Adverse Childhood Experiences & Disability in US Adults

Objective—To assess relationships between adverse childhood experiences and self-reported disabilities in adult life. Design—Cross-sectional random-digit-dialed state-population-based survey (Behavioral Risk Factor Surveillance System (BRFSS)) Setting—14 States and the District of Columbia Participants—Non-institutionalized adults aged ≥ 18 years surveyed in 2009 and/or in 2010 (n = 81,184). Methods—The BRFSS 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/ divorce) occurring before age 18. 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 and depression). A subset analysis of participants in these states evaluated the effect of adjusting for these conditions. © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved. Corresponding Author: Sophia Miryam Schüssler-Fiorenza Rose, MD, PhD, Spinal Cord Injury Service Veterans Affairs Palo Alto Health Care System 3801 Miranda Ave (Mailcode 128) Palo Alto, CA 94304 Phone: (650) 493-5000 x69147 Fax: (215) 573-2017 cms@alumni.med.upenn.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Early results were presented as a Poster Presentation at the 23rd International Trauma Conference in Boston, MA, June 2012. Related abstracts were presented as Poster Presentations at the 2012 AAPMR Annual Assembly, Atlanta, GA, Nov. 2012. Author Contributions: Sophia Miryam Schüssler-Fiorenza Rose: Conceptualized the study and its design, obtained and analyzed the data and wrote the manuscript. Dawie Xie: Contributed to study design, statistical analysis and interpretation of the data. Margaret Stineman: Contributed to study concept and design, statistical analysis and interpretation of the data. All authors contributed to the revision of the manuscript and approved the final version. NIH Public Access Author Manuscript PM R. Author manuscript; available in PMC 2015 August 01. Published in final edited form as: PM R. 2014 August ; 6(8): 670–680. doi:10.1016/j.pmrj. 2014.01. 013. N IH -P A A uhor M anscript N IH -P A A uhor M anscript N IH -P A A uhor M anscript Main Outcome Measures—The primary outcome was disability (self-reported activity limitation and/or assistive device use.) Results—Over half (57%) of participants reported at least one adverse childhood experience category and 23.2% reported disability. The odds ratio (OR [95% confidence interval]) of disability increased in a graded fashion from 1.3 [1.2-1.4] among those experiencing 1 adverse experience to 5.8 [4.6-7.5] among those with 7 to 8 adverse experiences compared to those with no such experiences, 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.