Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients.
BACKGROUND
Prescription drugs account for approximately 11% of national health expenditures. Prior research on adverse childhood experiences (ACEs), which include common forms of child maltreatment and related traumatic stressors, has linked them to numerous health problems. However, data about the relationship of these experiences to prescription drug use are scarce.


METHODS
We used the ACE Score (an integer count of 8 different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. We prospectively assessed the relationship of the Score to prescription drug use in a cohort of 15,033 adult HMO patients (mean follow-up: 6.1 years) and assessed mediation of this relationship by documented ACE-related health and social problems.


RESULTS
Nearly 1.2 million prescriptions were recorded; prescriptions rates increased in a graded fashion as the ACE Score increased (p for trend < 0.0001). Compared to persons with an ACE Score of 0, persons with a Score > or = 5 had rates increased by 40%; graded relationships were seen for all age groups (18-44, 45-64, and 65-89 years) (p for trend < 0.01). Graded relationships were observed for the risk of being in the upper decile of number of classes of drugs used; persons with scores of > or = 5 had this risk increased 2-fold. Adjustment for ACE-related health problems reduced the strength of the associations by more than 60%.


CONCLUSIONS
ACEs substantially increase the number of prescriptions and classes of drugs used for as long as 7 or 8 decades after their occurrence. The increases in prescription drug use were largely mediated by documented ACE-related health and social problems.
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. rfa1@cdc.gov
Robert F
RF
Anda
David W
DW
Brown
Vincent J
VJ
Felitti
Shanta R
SR
Dube
Wayne H
WH
Giles
D000328:Adult; D054523:Adult Survivors of Child Abuse; D002648:Child; D015331:Cohort Studies; D011307:Drug Prescriptions; D004358:Drug Therapy / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans