All states face a substantial economic burden of both direct medical spending and economic loss from reduced healthy life-years for ACE-associated adult health conditions. The variation in states’ estimated ACE economic burden is associated with each state’s total disease burden (eg, smoking-related disability and mortality) and its association with ACEs among adults in the state. State-level variation is expected in that subsequent life experiences, public health or medical interventions, or other contributing factors can mitigate the link between ACEs and adult health. Childhood adversity may be reduced through targeted strategies that create and sustain safe, stable, nurturing relationships and environments for all children and families, and focus the greatest attention on populations and communities that are most likely to experience multiple forms of adversity.
