Adverse Childhood Experiences and Chronic Disease Risk in the Southern Community Cohort Study

J Health Care Poor Underserved. 2021;32(3):1384-1402. doi: 10.1353/hpu.2021.0139.


We used the Southern Community Cohort Study of people residing in 12 states in the southeastern United States (n=38,200 participants) to examine associations between adverse childhood experiences (ACEs) and chronic disease risk. After adjustment for confounding, there were statistically significant positive associations for people reporting four or more ACEs relative to those reporting no ACEs, and this was true for all chronic diseases except hypertension. The most elevated risk was seen for depression when measured as a yes/no variable (odds ratio (OR) 2.84, 95% confidence interval (CI) 2.64-3.06) or when using the 10-item Center for Epidemiologic Student Depression (CESD) scale (OR 1.88, 95% CI 1.75-2.02). There were also statistically significant monotonic increases in risk with worsening ACE score for all chronic diseases except hypertension, cancer, and high cholesterol. The need to establish programs that build resilience during childhood is paramount for preventing chronic diseases that may result from childhood abuse, neglect, and household dysfunction.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adverse Childhood Experiences*
  • Child
  • Child Abuse*
  • Chronic Disease
  • Cohort Studies
  • Family Characteristics
  • Humans