Adverse childhood experiences and disability in U.S. adults.
OBJECTIVE
To assess relationships between adverse childhood experiences and self-reported disabilities in adult life.


METHODS
Cross-sectional, random-digit-dialed, state-population-based survey (Behavioral Risk Factor Surveillance System).


METHODS
Fourteen states and the District of Columbia.


METHODS
Noninstitutionalized adults ages ≥18 years surveyed in 2009 and/or in 2010 (n = 81,184).


METHODS
The Behavioral Risk Factor Surveillance System Adverse Childhood Experience (ACE) Module asks about abuse (physical, sexual, emotional), family dysfunction (exposures to domestic violence, living with mentally ill, substance abusing, or incarcerated family member(s), and/or parental separation and/or divorce) that occurred before age 18 years. The ACE score sums affirmed ACE categories (range, 0-8). We controlled for demographic characteristics (age, race, education, income, and marital status) and self-reported physical health conditions (stroke, myocardial infarction, diabetes, coronary heart disease, asthma). Five states asked participants about mental health conditions (anxiety, depression). A subset analysis of participants in these states evaluated the effect of adjusting for these conditions.


METHODS
The primary outcome was disability (self-reported activity limitation and/or assistive device use).


RESULTS
More than half of participants (57%) reported at least 1 adverse childhood experience category, and 23.2% reported disability. The odds ratio (95% confidence interval) of disability increased in a graded fashion from odds ratio 1.3 (95% confidence interval, 1.2-1.4) among those who experienced 1 adverse experience to odds ratio 5.8 (95% confidence interval, 4.6-7.5) among those with 7-8 adverse experiences compared with those with no such experiences when adjusting for demographic factors. The relationship between adverse experiences and disability remained strong after adjusting for physical and mental health conditions.


CONCLUSIONS
There is a strong graded relationship between childhood exposure to abuse and household dysfunction and self-reported disability in adulthood, even after adjusting for potentially mediating health conditions. Greater clinician, researcher, and policymaker awareness of the impact of childhood adversity on disability is crucial to help those affected by childhood adversity lead more functional lives.
Spinal Cord Injury Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave. (Mailcode 128), Palo Alto, CA 94304; Department of Orthopaedics. Stanford Hospital & Clinics, Stanford, CA(∗). Electronic address: cms@alumni.med.upenn.edu.
Sophia Miryam
SM
Schüssler-Fiorenza Rose
Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(†).
Dawei
D
Xie
Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(‡).
Margaret
M
Stineman
D000293:Adolescent; D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D017579:Domestic Violence / Q000706:statistics & numerical data*; D005190:Family; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult