Childhood Adversity and Adult Chronic Disease

An Update from Ten States and the District of Columbia, 2010
Published:October 06, 2014DOI:


      Adverse childhood experiences (ACEs), including child abuse and family dysfunction, are linked to leading causes of adult morbidity and mortality. Most prior ACE studies were based on a nonrepresentative patient sample from one Southern California HMO.


      To determine if ACE exposure increases the risk of chronic disease and disability using a larger, more representative sample of adults than prior studies.


      Ten states and the District of Columbia included an optional ACE module in the 2010 Behavioral Risk Factor Surveillance Survey, a national cross-sectional, random-digit-dial telephone survey of adults. Analysis was conducted in November 2012. Respondents were asked about nine ACEs, including physical, sexual, and emotional abuse and household member mental illness, alcoholism, drug abuse, imprisonment, divorce, and intimate partner violence. An ACE score was calculated for each subject by summing the endorsed ACE items. After controlling for sociodemographic variables, weighted AORs were calculated for self-reported health conditions given exposure to zero, one to three, four to six, or seven to nine ACEs.


      Compared to those who reported no ACE exposure, the adjusted odds of reporting myocardial infarction, asthma, fair/poor health, frequent mental distress, and disability were higher for those reporting one to three, four to six, or seven to nine ACEs. Odds of reporting coronary heart disease and stroke were higher for those who reported four to six and seven to nine ACEs; odds of diabetes were higher for those reporting one to three and four to six ACEs.


      These findings underscore the importance of child maltreatment prevention as a means to mitigate adult morbidity and mortality.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Felitti V.J.
        • Anda R.F.
        • Nordenberg D.
        • et al.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study.
        Am J Prev Med. 1998; 14: 245-258
        • Brown D.W.
        • Anda R.F.
        • Tiemeier H.
        • et al.
        Adverse childhood experiences and the risk of premature mortality.
        Am J Prev Med. 2009; 37: 389-396
        • Kelly-Irving M.
        • Lepage B.
        • Dedieu D.
        • et al.
        Adverse childhood experiences and premature all-cause mortality.
        Eur J Epidemiol. 2013; 28: 721-734
        • Shonkoff J.P.
        • Boyce W.T.
        • McEwen B.S.
        Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention.
        JAMA. 2009; 301: 2252-2259
        • Sterling P.
        • Eyer J.
        Allostasis: a new paradigm to explain arousal pathology.
        in: Fisher J. Reason J. Handbook on life stress, cognition, and health. John Wiley & Sons Inc, New York NY1988
        • McEwen B.S.
        Brain on stress: how the social environment gets under the skin.
        Proc Natl Acad Sci U S A. 2012; 109: 17180-17185
      1. Center on the Developing Child at Harvard University. The science of neglect: the persistent absence of responsive care disrupts the developing brain: Working paper 12. 2012.

        • Rogosch F.A.
        • Dackis M.N.
        • Cicchetti D.
        Child maltreatment and allostatic load: consequences for physical and mental health in children from low-income families.
        Dev Psychopathol. 2011; 23: 1107-1124
        • Finkelhor D.
        • Shattuck A.
        • Turner H.
        • Hamby S.
        Improving the Adverse Childhood Experiences Study Scale.
        JAMA Pediatr. 2013; 167: 70-75