Associations between patterns of adverse childhood experiences and adult chronic conditions: A population-based study

Prior studies on the health sequelae of adverse childhood experiences (ACEs) primarily counted ACE numbers, but ACEs often co-occur and have varying impacts.

To examine ACE patterns and their specific associations with chronic conditions.

300,854 US adults (51.4 % women, 75.8 % <65 years) randomly sampled in the 2021 and 2022 Behavioral Risk Factor Surveillance System.

ACEs were measured using the CDC-Kaiser Permanente ACE study questionnaire on household dysfunction, abuse, and neglect. Chronic health conditions were self-reported, including heart attack, angina/coronary heart disease, stroke, asthma, COPD/emphysema/chronic bronchitis, kidney disease, diabetes, arthritis, and depressive disorder. Descriptive statistics were weighted to increase sample representativeness. Latent class analysis identified ACE patterns. Bivariate and multivariable robust Poisson regression examined associations with chronic conditions adjusting for sociodemographic characteristics. Population attributable fractions (PAFs) were calculated.

A 3-class model of ACE patterns was identified, referring to low ACE class (73.8 %), non-sexual high ACE class (18.9 %), and high ACE class with sexual abuse (7.3 %). The high ACE class with sexual abuse showed higher adjusted RRs (range 1.29-2.46; PAFs range 0.22-0.59) with each of the chronic conditions and multimorbidity, compared with the non-sexual high ACE class (aRRs range 1.10-2.01; PAFs range 0.09-0.50) and low ACE class (reference).

ACEs can be differentiated into three classes in US adults. The high ACE class with sexual abuse showed higher risks for chronic conditions and multimorbidity. Screening of ACEs can be integrated into prevention programs for chronic conditions. Personalized interventions are warranted for different ACE classes.