Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population

J Health Care Poor Underserved. 2019;30(2):749-767. doi: 10.1353/hpu.2019.0054.


Objective: To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population.

Methods: Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Southeastern states. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were computed.

Results: The percentages reporting emergency room visits and doctor's office visits, with high chronic disease index scores, rose monotonically (ptrend<.001) with rising ACE score. Odds ratios (CIs) for those with four or more vs. zero ACEs were 1.37 (95% CI 1.27-1.47) for 1-10 times and 1.80 (95% CI 1.29-2.52) for more than 10 times ER visits, 1.37 (95% CI 1.18-1.59) for over 10 doctor's visits, and 2.29 (95% CI 2.06-2.54) for three or more chronic diseases.

Conclusions: High ACE levels were associated with greater chronic disease burden and greater health care utilization in adulthood. Long-lasting effects from ACE on the health care of underserved populations are indicated. There is an urgent need to train health care providers, patients, and their families on ACE effects and treatments for better health care outcomes.

MeSH terms

  • Adult
  • Adverse Childhood Experiences / statistics & numerical data*
  • Aged
  • Chronic Disease / epidemiology
  • Chronic Disease / therapy
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Office Visits / statistics & numerical data
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Poverty / statistics & numerical data*
  • Southeastern United States / epidemiology
  • Surveys and Questionnaires