Exploring the Relationship Among Disability, Adverse Childhood Experiences, and Health

Background and Purpose

Since 1998, extensive research has documented the pervasiveness of adverse childhood experiences (ACEs) and their dose-response effect on poorer health outcomes in adulthood. Despite two decades of inquiry, little is known about the impact of ACEs for people with disabilities (PWD). This is concerning as PWD have higher rates of chronic health conditions and mortality and less access to preventative healthcare. The need for additional research among PWD is further necessitated by their increased exposure to maltreatment and increased vulnerability to traumatic sequelae. The current study explores the relationships among disability, ACEs, and physical health.

Methods

A secondary data analysis was conducted using the 2018 Behavioral Risk Factor Surveillance System data for one midwestern state. A total of 6,483 persons participated in the survey. A majority of the sample was 65 years or older (n = 2,714, 41.9%), female (n = 3,780, 58.5%), and White, Non-Hispanic (n = 5,436, 85.3%). Approximately 35% of the sample (n = 2,301) indicated having a disability. Disability status was assessed via functional limitations in six categories. ACEs were assessed using 11 items related to childhood adversity. Perception of physical health was assessed by the number of days in the past month that physical health was poor. Relationships among variables were examined using correlations and independent t-tests. A hierarchical regression model examined the cumulative explanatory power of each set of variables- (a) demographics; (b) disability status; (c) high ACE exposure (≥ 3 ACEs); and (d) the interaction between disability and high ACE exposure to predict perceived quality of physical health.

Results

Significant differences between PWD and those without disabilities were noted for ACEs (t(5965) = -11.47, p < 0.001; Hedges’ g = .31) and physical health (t(6334) = -37.43, p < 0.001; Hedge’s g = .99). PWD had higher ACE scores (M = 1.72, SD = 1.99) and more days with poorer physical health (M = 10.29, SD = 12.14) than those without a disability (M = 1.18, SD =1.60; M = 1.94, SD = 5.58; respectively). Results of the final regression model were statistically significant [F(8, 4661) = 161.91, p < 0.001, adj R² = .216]. The interaction between disability and high ACE exposure significantly predicted poorer physical health. PWD and high ACE exposure had approximately 2.31 more days of poor physical health in the past month above and beyond only having a disability.

Conclusion and Implications

Although PWD experience a greater number of days in poorer health, these outcomes are exacerbated by exposure to ACEs. A better understanding of the relationship between disability and childhood adversity and the impact on health is a critical step forward in improving the quality of life for PWD. Although social work is uniquely situated to understand the complexities of adversity and disability, PWD have rarely been at the forefront of the profession’s discourse. Further exploration of the impact of adversity on health among PWD is needed to shape health-related services and promote social change.