Exploring the Association Between Adverse Childhood Experiences and Missed Primary Care Appointments in Adult...

Missed medical appointments lead to adverse health outcomes and financial costs. Adverse childhood experiences (ACEs) are associated with poor health outcomes and may influence health care-seeking behavior in adulthood. This study explored the relationship between ACE scores and missed primary care appointments in a predominantly Black safety-net population.

The authors conducted a retrospective cohort study of 307 adult patients in a primary care clinic between January and August of 2022. Patients were recruited using a systematic sampling protocol and completed the 10-item Adverse Childhood Experiences Questionnaire. The primary outcome was no-show behavior, defined as having at least 1 scheduled appointment not attended and not canceled in advance. Logistic regression analyses assessed associations between ACE scores and missed appointments.

The sample was 91.9% Black, 44.0% male, with mean age 59.6 years. Average ACE score was 2.3, with 22.5% having ACE scores ≥ 4. Overall, 43.7% of patients had at least 1 no-show visit. ACE scores were not significantly associated with missed appointments (odds ratio, 1.01; 95% confidence interval, 0.89-1.14; P = .94). Medicaid insurance status was the only significant predictor in multivariable analysis (odds ratio, 2.15; 95% confidence interval, 1.07-4.30; P = .03).

Contrary to the authors' hypothesis, ACE scores were not associated with appointment adherence. Medicaid insurance status was the strongest predictor of no-show behavior, highlighting the impact of socioeconomic disadvantage on health care engagement.

Social determinants such as insurance status may have a stronger influence on appointment adherence than childhood trauma history. Findings underscore the need to address structural barriers in vulnerable populations.