Disease burden of adverse childhood experiences across 14 states

Abstract

Objective To examine whether the relationship between Adverse Childhood Experiences (ACEs) and health outcomes is similar across states and persists net of ACEs associations with smoking, heavy drinking, and obesity. Methods We use data from the Behavioral Risk Factor Surveillance System for 14 states. Logistic regressions yield estimates of the direct associations of ACEs exposure with health outcomes net of health risk factors, and indirect ACEs-health associations via health risk factors. Models were estimated for California (N = 22,475) and pooled data from 13 states (N = 110,076), and also separately by state. Results Exposure to ACEs is associated with significantly higher odds of smoking, heavy drinking, and obesity. Net of these health risk factors, there was a significant and graded relationship in California and the pooled 13-state data between greater ACEs exposure and odds of depression, asthma, COPD, arthritis, and cardiovascular disease. Four or more ACEs were less consistently associated across states with cancer and diabetes and a dose-response relationship was also not present. There was a wide range across individual states in the percentage change in health outcomes predicted for exposure to 4+ ACEs. ACEs-related smoking, heavy drinking, and obesity explain a large and significant proportion of 4+ ACEs associations with COPD and cardiovascular disease, however some effect, absent of risk behavior, remained. Conclusions ACE's associations with most of the health conditions persist independent of behavioral pathways but only asthma, arthritis, COPD, cardiovascular disease, and depression consistently exhibit a dose-response relationship. Our results suggest that attention to child

Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences

“…A growing body of research shows that ACEs can lead to changes in the structure and function of children's developing brains resulting in chronic dysregulation of the stress response as well as other hormones that regulate functions such as heart rate, blood pressure, metabolism, appetite, and reproduction [34][35][36][37], and long-term changes in the brain and immune system leading to increased measures of inflammation and impairments of certain immune functions [38,39]. Consistent with such physiological changes, studies of health outcomes have shown that ACEs can be plausibly linked to higher odds of asthma, arthritis, cardiovascular disease, COPD, and health risks such as obesity, smoking, and heavy drinking [e.g., 13,18,23]. This study provides the first US estimate of the economic burden of these negative health outcomes of ACEs.…”

“…We estimate healthcare costs of exposure to ACEs in California, by combining prevalence data from four years of the California Behavioral Risk Factor Survey (BRFS) with estimates of healthcare costs during 2013 from Dieleman et al [12] for those chronic conditions identified as plausibly linked to ACEs in Waehrer et al [13] The California BRFS is part of the Behavioral Risk Factor Surveillance System (BRFSS), the US system of cross-sectional state-based telephone surveys of residents' health-related behaviors. State health departments queried residents aged 18 and older in all 50 states and 3 US territories about demographics, risk behaviors, chronic health conditions, and use of preventive services using a standardized questionnaire developed in collaboration with the Centers for Disease Control (CDC).…”

“…This study is based on 2008, 2009, 2011, and 2013 California BRFS data on ACEs from the California Department of Public Health (CDPH) [14]. socioeconomic controls to examine whether the direct ACEs-health relationship for seven health outcomes persisted net of health risk factors such as smoking, heavy drinking, and obesity [13,24]. We applied the models to BRFSS data from California and 13 other states.…”

“…That study also estimated the extent to which ACEs association with health outcomes ran indirectly through smoking, heavy drinking, and obesity by comparing the results from models with and without the three health risk factors. Health outcomes were deemed to be ACEs-related if, (1) net of the three health risk factors, they had a graded, dose-response relationship with the number of ACEs, (2) they were significantly associated with exposure to 4 or more ACEs, and (3) these relationships were consistently observed across the different BRFSS states [13,24]. Among the seven health outcomes analyzed, five-asthma, arthritis, depression, COPD, and cardiovascular disease-were plausibly linked to ACEs under the criteria listed above.…”

“…To estimate the excess risk of disease associated with ACEs exposure, we combined results from logit models in Waehrer et al [13] with California BRFS data on (1) the prevalence of ACEs-related health conditions for different ACEs exposures and (2) the proportion of CA population exposed to ACEs. Specifically, Table 1 presents the average change in the probability of the health condition for those with ACEs relative to those with zero ACEs using estimates from Waehrer et al [13]. S1 Table presents the full set of estimates and confidence intervals from that study.…”