Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020

Swedo, Elizabeth A.; Aslam, Maria; Dahlberg, Linda L.; Niolon, Phyllis Holditch; Guinn, Angie S.; Simon, Thomas R.; Mercy, James A.

doi:10.15585/mmwr.mm7226a2

Cited by 41 publications

(19 citation statements)

References 7 publications

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“…Because just 37 jurisdictions included BRFSS ACE module questions during 2019-2020 and in each state 14% to 33% of the respondents skipped 1 or more ACE survey question, the small area estimates approach (a statistical process that used actual survey responses to generate modeled responses if data were missing) from the unpublished study provided a way to use the most recent BRFSS ACEs data to analyze all states and include more respondents. There was further support for this approach in a recent analysis of state-level BRFSS ACEs data spanning 2011-2020 (the minimum timeline to include data from all states), which reported that respondents who skipped some ACEs questions (27% of respondents) had a higher prevalence of individual ACEs compared with survey respondents who answered all ACE questions . Estimated proportions of US adults with ACEs by count including small area estimates (unpublished study by M.V.A.…”

Section: Methodsmentioning

confidence: 99%

“…Previous cross-sectional studies have estimated a substantial ACE-associated health economic burden in adulthood in Europe and North America, the UK, and California . To our knowledge, similar economic estimates do not yet exist for other US states or for the US in total, although the ACE-related health burden among adults is extensively documented . This study aimed to estimate the economic burden of health conditions associated with ACEs among US adults.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Peterson,

Aslam,

Niolon

et al. 2023

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

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“…1 Endorsement of childhood adversities is prevalent with >60% of US adults reporting ≥1 types of adversities. 2 Exposure to adversities during childhood is associated with increased risk for mental health disorders, substance abuse, suicidal attempts, a myriad of chronic diseases, including heart disease, obesity, diabetes, and cancer, and premature mortality. 3 The Adverse Childhood Event study noted a higher risk of stroke, ischemic heart disease, and myocardial infarction with increasing number of adverse experiences in childhood.…”

Section: Editorialmentioning

confidence: 99%

Considering Social Context to Understand Childhood Adversities and Cardiovascular Health

Suglia,

April-Sanders

2024

Circ: Cardiovascular Quality and Outcomes

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“…Adverse childhood experiences (ACEs) are defined as stressful and/or traumatic experiences that occur before the age of 18 years and consist of abuse (physical, emotional, sexual), neglect (physical, emotional), and household dysfunction (parental incarceration, divorce, substance use, abuse toward mother). 1 ACEs are a common occurrence, with nearly two-thirds of US adults reporting having experienced at least 1 ACE, 2 and most individuals who experience ACEs experience more than one type. 2 Unfortunately, ACEs are associated with a range of problematic health outcomes, including substance use (eg, tobacco, 3 -6 cannabis, 4,6,7 alcohol 6,8,9 ) and mental health conditions (eg, depression, 6,9,10 anxiety 10 -12 ) during adulthood.…”

Section: Introductionmentioning

confidence: 99%

“…1 ACEs are a common occurrence, with nearly two-thirds of US adults reporting having experienced at least 1 ACE, 2 and most individuals who experience ACEs experience more than one type. 2 Unfortunately, ACEs are associated with a range of problematic health outcomes, including substance use (eg, tobacco, 3 -6 cannabis, 4,6,7 alcohol 6,8,9 ) and mental health conditions (eg, depression, 6,9,10 anxiety 10 -12 ) during adulthood.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis

Romm,

Berg

2024

Substance Use & Addiction Journal

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Introduction: Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. Methods: Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults ( Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education). Results: Overall, 65.4% reported ≥1 ACE ( M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes. Conclusions: Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

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Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020

Cited by 41 publications

References 7 publications

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

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

Considering Social Context to Understand Childhood Adversities and Cardiovascular Health

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis

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