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Published on: September 30, 2020
Age, Adverse Childhood Experiences, and Health Care Utilization
Charles V Golden1, Raymen R Assaf1,2, Ricardo Aguilar1
1Children's Hospital of Orange County, Orange, California.
Insights
Adverse childhood experiences (ACEs) impact pediatric healthcare use differently by age. Infants with ACEs showed lower utilization, while older children had increased emergency department visits and hospitalizations.
Area of Science:
- Pediatric Health Services Research
- Childhood Trauma Studies
- Public Health Policy
Background:
- Adverse childhood experiences (ACEs) are linked to various health outcomes.
- Previous research has not fully elucidated age-dependent associations between ACEs and healthcare utilization.
Purpose of the Study:
- To determine if the relationship between ACEs and pediatric healthcare utilization varies by patient age.
- To identify age-specific patterns in healthcare access following ACEs screening.
Main Methods:
- Retrospective cohort study of 37,315 pediatric patients undergoing ACEs screening.
- ACEs scores categorized as none, low (1-3), or high (≥4).
- Multivariable logistic regression analyzed emergency department (ED) and inpatient utilization within 6 months post-screening.
Main Results:
- 15.7% of patients used ED services, and 2.5% were hospitalized within 6 months.
- Infants and toddlers with ACEs had lower odds of ED and inpatient use compared to those with no ACEs.
- Older children with ACEs demonstrated significantly higher odds of ED and inpatient utilization, increasing with age.
Conclusions:
- The association between ACEs and pediatric healthcare utilization is age-dependent.
- Findings suggest a more complex relationship than previously understood.
- Results can inform age-tailored therapeutic interventions for children exposed to ACEs.
Objectives:
To assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age.
Methods:
In this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening.
Results:
Among 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age.
Conclusions:
The association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.
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