Relationship between adverse childhood experiences and healthcare expenditure: A comparison between states

Adverse childhood experiences (ACE) are a growing concern among social epidemiologists, for health outcomes throughout the adult lifespan. These experiences have been identified as a risk factor for a number of poor health outcomes in adulthood, as well as premature mortality. Individuals with high ACE scores are also theorized to consume more medical resources, and thus are greater cost to society. This analysis seeks to test this theory at a national level, by comparing prevalence of ACEs measured within 10 states, with healthcare expenditure within those states. Data for ACE prevalence comes from the 2009 and 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey, which included a module for ACEs in a total of ten states over the two years. Data on healthcare spending comes from the Centers for Medicare and Medicaid Services (CMS), and includes estimates of personal, Medicaid, and Medicare spending per capita, broken into types of use categories. Among the dependent variables examined are mean ACE scores within states, frequencies scoring over high thresholds, and frequencies of specific powerful ACE categories. The results of this analysis will be discussed, including possible significant associations, as well as the many threats to causal inferences in this type of macro-level approach. Directions for future study will be proposed, including a similar analysis using a much higher sample of much smaller geographical units, such as counties or cities.