This study has limitations. The results describe an economic burden of adult health conditions associated with but not definitively and exclusively caused by ACEs. The BRFSS offers population-based US survey data on ACEs among adults but limited analytic opportunities to control for non-ACE factors, for example, environmental or economic, during childhood that also affect adult health. This study controlled for adults’ employment status and educational attainment but not similar household characteristics during childhood. Low household socioeconomic status is associated with both ACEs (eg, parental separation, substance use disorder, and family member incarceration) and adult health conditions analyzed in this study (eg, chronic obstructive pulmonary disease and asthma) by way of factors such as greater exposure to poor air quality among households with lower socioeconomic status. Further interrogation of the association between ACEs and adult health outcomes independent of childhood socioeconomic and other factors is important.
