Department of Management, Policy and Community Health University of Texas Health Science Center at Houston, USA.
Johns Hopkins Bloomberg School of Public Health Johns Hopkins University, USA.
Soc Sci Med. 2022 Dec;314:115194. doi: 10.1016/j.socscimed.2022.115194. Epub 2022 Jul 5.
Adverse childhood experiences (ACEs) negatively impact health over the life-course. Yet, compared to the robust literature on the consequences for ACEs for health, substantially fewer studies assess the implications of exposure to ACEs for health insurance status and health care utilization in adulthood.
To assess the association between accumulating ACEs and (1) an individual's health insurance status, and (2) usual source of care, as well as examine the mediating role of adult socioeconomic status.
Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 8,757). Multinomial logistic regression is used to assess the relationship between ACEs and health insurance status and the usual source of care.
Net of control and mediating variables, accumulating exposure to ACEs -particularly four or more ACEs- is associated with a higher likelihood of being uninsured and utilizing the emergency room as the usual source of care. Adult socioeconomic status including educational attainment, household income, employment status, and being uninsured-in the case of usual source of care-substantially mediates these associations.
ACEs carry negative repercussions for health insurance and patterns of healthcare utilization that spans into adulthood, and this is largely driven by poor adult socioeconomic status.
不良的儿童期经历（ACEs）会对人的一生的健康产生负面影响。然而，相较于 ACEs 对健康影响的大量文献，评估 ACEs 暴露对成年人健康保险状况和医疗保健利用的影响的研究要少得多。
评估累积 ACEs 与（1）个人健康保险状况，以及（2）常规医疗服务来源之间的关联，并检验成年社会经济地位的中介作用。
数据来自青少年至成人健康纵向研究（N=8757）。采用多项逻辑回归来评估 ACEs 与健康保险状况和常规医疗服务来源之间的关系。
在控制和中介变量的基础上，累积 ACEs 暴露——尤其是四种或更多 ACEs——与更高的未参保率和将急诊室作为常规医疗服务来源的可能性相关。包括教育程度、家庭收入、就业状况和未参保状况（在常规医疗服务来源的情况下）在内的成年社会经济地位在很大程度上中介了这些关联。
ACEs 对健康保险和医疗保健利用模式产生负面影响，这种影响会持续到成年期，而这主要是由较差的成年社会经济地位导致的。
