Adverse Childhood Experiences and Indigenous Identity: Testing for Aggregation Fallacy in the Multiracial Category

Adverse childhood experiences (ACEs) predict poor adulthood health. ACEs are most common among American Indian/Alaska Native (AI/AN) and Multiracial groups, two groups that overlap substantially in population. We aimed to determine if the Multiracial population's high mean ACE score differs by those who do and do not identify as AI/AN. We analyzed Waves 1, 3, and 4 (1994-2009) of the National Longitudinal Study of Adolescent to Adult Health (N = 12,372), estimating race-specific mean ACE scores and component prevalence, and disaggregating the Multiracial group by AI/AN identity. We compared means and prevalence ratios using Bonferroni-corrected Tukey's honestly significant tests of differences. Mean scores on a 10-point scale were higher among AI/AN (mean = 3.21, 95% CI: 2.54, 3.97), Multiracial AI/AN (2.95, 95% CI: 2.71, 3.18), Multiracial non-AI/AN (2.88, 95% CI: 2.57, 3.19), and Black (2.84, 95% CI: 2.65, 3.02) groups than White (2.35, 95% CI: 2.26, 2.44) and Asian/Pacific Islander (2.32, 95% CI: 2.09, 2.54) groups. Tests of mean and prevalence differences between the AI/AN and two Multiracial groups were all insignificant. The Multiracial population's high mean ACE score does not differ by those that do and do not identify as AI/AN. ACEs prevention strategies should be tailored to meet the specific needs of groups at higher risk of exposure to improve health equity.