Jemiyo Christianah, McGregor Brett A, Rehana Hasin, Hur Junguk
Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, 58202, USA.
BMC Public Health. 2025 May 5;25(1):1650. doi: 10.1186/s12889-025-22785-2.
Recent evidence suggests a significant association between adverse childhood experience (ACE) and chronic health outcomes among U.S. adults. However, there remains a critical need to explore these associations specifically with respect to racial disparities. Early adversity and preexisting health vulnerabilities may interact, compounding the risk of chronic diseases in historically marginalized populations. This study further explored the relationship between ACE and chronic disease, recognizing that ACEs may exert a more pronounced effect in racial and ethnic groups already at elevated risk. To investigate this relationship, subgroup analysis was conducted to explore variations by race and ethnicity.
We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) collected from 33 states between 2019 and 2023. ACE scores were categorized as none, low (1-2), or high (3+). Log-binomial regression assessed the relationship between ACE scores and 17 health outcomes. Subgroup analyses examined variation by race/ethnicity, and geographic patterns were summarized by state. All analyses accounted for age, sex, race/ethnicity, income, and education.
Of 359,507 participants, 24.4% reported high ACE exposure. Emotional abuse, parental separation, and household substance abuse were the most reported ACEs. Individuals with high ACE exposure had higher risks of depression, smoking, coronary heart disease, and other conditions. Racial disparities were evident in the subgroup analysis. While white respondents with high ACE were significantly associated with many health outcomes, other races/ethnicities often demonstrated higher risk ratios when significant. Particularly, AIAN respondents showed the highest national-level risk for conditions such as heart attack, coronary heart disease, and stroke. Geographically, ACE prevalence and health-related outcomes varied by state, with Oregon and Nevada exhibiting the highest mean ACE scores.
High ACE scores are associated with chronic disease and mental health issues. These findings highlight significant racial and geographic disparities in ACE exposure and its health impacts. Addressing ACEs holistically by considering state-related factors and predisposed health risks among racial/ethnic groups is an emerging need. State-level policies focused on trauma prevention, particularly for vulnerable racial groups and high-risk geographic areas, may help implement interventions tailored to address the unique associations between ACEs and health outcomes in diverse populations.
近期证据表明，美国成年人童年不良经历（ACE）与慢性健康结果之间存在显著关联。然而，迫切需要专门针对种族差异来探究这些关联。早期逆境与先前存在的健康脆弱性可能相互作用，加剧历史上边缘化人群患慢性病的风险。本研究进一步探讨了ACE与慢性病之间的关系，认识到ACE可能在已处于高风险的种族和族裔群体中产生更显著的影响。为了调查这种关系，进行了亚组分析以探讨种族和族裔差异。
我们分析了2019年至2023年期间从33个州收集的行为风险因素监测系统（BRFSS）的数据。ACE得分分为无、低（1 - 2）或高（3分及以上）。对数二项回归评估了ACE得分与17种健康结果之间的关系。亚组分析按种族/族裔检查差异，各州总结地理模式。所有分析均考虑了年龄、性别、种族/族裔、收入和教育因素。
在359,507名参与者中，24.4%报告有高ACE暴露。情感虐待、父母离异和家庭药物滥用是报告最多的ACE类型。高ACE暴露个体患抑郁症、吸烟、冠心病和其他疾病的风险更高。亚组分析中种族差异明显。虽然高ACE的白人受访者与许多健康结果显著相关，但其他种族/族裔在显著时往往显示出更高的风险比。特别是，美国印第安人和阿拉斯加原住民受访者在心脏病发作、冠心病和中风等疾病方面显示出全国最高风险。在地理上，ACE患病率和与健康相关的结果因州而异，俄勒冈州和内华达州的平均ACE得分最高。
高ACE得分与慢性病和心理健康问题相关。这些发现突出了ACE暴露及其对健康影响方面的显著种族和地理差异。通过考虑与州相关的因素以及种族/族裔群体中预先存在的健康风险来全面解决ACE问题是一项新出现的需求。侧重于创伤预防的州级政策，特别是针对弱势群体和高风险地理区域，可能有助于实施量身定制的干预措施，以解决不同人群中ACE与健康结果之间的独特关联。
