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

2019 ◽  
Vol 25 (10) ◽  
pp. 1700-1710 ◽  
Author(s):  
Kelcie M Witges ◽  
Charles N Bernstein ◽  
Kathryn A Sexton ◽  
Tracie Afifi ◽  
John R Walker ◽  
...  

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.

2017 ◽  
Vol 22 (3) ◽  
pp. 168-177 ◽  
Author(s):  
Mark Bellis ◽  
Karen Hughes ◽  
Katie Hardcastle ◽  
Kathryn Ashton ◽  
Kat Ford ◽  
...  

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.


2018 ◽  
Vol 25 (6) ◽  
pp. 514-520 ◽  
Author(s):  
Angie S Guinn ◽  
Katie A Ports ◽  
Derek C Ford ◽  
Matt Breiding ◽  
Melissa T Merrick

Adverse childhood experiences (ACEs) can negatively affect lifelong health and opportunity. Acquired brain injury (ABI), which includes traumatic brain injury (TBI) as well as other causes of brain injury, is a health condition that affects millions annually. The present study uses data from the 2014 North Carolina Behavioral Risk Factor Surveillance System to examine the relationship between ACEs and ABI. The study sample included 3454 participants who completed questions on both ABI and ACEs. Multivariable logistic regression models were used to determine the relationship between ACEs and ABI as well as ACEs and TBI. Sexual abuse, emotional abuse, physical abuse, household mental illness and household substance abuse were significantly associated with ABI after adjusting for age, race/ethnicity, gender and employment. Compared with those reporting no ACEs, individuals reporting three ACEs had 2.55 times the odds of having experienced an ABI; individuals reporting four or more ACEs had 3.51 times the odds of having experienced an ABI. Examining TBI separately, those who experienced sexual abuse, physical abuse, household mental illness and had incarcerated household members in childhood had greater odds of reported TBI, after adjusting for age, race/ethnicity, gender and income. Respondents reporting three ACEs (AOR=4.16, 95% CI (1.47 to 11.76)) and four or more ACEs (AOR=3.39, 95% CI (1.45 to 7.90)) had significantly greater odds of reporting TBI than respondents with zero ACEs. Prevention of early adversity may reduce the incidence of ABI; however, additional research is required to elucidate the potential pathways from ACEs to ABI, and vice versa.


Author(s):  
Lei Zhang ◽  
Dandan Zhang ◽  
Ying Sun

The association between adverse childhood experiences (ACEs) and pubertal timing has been a topic of enduring controversy. A systematic search of PubMed and Web of Science databases was undertaken to quantify the magnitude of total and specific forms of ACEs effects on early pubertal timing among girls. Our search identified 3280 records, of which 43 studies with 46 independent data sets met inclusion criteria. We estimated pooled effect sizes (Cohen’s ds) for the association between ACEs with early pubertal timing. Total ACEs was not associated with early pubertal timing. When we examined the specific types of ACEs, associations were small to medium for father absence (d = −0.40, 95% confidence interval [CI]: −0.63, −0.16) and small for sexual abuse (d = −0.13, CI: −0.17, −0.10) and family dysfunction (d = −0.08, CI: −0.11, −0.02). We identified considerable heterogeneity between estimates for almost all of the outcomes. ACEs exposure may affect female reproductive reproduction, particularly father absence, sexual abuse, and family dysfunction. We propose that future research in this area test a theoretical model linking adversity with earlier reproductive strategy, which includes early pubertal timing as a core component linking early adversity and stress physiology with poor health outcomes later in life in females.


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