Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults.
paper
Cited
Public
- Authors
- Peterson, Cora; Aslam, Maria V; Niolon, Phyllis H; Bacon, Sarah; Bellis, Mark A; Mercy, James A; Florence, Curtis
- Year
- 2023
- Journal
- JAMA network open
- PMID
- 38055277
- DOI
- 10.1001/jamanetworkopen.2023.46323
- PMCID
- PMC10701608
IMPORTANCE: Adverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk behaviors and worse health outcomes; the economic burden associated with these issues is uncertain. OBJECTIVE: To estimate the economic burden of ACE-associated health conditions among US adults. DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, regression models of cross-sectional survey data from the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and previous studies were used to estimate ACE population-attributable fractions (PAFs) (ie, the fraction of total cases associated with a specific exposure) for selected health outcomes (anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, and violence) and risk factors (heavy drinking, illicit drug use, overweight and obesity, and smoking) among the 2019 US adult population. Adverse childhood experience PAFs were used to calculate the proportion of total condition-specific medical spending and lost healthy life-years related to ACEs using Global Burden of Disease Study data. Data analysis was performed from September 10, 2021, to November 29, 2022. EXPOSURE: Adverse childhood experiences (age <18 years). MAIN OUTCOMES AND MEASURES: Monetary valuation of ACE-associated morbidity and mortality using standard US value of statistical life methods and presented in terms of annual and lifetime per affected person and total population estimates at the national and state levels. RESULTS: A total of 820 673 adults, representing 255 million individuals, participated in the BRFSS in 2019 and 2020. An estimated 160 million of the total 255 million US adult population (63%) had 1 or more ACE, associated with an annual economic burden of $14.1 trillion ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years). This was $88 000 per affected adult annually and $2.4 million over their lifetimes. The lifetime economic burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the total economic burden-the estimated per person lifetime economic burden for those adults was $4.0 million. CONCLUSIONS AND RELEVANCE: In this cross-sectional analysis of the US adult population, the economic burden of ACE-related health conditions was substantial. The findings suggest that measuring the economic burden of ACEs can support decision-making about investing in strategies to improve population health.
State-Level per Affected Person Lifetime Adverse Childhood Experience Economic Burden Among US Adults in 2019 US DollarseTable 6 in Supplement 1 reports underlying state-level data.
| # | Section | Preview |
|---|---|---|
| 20 | Discussion — Limitations | the estimated ACE annual economic burden to an average lifetime per-person economic burden assumed… |
| 21 | Conclusions | This economic evaluation observed that among the 63% of US adults who had 1 or more ACE, the… |
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| Name | Type |
|---|---|
| academic performance | phenotype |
| ACE count local | phenotype |
| Adult health conditions local | phenotype |
| adult health economic burden local | phenotype |
| Adult health outcomes local | phenotype |
| adverse childhood experience local | phenotype |
| Adverse childhood experience local | phenotype |
| adverse childhood experiences | phenotype |
| anxiety | phenotype |
| Arkansas local | cohort |
| arrest | phenotype |
| Arthritis local | phenotype |
| asthma | phenotype |
| Behavioral Risk Factor Surveillance System local | cohort |
| BRFSS local | cohort |
| BRFSS ACEs data local | cohort |
| BRFSS ACEs small area estimates local | cohort |
| California | cohort |
| cancer | phenotype |
| cardiovascular disease | phenotype |
| Childhood socioeconomic status local | phenotype |
| chronic disease | phenotype |
| chronic obstructive pulmonary disease | phenotype |
| crime | phenotype |
| DALY local | phenotype |
| DALY morbidity local | phenotype |
| death | phenotype |
| depression | phenotype |
| diabetes | phenotype |
| Disability-Adjusted Life Year local | phenotype |
| disease burden | phenotype |
| Economic burden local | phenotype |
| educational attainment | phenotype |
| emotional abuse | phenotype |
| employment | phenotype |
| European ancestry | cohort |
| extreme obesity | phenotype |
| Family Member Incarceration local | phenotype |
| Gastrointestinal conditions local | phenotype |
| Global Burden of Disease local | cohort |
| Global Burden of Disease (GBD) study local | cohort |
| health conditions local | phenotype |
| Health economic burden local | phenotype |
| Health outcomes | phenotype |
| Health risk factors local | phenotype |
| healthy life-year losses local | phenotype |
| heavy drinking | phenotype |
| High ACE exposure local | phenotype |
| Household Member Substance Use Disorder local | phenotype |
| illicit drug use | phenotype |
| incarceration | phenotype |
| individual ACEs local | phenotype |
| Infectious disease | phenotype |
| interpersonal violence local | phenotype |
| Kidney disease | phenotype |
| Lost healthy life-years local | phenotype |
| Low Household Socioeconomic Status local | phenotype |
| Maternal health outcomes local | phenotype |
| medical spending local | phenotype |
| Medical spending local | phenotype |
| mood disorders | phenotype |
| mortality | phenotype |
| Musculoskeletal conditions local | phenotype |
| North America | cohort |
| North Dakota local | cohort |
| obesity | phenotype |
| overweight | phenotype |
| overweight or obesity local | phenotype |
| Overweight or obesity local | phenotype |
| parental divorce/separation | phenotype |
| physical abuse | phenotype |
| quality and number of life-years local | phenotype |
| Race and ethnicity local | cohort |
| Race and ethnicity local | phenotype |
| Risk factors for ill health local | phenotype |
| self-harm | phenotype |
| Self-reported disability local | phenotype |
| smoking | phenotype |
| Smoking-related disability local | phenotype |
| social deprivation | phenotype |
| States local | cohort |
| stroke | phenotype |
| substance use | phenotype |
| suicide | phenotype |
| Total disease burden local | phenotype |
| trauma | phenotype |
| unemployment | phenotype |
| United Kingdom | cohort |
| United States | cohort |
| US Centers for Medicare & Medicaid Services local | cohort |
| US Department of Health and Human Services local | cohort |
| Violence perpetration local | phenotype |
| Witnessing Intimate Partner Violence local | phenotype |
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