Adverse childhood experiences were associated with a total annual economic burden of $14.1 trillion (comprising $183 billion in medical spending and $13.9 trillion in lost healthy life-years) for adult health conditions related to ACEs (Table 2). Largely corresponding with population size, ACE total annual economic burden was lowest in North Dakota ($15 billion) and highest in California ($1.5 trillion) (eTable 6 in Supplement 1). The ACE per person annual economic burden was $88 000 per affected adult and $2.4 million over their lifetime; lifetime burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million) (Figure; eTable 6 in Supplement 1). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the US total economic burden; per person economic burden estimates for those adults were correspondingly far higher ($4.0 million, range by state: $2.6 million in North Dakota to $6.8 million in Arkansas) (eTable 6 in Supplement 1).
