Adverse Childhood Experiences and the Risk of Chronic Disease and Disability — Results from Ten U.S. States and the District of Columbia, 2010

Background: Adverse childhood experiences (ACEs), including child abuse and family dysfunction, are linked to leading causes of adult morbidity and mortality.  However, prior ACE studies were based on a non-representative patient sample from a health maintenance organization in Southern California.  Therefore, the study objective was to determine if ACE exposure increased the risk for chronic disease and disability using a larger sample of adults representative of multiple U.S. states.

Methods: Ten states and the District of Columbia included an optional ACEs module in the 2010 Behavioral Risk Factor Surveillance Survey, a national cross-sectional, random-digit-dial telephone survey of adults.  Respondents were asked about nine ACEs including physical, sexual, and emotional abuse and household member mental illness, alcoholism, drug abuse, imprisonment, divorce, and intimate partner violence. An ACE score was calculated for each subject by summing the number of ACE items endorsed.  After controlling for sociodemographic variables, weighted adjusted odds ratios were calculated for self-reported health conditions given exposure to 0, 1-3, 4-6, or 7-9 ACEs.

Results:  Compared to those who reported no ACE exposure, the adjusted odds of reporting myocardial infarction; asthma; fair/poor health; frequent mental distress; and disability were higher for those reporting 1-3, 4-6, and 7-9 ACEs. The odds of reporting coronary heart disease and stroke were higher for those who reported 4-6 and 7-9 ACEs; and the odds of diabetes was higher for those reporting 1-3 and 4-6 ACEs. 

Conclusion:  These findings underscore the importance of child maltreatment prevention as a means to mitigate adult morbidity and mortality.