Adverse Childhood Experiences and Preventable Chronic Disease: Findings from the 2014 South Carolina Behavioral Risk Factor Surveillance System Survey

Background and Purpose: Preventable chronic diseases are among the leading causes of death and have an economic impact of $1.3 trillion annually. Adverse childhood experiences (ACEs) have long-term health implications with extant research suggesting a dose-response relationship between ACEs and health outcomes. Prior research suggests that ACEs may contribute to familial and intergenerational risk for both ACEs and chronic disease. Given the intergenerational implications for identification and prevention of ACEs and chronic disease, this study examined the prevalence and association of ACE and preventable chronic diseases among South Carolina (SC) residents.

Methods: 2014 SC Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using a sample of SC adults (≥18 years, n=10,621) who completed core BRFSS questions and the ACE module.  SAS SURVEYFREQ and SURVEYLOGISTIC were used to estimate weighted prevalence and adjusted odds ratios for the association between ACEs and preventable chronic diseases. ACE variables included: ACE (yes/no), ACE category (household dysfunction or abuse), and ACE score (0, 1, 2, 3, 4+). Chronic disease variables captured lifetime prevalence (yes/no) of heart disease, heart attack, stroke, skin/other cancer, diabetes, arthritis, asthma, chronic obstructive pulmonary disorder (COPD), and kidney disease.

Results: In 2014, 52% of respondents reported at least one chronic disease and 62% reported at least one ACE. For every chronic disease variable except skin cancer, individuals exposed to ACEs had higher prevalence than those with no ACEs. Sixty-nine percent of those reporting asthma, COPD, and kidney disease also reported ACEs. Respondents with asthma (25%) and COPD (27%) had the highest prevalence of 4+ ACEs. Among respondents reporting abuse, COPD (50%) and kidney disease (47%) were the most prevalent; among those reporting household dysfunction, asthma (57%), COPD (54%), and kidney disease (53%) were the most prevalent. After controlling for socio-demographics (sex, race, income, age) and access to care (recent checkup, personal doctor, healthcare coverage), logistic regression revealed that compared to those with no ACEs, respondents reporting ACEs had increased odds of COPD (AOR=1.7, 95% CI 1.4-2.1), kidney disease (AOR=1.5, 95% CI 1.1-2.1), heart disease (AOR=1.4, 95% CI 1.1-1.8), and arthritis (AOR=1.4, 95% CI 1.2-1.6); respondents reporting abuse had increased odds of asthma (AOR=1.3, 95% CI 1.1-1.6), COPD (AOR=2.1, 95% CI 1.7-2.6), and arthritis (AOR=1.5, 95% CI 1.3-1.7); respondents reporting household dysfunction had increased odds of asthma (AOR=1.2, 95% CI 1.1-1.5), COPD (AOR=1.6, 95% CI 1.3-2.0), heart disease (AOR=1.4, 95% CI 1.1-1.8), heart attack (AOR=1.4, 95% CI 1.1-1.9), and arthritis (AOR=1.4, 95% CI 1.2-1.6); respondents reporting 4+ ACEs had increased odds for asthma (AOR=1.5, 95% CI 1.2-2.0), COPD (AOR=2.5, 95% CI 1.9-3.4), and arthritis (AOR=2.1, 95% CI 1.7-2.7).

Conclusions and Implications: SC residents exposed to ACEs have higher prevalence of chronic disease compared to those with no ACEs. The associations between ACEs and chronic diseases vary by ACE exposure, ACE category, and ACE score.  These findings coupled with emergent research on the intergenerational transmission of health risks for those exposed to ACEs suggests future research should focus on the intergenerational effects of ACEs on health.