Adverse childhood experiences and the onset of chronic disease in young adulthood

Prev Med. 2019 Jun;123:163-170. doi: 10.1016/j.ypmed.2019.03.032. Epub 2019 Mar 20.


This study examined the association of adverse childhood experiences (ACEs) with early-onset chronic conditions. We analyzed data from the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS), which included 86,968 respondents representing a nine-state adult population of 32 million. ACE questions included physical, emotional, and sexual abuse; substance use, mental illness or incarceration of a household member; domestic violence, and parental separation. Outcomes included chronic conditions (cardiovascular disease, chronic obstructive pulmonary disease, cancer, depression, diabetes, and prediabetes); overall health status; and days of poor mental or physical health in the past month. We estimated Poisson regression models of the likelihood of chronic conditions and poor health status comparing adults reporting ≥4 ACEs to respondents with no ACEs within three age strata: 18-34, 35-54 and ≥55 years. The prevalence of ≥4 ACEs was highest among youngest respondents (19%). There was a dose-response gradient between ACE scores and outcomes except for cancer in older adults. Among younger respondents, those reporting ≥4 ACEs had two to four times the risk for each chronic condition and poor health status compared to respondents reporting no ACEs. With few exceptions (depression, poor mental and physical health in the past month), incidence rate ratios were highest in young adults and successively decreased among older adults. This study is among the first to analyze patterns of association between ACEs and adult health disaggregated by age. Young adults with high ACE scores are at increased risk of early-onset chronic disease. Trauma-informed care and ACEs prevention are crucial public health priorities.

Keywords: Adverse childhood experiences; Behavioral risk factor surveillance system; Chronic disease; Health disparities; Health status; Self-rated health; Young adult.

MeSH terms

  • Adolescent
  • Adult
  • Adverse Childhood Experiences / statistics & numerical data*
  • Behavioral Risk Factor Surveillance System
  • Cardiovascular Diseases / epidemiology*
  • Child
  • Chronic Disease / epidemiology*
  • Cross-Sectional Studies
  • Depressive Disorder / epidemiology
  • Diabetes Mellitus / epidemiology
  • Domestic Violence / statistics & numerical data
  • Female
  • Health Status
  • Health Status Disparities*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / epidemiology
  • Prevalence
  • Public Health
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Risk Assessment
  • Substance-Related Disorders / epidemiology
  • Surveys and Questionnaires*
  • United States
  • Young Adult