ACEs (Table 2). For example, the AOR for smoking among adults with 4 or more ACEs was 6.48 (95% CI, 6.20-6.78), indicating that adults with that ACE count were more than 6 times as likely to smoke as other adults. Depression had the highest (78%) and overweight or obesity had the lowest (3%) ACE PAF among US adults (Table 2; state-level data in eTable 3 in Supplement 1). As expected, ACE PAFs for health outcomes when adjusted for all other analyzed health outcomes were consistently lower than unadjusted PAFs. For example, controlling for heart disease, diabetes, and all other analyzed health conditions, the adjusted ACE PAF for stroke indicated that ACEs were associated with an estimated 10% of stroke prevalence compared with an unadjusted estimate of 21% (Table 2). The estimated annual ACE DALY economic burden by health condition was highest for smoking; ACEs were associated with 55% of smoking among US adults, with an annual DALY economic burden of $4.1 trillion (Table 2; eTable 4 in Supplement 1). The estimated annual ACE medical spending burden by health condition was highest for depression, with annual medical spending of $50 billion (Table 2; eTable 5 in Supplement 1).
