nearly half of all adults experienced at least one ACE during childhood, and this did not vary by gender. Overall, in adjusted models, ACEs were associated with poor health, obesity, depression, diabetes, and asthma, but not myocardial infarction. These associations varied by gender for obesity, myocardial infarction, and depression, but not for poor health, diabetes, or asthma. Among women, the relationship between ACEs and depression was stronger than among men, most strikingly among those with 4 or more ACEs (OR men = 2.14, 95% CI = 1.06 – 4.32, versus OR women = 11.66, 95% CI = 7.07 – 19.25). Conclusion: ACEs are common among California adults. ACEs are associated with negative health outcomes and this association varies according to gender. Future research should examine these associations in clinical, population-based studies.