RELATIONSHIP OF CHILDHOOD ABUSE AND HOUSEHOLD DYSFUNCTION TO MANY OF THE LEADING CAUSES OF DEATH IN ADULTS - THE ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY

Background: The relationship of health risk behavior and disease in ad ulthood to the breadth of exposure to childhood emotional, physical, o r sexual abuse, and household dysfunction during childhood has not pre viously been described. Methods: A questionnaire about adverse childho od experiences was mailed to 13,494 adults who had completed a standar dized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seve n categories of adverse childhood experiences were studied: psychologi cal, physical, or sexual abuse; violence against mother; or living wit h household members who were substance abusers, mentally ill or suicid al, or ever imprisoned. The number of categories of these adverse chil dhood experiences was then compared to measures of adult risk behavior , health status, and disease. Logistic regression was used to adjust f or effects of demographic factors on the association between the cumul ative number of categories of childhood exposures (range: 0-7) and ris k factors for the leading causes of death in adult life. Results: More than half of respondents reported at least one, and one-fourth report ed greater than or equal to 2 categories of childhood exposures. We fo und a graded relationship between the number of categories of childhoo d exposure and each of the adult health risk behaviors and diseases th at were studied (P < .001). Persons who had experienced four or more c ategories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug a buse, depression, and suicide attempt; a 2- to 4-fold increase in smok ing, poor self-rated health, greater than or equal to 50 sexual interc ourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fo ld increase in physical inactivity and severe obesity. The number of c ategories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, ca ncer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly inter related and persons with multiple categories of childhood exposure wer e Likely to have multiple health risk factors later in life. Conclusio ns: We found a strong graded relationship between the breadth of expos ure to abuse or household dysfunction during childhood and multiple ri sk factors for several of the leading causes of death in adults.