This analysis assessed the association between ACEs and adult health conditions using self-reported survey data; survey measurement bias, confounding, and reporting bias could have affected the results. The BRFSS does not include institutionalized respondents. Parental separation is typically assessed as an ACE and, even in the absence of other ACEs, has been associated with a range of negative life course outcomes.37 However, it is discordant to discuss parental separation in terms of a preventable public health issue in the same manner as other ACEs. Burden estimates by health condition were based on available data for each condition as defined in reference sources and may not reflect total costs; for example, medical spending on overweight or obesity was operationalized as the cost of morbid obesity (the best available estimate for data source consistency but likely an overestimate of unit cost). Converting the estimated ACE annual economic burden to an average lifetime per-person economic burden assumed that population-level association between ACEs and adult health outcomes remains constant over adult lifetimes. Adverse childhood experience PAFs were used in combination with total DALY burden
