TY - JOUR
T1 - Adverse childhood experiences and the onset of chronic disease in young adulthood
AU - Sonu, Stan
AU - Post, Sharon
AU - Feinglass, Joe
N1 - Funding Information:
Currently, what is less well documented is the extent to which childhood adversity increases risk of chronic disease and poor self-rated health status across different ages of adulthood, and in particular, among young adults. Indeed, we did not find any studies specifically assessing the association of ACEs and chronic disease or poor self-rated health among young adults. The effect of ACEs on health in this age group is of growing interest, however, as recent advances in chronic disease epidemiology have deepened understanding of the relationship between risk factors for chronic disease and onset of disease. Studies in cardiovascular disease (CVD) epidemiology have found that the duration of risk factors among older individuals is a key factor in the lifetime risk of developing CVD (Berry et al., 2012). That is, the high prevalence of CVD in advanced age may in part reflect the prolonged length of time individuals have lived with risk factors of CVD (i.e. obesity, smoking, high cholesterol, diabetes, hypertension, etc). This claim is supported by large cohort data analyzing lifetime risks of CVD; individuals in the Framingham cohort who had an optimal CVD risk factor profile at age 55 were found to have a markedly lower absolute risk of CVD at age 80 (5–8%) compared to similarly aged individuals who had ≥2 risk factors at age 55 (50–68%) (Berry et al., 2012; Kannel & Vasan, 2009). Consistent with these developments in CVD epidemiology, a recent American Heart Association scientific statement calls for additional research on adolescent adversity and cardiometabolic outcomes across the life-course (Suglia et al., 2017).☆ This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We would like to thank Drs. Audrey Stillerman and Pat Rush for their expertise, enduring support, and thoughtful input into the development of this manuscript.☆ This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2019
PY - 2019/6
Y1 - 2019/6
N2 - This study examined the association of adverse childhood experiences (ACEs) with early-onset chronic conditions. We analyzed data from the 2011–2012 Behavioral Risk Factor Surveillance System (BRFSS), which included 86,968 respondents representing a nine-state adult population of 32 million. ACE questions included physical, emotional, and sexual abuse; substance use, mental illness or incarceration of a household member; domestic violence, and parental separation. Outcomes included chronic conditions (cardiovascular disease, chronic obstructive pulmonary disease, cancer, depression, diabetes, and prediabetes); overall health status; and days of poor mental or physical health in the past month. We estimated Poisson regression models of the likelihood of chronic conditions and poor health status comparing adults reporting ≥4 ACEs to respondents with no ACEs within three age strata: 18–34, 35–54 and ≥55 years. The prevalence of ≥4 ACEs was highest among youngest respondents (19%). There was a dose-response gradient between ACE scores and outcomes except for cancer in older adults. Among younger respondents, those reporting ≥4 ACEs had two to four times the risk for each chronic condition and poor health status compared to respondents reporting no ACEs. With few exceptions (depression, poor mental and physical health in the past month), incidence rate ratios were highest in young adults and successively decreased among older adults. This study is among the first to analyze patterns of association between ACEs and adult health disaggregated by age. Young adults with high ACE scores are at increased risk of early-onset chronic disease. Trauma-informed care and ACEs prevention are crucial public health priorities.
AB - This study examined the association of adverse childhood experiences (ACEs) with early-onset chronic conditions. We analyzed data from the 2011–2012 Behavioral Risk Factor Surveillance System (BRFSS), which included 86,968 respondents representing a nine-state adult population of 32 million. ACE questions included physical, emotional, and sexual abuse; substance use, mental illness or incarceration of a household member; domestic violence, and parental separation. Outcomes included chronic conditions (cardiovascular disease, chronic obstructive pulmonary disease, cancer, depression, diabetes, and prediabetes); overall health status; and days of poor mental or physical health in the past month. We estimated Poisson regression models of the likelihood of chronic conditions and poor health status comparing adults reporting ≥4 ACEs to respondents with no ACEs within three age strata: 18–34, 35–54 and ≥55 years. The prevalence of ≥4 ACEs was highest among youngest respondents (19%). There was a dose-response gradient between ACE scores and outcomes except for cancer in older adults. Among younger respondents, those reporting ≥4 ACEs had two to four times the risk for each chronic condition and poor health status compared to respondents reporting no ACEs. With few exceptions (depression, poor mental and physical health in the past month), incidence rate ratios were highest in young adults and successively decreased among older adults. This study is among the first to analyze patterns of association between ACEs and adult health disaggregated by age. Young adults with high ACE scores are at increased risk of early-onset chronic disease. Trauma-informed care and ACEs prevention are crucial public health priorities.
KW - Adverse childhood experiences
KW - Behavioral risk factor surveillance system
KW - Chronic disease
KW - Health disparities
KW - Health status
KW - Self-rated health
KW - Young adult
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U2 - 10.1016/j.ypmed.2019.03.032
DO - 10.1016/j.ypmed.2019.03.032
M3 - Article
C2 - 30904602
AN - SCOPUS:85063407693
SN - 0091-7435
VL - 123
SP - 163
EP - 170
JO - Preventive Medicine
JF - Preventive Medicine
ER -
