Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis

Child Abuse Negl. 2019 Nov:97:104127. doi: 10.1016/j.chiabu.2019.104127. Epub 2019 Aug 24.


Background: The Center for Disease Control (CDC) and Kaiser Permanente developed the Adverse Childhood Experiences (ACE) scale to identify negative experiences in childhood. The goal of this study is to systematically review outcomes associated with the ACEs in the CDC-Kaiser ACE scale to understand the diversity of outcomes associated with this scale.

Methods: The authors conducted a search of English language articles published through September 30, 2016 using OVID Medline®; Ovid Medline® Daily; Epub Ahead of Print, In-Process & Other Non-indexed citations; ERIC®; HAPI®; and SCOPUS®. Articles were selected by trained reviewers based on a priori inclusion criteria including: research, healthy sample, used the CDC-Kaiser ACE scale, and assessed some health outcome. Two reviewers used an abstraction form to independently collect data from each study. Unadjusted and adjusted odds ratio associated with ACE scale scores were aggregated and compared.

Results: From 3167 unique titles, we identified 96 articles that assessed health outcomes associated with the ACEs in the CDC-Kaiser ACE scale. There were more studies focusing on psychosocial/behavioral outcomes than medical outcomes. The majority of the included studies were retrospective, observational, and relied on the same data set. Psychosocial/behavioral outcomes had higher odds ratio than medical outcomes with increasing ACE scale scores.

Conclusions: Exposure to multiple ACEs is associated with a wide variety of outcomes. This data suggests a benefit of screening for ACEs using this scale and highlights the need to find interventions to ameliorate their effects.

Keywords: Adverse childhood experiences; CDC-Kaiser ACE scale.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Adverse Childhood Experiences / statistics & numerical data*
  • Child
  • Child Abuse / psychology*
  • Child, Preschool
  • Female
  • Health Status*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Observational Studies as Topic
  • Psychiatric Status Rating Scales
  • Retrospective Studies
  • Young Adult