Racial/Ethnic Disparities in Health Care Access Are Associated with Adverse Childhood Experiences

Introduction Children exposed to adverse childhood experiences (ACEs) may access multiple systems of care to address medical and social complexities. Care coordination (CC) optimizes health outcomes for children with special health care needs who often use multiple systems of care. Little is known about whether ACEs are associated with the need and unmet need for CC. Methods Use of the 2016–2017 National Survey of Children’s Health to identify children who saw ≥1 health care provider in the last 12 months. The study team used weighted logistic regression analyses to examine associations between 9 ACE types, ACE score, and need and unmet need for CC. Results In the sample ( N = 39,219, representing 38,316,004 US children), material hardship (adjusted odds ratio (aOR), 1.50; 95% confidence interval (CI), 1.29–1.75), parental mental illness (aOR, 1.31; 95% CI, 1.07–1.60), and neighborhood violence (aOR, 1.33; 95% CI, 1.01–1.74) were significantly associated with an increased need for CC. Material hardship was also associated with an unmet need for CC (aOR, 2.37; 95% CI, 1.80–3.11). Children with ACE scores of 1, 2, 3, and ≥4 had higher odds of need and unmet need for CC than children with 0 ACEs. Discussion Specific ACE types and higher ACE scores were associated with the need and unmet need for CC. Evaluating the unique needs of children who endured ACEs should be considered in the design and implementation of CC processes in the pediatric health care system.

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The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study

Journal of Health Services Research & Policy ◽

10.1177/1355819617706720 ◽

2017 ◽

Vol 22 (3) ◽

pp. 168-177 ◽

Cited By ~ 27

Author(s):

Mark Bellis ◽

Karen Hughes ◽

Katie Hardcastle ◽

Kathryn Ashton ◽

Kat Ford ◽

...

Keyword(s):

Health Care ◽

Life Course ◽

Hospital Stay ◽

Adverse Childhood Experiences ◽

Service Use ◽

Health Care Use ◽

Life Course Perspective ◽

Childhood Experiences ◽

Adverse Childhood ◽

The Impact

Objectives The lifelong health impacts of adverse childhood experiences are increasingly being identified, including earlier and more frequent development of non-communicable disease. Our aim was to examine whether adverse childhood experiences are related to increased use of primary, emergency and in-patient care and at what ages such impact is apparent. Methods Household surveys were undertaken in 2015 with 7414 adults resident in Wales and England using random probability stratified sampling (age range 18–69 years). Nine adverse childhood experiences (covering childhood abuse and household stressors) and three types of health care use in the last 12 months were assessed: number of general practice (GP) visits, emergency department (ED) attendances and nights spent in hospital. Results Levels of use increased with increasing numbers of adverse childhood experiences experienced. Compared to those with no adverse childhood experiences, odds (±95% CIs) of frequent GP use (≥6 visits), any ED attendance or any overnight hospital stay were 2.34 (1.88–2.92), 2.32 (1.90–2.83) and 2.67 (2.06–3.47) in those with ≥ 4 adverse childhood experiences. Differences were independent of socio-economic measures of deprivation and other demographics. Higher health care use in those with ≥ 4 adverse childhood experiences (compared with no adverse childhood experiences) was evident at 18–29 years of age and continued through to 50–59 years. Demographically adjusted means for ED attendance rose from 12.2% of 18-29 year olds with no adverse childhood experiences to 28.8% of those with ≥ 4 adverse childhood experiences. At 60–69 years, only overnight hospital stay was significant (9.8% vs. 25.0%). Conclusions Along with the acute impacts of adverse childhood experiences on child health, a life course perspective provides a compelling case for investing in safe and nurturing childhoods. Disproportionate health expenditure in later life might be reduced through childhood interventions to prevent adverse childhood experiences.

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Racial/Ethnic Differences in the Impact of Adverse Childhood Experiences on Posttraumatic Stress Disorder in a Nationally Representative Sample of Adolescents

Child and Adolescent Social Work Journal ◽

10.1007/s10560-018-0585-x ◽

2018 ◽

Vol 36 (5) ◽

pp. 449-457 ◽

Cited By ~ 3

Author(s):

Jennifer Elkins ◽

Harold E. Briggs ◽

Keva M. Miller ◽

Irang Kim ◽

Roberto Orellana ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Ethnic Differences ◽

Adverse Childhood Experiences ◽

Stress Disorder ◽

Childhood Experiences ◽

Adverse Childhood ◽

Nationally Representative ◽

The Impact ◽

Racial Ethnic

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The Relationship Between Adverse Childhood Experiences and Health Care Use in the Manitoba IBD Cohort Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz054 ◽

2019 ◽

Vol 25 (10) ◽

pp. 1700-1710 ◽

Cited By ~ 3

Author(s):

Kelcie M Witges ◽

Charles N Bernstein ◽

Kathryn A Sexton ◽

Tracie Afifi ◽

John R Walker ◽

...

Keyword(s):

Health Care ◽

Sexual Abuse ◽

Cohort Study ◽

Prescription Drugs ◽

Adverse Childhood Experiences ◽

Health Care Use ◽

Severe Illness ◽

Childhood Experiences ◽

Physician Visits ◽

Adverse Childhood

Abstract Background We aimed to determine the prevalence of adverse childhood experiences (ACEs) in persons with inflammatory bowel disease (IBD) and whether having ACEs was associated with health care utilization post-IBD diagnosis. Method Three hundred forty-five participants from the population-based Manitoba IBD Cohort Study self-reported ACEs (ie, physical abuse, sexual abuse, death of a very close friend or family member, severe illness or injury, upheaval between parents, and any other experience thought to significantly impacts one’s life or personality) at a median of 5.3 years following IBD diagnosis. Cohort study data were linked to administrative health databases that captured use of hospitals, physician visits, and prescription drugs; use was classified as IBD-related and non-IBD-related. Mean annual estimates of health care use were produced for the 60-month period following the ACE report. Generalized linear models (GLMs) with generalized estimating equations (GEEs) with and without covariate adjustment were fit to the data. Results The prevalence of at least 1 ACE was 74.2%. There was no statistically significant association between having experienced an ACE and health care use. However, unadjusted mean annual non-IBD-related general practitioner visits were significantly higher for participants exposed to physical and sexual abuse than those not exposed. Selected adjusted rates of IBD-related health care use were lower for participants who reported exposure to an upheaval between parents and high perceived trauma from ACEs. Conclusion The estimated prevalence of at least 1 self-reported ACE in persons with diagnosed IBD was high. Health care use among those who experienced ACEs may reflect the impacts of ACE on health care anxiety.

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