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

Miller, Ted R.; Waehrer, Geetha M.; Oh, Debora L.; Boparai, Sukhdip Purewal; Walker, Sheila O.; Marques, Sara Silvério; Harris, Nadine Burke

doi:10.1371/journal.pone.0228019

Cited by 15 publications

(27 citation statements)

References 62 publications

(59 reference statements)

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“…Using 2017 BRFSS data from TN and VA, this study aimed to show the economic impact of exposure to any ACE to an associated medical cost or DALYs burden for several adulthood health outcomes, health risk factors, and chronic health conditions. Consistent with other studies, the current study found attributable risks due to exposure to any ACEs for arthritis, COPD, depression, obesity, smoking, and alcohol use (Miller et al, 2020;Sidmore, 2018;Sycamore Institute, n.d.). An analysis of 2013 BRFSS data by Sidmore showed a population attributable risk (PAR) between ACEs and frequent mental distress, COPD, emphysema, chronic bronchitis, increased days of poor physical health, smoking, asthma (current or former), diabetes, heavy alcohol consumption, obesity, increased activity limitation, diagnosis of arthritis, insufficient sleep, and separation or divorce in Alaska (Sidmore, 2018).…”

Section: Discussionsupporting

confidence: 90%

“…The differences between the current study and the study done in CA could be due to disparities in costs between the states; the CA study did not calculate DALYs 420,902 114,734 127,513 15,469,993,515 20,276,379,560 646,945,848 942,089,507 for drinking, smoking or obesity; and the current study could not calculate attributable risk for asthma or CVD for the population studied due to data limitations. The prevalence of exposure to ACEs was similar in the three states; CA 61%, (Miller et al, 2020), TN 59.1%, and VA 61.7%.…”

Section: Discussionmentioning

confidence: 84%

“…While medical expenses represent a significant burden, reduced quality of life resulting from ACE attributable conditions also represents a burden in disability adjusted life years (DALYs) and premature morbidity. Previous research has utilized a variety of methods to calculate lifetime costs of ACEs based upon costs of health care and absenteeism in a single state, healthcare costs and DALYs correlating to several chronic conditions for a single state, or estimated national costs for childhood maltreatment (Miller et al, 2020;Sidmore, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the data was examined as continuous and then the cutoff threshold was determined based on the data. From a different article that examined health burden in California using BFRSS data, most of the health burden resulted from exposure to fewer ACEs and they questioned the strategy of focusing on 4 or more ACEs (Miller et al, 2020).…”

Section: Methodsmentioning

confidence: 99%

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Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

Okwori

Stewart

Quinn

et al. 2021

Journ Child Adol Trauma

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To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

Okwori

Stewart

Quinn

et al. 2021

Journ Child Adol Trauma

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show abstract

“…The economic costs of CA in terms of excess healthcare and other services (legal, social, etc.) take a huge toll on government spending, 45 46 and investing appropriately to combat CA will ultimately save societal costs. 11 12 42 Finally, governments could monitor the prevalence of CA in populations and consider reductions in reports of CA a priority in efforts to achieve Sustainable Development Goals.…”

Section: Discussionmentioning

confidence: 99%

Cumulative risk of compromised physical, mental and social health in adulthood due to family conflict and financial strain during childhood: a retrospective analysis based on survey data representative of 19 European countries

et al. 2021

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BackgroundChildhood adversity (CA) has previously been linked to various health problems in adulthood. Investigations into the differential impact of distinct types of CA on a wide range of outcomes are scarce. This study aimed to assess the impact of self-reported childhood family conflict and/or financial strain on health and social functioning in adulthood among Europeans, while taking into account the mediating role of adulthood socioeconomic disadvantage (SED) in these associations.MethodsUsing the European Social Survey (ESS) collected in 2014, nationally representative cross-sectional data from 35 475 participants aged 15 years and older in 19 European countries were analysed. Logistic regressions were conducted to assess associations of retrospectively reported family conflict and/or financial strain in childhood with physical and mental health as well as health behaviours and social functioning in adulthood.ResultsA quarter of the European population reported having experienced family conflict, financial strain or both in childhood. Financial strain was reported more among older age groups and conflict more among younger age groups. A dose-response pattern with increased risk was demonstrated for almost all physical, behavioral, mental and social outcomes for these aspects of CA compared with no CA, with the highest risk observed in those who experienced both financial strain and family conflict. Adulthood SED mediated a significant proportion of the associations with financial strain (ranging from 5.4% to 72.4%), but did not mediate the associations with conflict.ConclusionIndividuals reporting family conflict or financial strain during childhood are at increased risk of developing a wide range of health and social problems. Those who report financial strain in childhood are more likely to experience SED in adulthood, which in turn increases their risk of experiencing health and social problems. Reported family conflict during childhood conferred increased risk of health and social problems, but adulthood SED did not appear to operate as an indirect pathway.

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Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults

Peterson,

Aslam,

Niolon

et al. 2023

JAMA Netw Open

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ImportanceAdverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk behaviors and worse health outcomes; the economic burden associated with these issues is uncertain.ObjectiveTo estimate the economic burden of ACE-associated health conditions among US adults.Design, Setting, and ParticipantsIn this economic evaluation, regression models of cross-sectional survey data from the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and previous studies were used to estimate ACE population-attributable fractions (PAFs) (ie, the fraction of total cases associated with a specific exposure) for selected health outcomes (anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, and violence) and risk factors (heavy drinking, illicit drug use, overweight and obesity, and smoking) among the 2019 US adult population. Adverse childhood experience PAFs were used to calculate the proportion of total condition-specific medical spending and lost healthy life-years related to ACEs using Global Burden of Disease Study data. Data analysis was performed from September 10, 2021, to November 29, 2022.ExposureAdverse childhood experiences (age &lt;18 years).Main Outcomes and MeasuresMonetary valuation of ACE-associated morbidity and mortality using standard US value of statistical life methods and presented in terms of annual and lifetime per affected person and total population estimates at the national and state levels.ResultsA total of 820 673 adults, representing 255 million individuals, participated in the BRFSS in 2019 and 2020. An estimated 160 million of the total 255 million US adult population (63%) had 1 or more ACE, associated with an annual economic burden of $14.1 trillion ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years). This was $88 000 per affected adult annually and $2.4 million over their lifetimes. The lifetime economic burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the total economic burden—the estimated per person lifetime economic burden for those adults was $4.0 million.Conclusions and RelevanceIn this cross-sectional analysis of the US adult population, the economic burden of ACE-related health conditions was substantial. The findings suggest that measuring the economic burden of ACEs can support decision-making about investing in strategies to improve population health.

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

Cited by 15 publications

References 62 publications

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

Cumulative risk of compromised physical, mental and social health in adulthood due to family conflict and financial strain during childhood: a retrospective analysis based on survey data representative of 19 European countries

Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults

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