Okwori Glory, Stewart Steven, Quinn Megan, Lawson Delaney
Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN USA.
Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN USA.
J Child Adolesc Trauma. 2021 Aug 18;15(3):727-739. doi: 10.1007/s40653-021-00390-w. eCollection 2022 Sep.
To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (< .0001). ACEs' exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.
估算2017年田纳西州（TN）和弗吉尼亚州（VA）与童年不良经历（ACEs）暴露相关疾病的归因负担和成本。这是一项利用行为风险因素监测系统（BRFSS）数据对18岁及以上有ACEs暴露经历个体的横断面研究。分析了与ACEs相关的八种慢性病（哮喘、肥胖、高血压、糖尿病、慢性阻塞性肺疾病（COPD）、抑郁症、心血管疾病和关节炎）以及两种风险因素（吸烟和饮酒）。采用Pearson卡方检验分析ACEs、风险因素与慢性病之间的关联。估算了ACEs相关疾病和风险因素的人群归因风险（PAR），并结合医疗费用和伤残调整生命年（DALYs）进行分析。在TN州至少经历过1次ACEs的人群中，10%患有COPD，17%患有糖尿病，36%患有肥胖症，30%患有抑郁症。与未经历过ACEs的人群相比，VA州至少经历过1次ACEs的个体患COPD、肥胖症和抑郁症的比例更高（<0.0001）。ACEs暴露在TN州和VA州分别导致约11.5万年和12.7万年的DALYs负担。基于PARs，TN州和VA州与ACEs相关的医疗总支出分别约为6.47亿美元（每位成年人165美元）和9.42亿美元（每位成年人292美元）。TN州和VA州与ACEs相关的总成本分别约为155亿美元（每人3948美元）和202亿美元（每人6288美元）。本研究强调了由于高健康成本和财务成本而减少ACEs的必要性。
