Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
Department of Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California.
Am J Prev Med. 2019 May;56(5):698-707. doi: 10.1016/j.amepre.2018.11.019. Epub 2019 Mar 21.
Adverse childhood experiences are associated with higher risk of common chronic mental and physical illnesses in adulthood, but little evidence exists on whether this influences medical costs or expenses. This study estimated increases in household medical expenses associated with adults' reported adverse childhood experience scores.
Household out-of-pocket medical cost and adverse childhood experience information was collected in the 2011 and 2013 waves of the Panel Study of Income Dynamics and its linked 2014-2015 Panel Study of Income Dynamics Childhood Retrospective Circumstances Study supplement and analyzed in 2017. Generalized linear regression models estimated adjusted annual household out-of-pocket medical cost differences by retrospective adverse childhood experience count and compared costs by family type and size. Logistic models estimated odds of out-of-pocket costs that were >10% of household income or >100% of savings, as well as odds of household debt.
Adverse childhood experience scores were associated with higher out-of-pocket costs. Annual household total out-of-pocket medical costs were $184 (95% CI=$90, $278) or 1.18-fold higher when respondents reported one to two adverse childhood experiences and $311 (95% CI=$196, $426) or 1.30-fold higher when three or more adverse childhood experiences were reported by an adult in the household. Odds of household medical costs >10% of income, >100% of savings, and the presence of household medical debt were 2.48-fold (95% CI=1.40, 4.38), 2.25-fold (95% CI=1.69, 2.99), and 2.29-fold (95% CI=1.56, 3.34) higher when an adult in the household reported three or more adverse childhood experiences compared with none.
Greater exposure to adverse childhood experiences is associated with higher household out-of-pocket medical costs and financial burden in adulthood.
不良的童年经历与成年人常见的慢性精神和身体疾病的风险增加有关，但几乎没有证据表明这会影响医疗费用。本研究估计了与成年人报告的不良童年经历得分相关的家庭医疗支出的增加。
家庭自付医疗费用和不良童年经历信息是在收入动态面板研究的 2011 年和 2013 年以及与其相关的 2014-2015 年收入动态面板研究儿童回顾性情况研究补充调查中收集的，并在 2017 年进行了分析。广义线性回归模型根据回顾性不良童年经历计数估计了调整后的年度家庭自付医疗费用差异，并按家庭类型和规模比较了成本。Logistic 模型估计了自付费用超过家庭收入 10%或超过储蓄 100%的可能性，以及家庭债务的可能性。
不良童年经历得分与更高的自付费用相关。当报告一到两个不良童年经历时，家庭总自付医疗费用为 184 美元（95%CI=90 美元，278 美元）或 1.18 倍，当家庭中的成年人报告三到多个不良童年经历时，家庭总自付医疗费用为 311 美元（95%CI=196 美元，426 美元）或 1.30 倍。当家庭中的成年人报告三到多个不良童年经历时，家庭医疗费用超过收入的 10%、超过储蓄的 100%以及存在家庭医疗债务的可能性分别是无不良童年经历的 2.48 倍（95%CI=1.40，4.38）、2.25 倍（95%CI=1.69，2.99）和 2.29 倍（95%CI=1.56，3.34）。
更多地接触不良的童年经历与成年人更高的家庭自付医疗费用和经济负担有关。
