Vital Signs

Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017

Melissa T. Merrick, PhD; Derek C. Ford, PhD; Katie A. Ports, PhD; Angie S. Guinn, MPH; Jieru Chen, PhD; Joanne Klevens, MD, PhD; Marilyn Metzler, MPH; Christopher M. Jones, PharmD, DrPH; Thomas R. Simon, PhD; Valerie M. Daniel, MPH; Phyllis Ottley, PhD; James A. Mercy, PhD


Morbidity and Mortality Weekly Report. 2019;68(44):999-1005. 

In This Article


Overall, 60.9% of adults in the study population experienced at least one type of adverse childhood experience, and 15.6% experienced four or more types (Table 1). Sex, race/ethnicity, and age group were independently associated with adverse childhood experience exposure. Women, AI/AN, blacks, and the Other racial/ethnic group were more likely to experience four or more types of adverse childhood experiences than were men and whites. Younger adults reported exposure to more adverse childhood experience types than did older adults, particularly those aged ≥65 years.

Logistic regression analysis of the association between adverse childhood experience exposure and the health outcomes examined found that adults with the highest level of adverse childhood experience exposure had higher odds of having chronic health conditions, with adjusted odds ratios (AORs) ranging from 1.2 (95% CI = 1.1–1.3) for overweight or obesity to 2.8 (95% CI = 2.5–3.1) for COPD, compared with those reporting no adverse childhood experience exposure (Table 2). After adjusting for age, sex, and race/ethnicity, odds of depression (AOR = 5.3, 95% CI = 4.9–5.7), being a current smoker (AOR = 3.1, 95% CI = 2.8–3.3) or heavy drinker (AOR = 1.8, 95% CI = 1.6–2.0), and socioeconomic challenges including current unemployment (AOR = 1.7, 95% CI = 1.5–2.0) were also higher among adults with the highest levels of adverse childhood experience exposure, compared with those reporting no adverse childhood experience exposure.

The largest reductions in observed outcomes were estimated to be among the group with the most exposures (four or more types of adverse childhood experiences) across all outcomes (Table 3). The estimated overall percentage reductions in chronic health conditions associated with preventing all adverse childhood experiences ranged from 1.7% for overweight or obesity to 27.0% for COPD. Substantial reductions were also estimated for depression (44.1%), current smoking (32.9%), and heavy drinking (23.9%). The reductions in socioeconomic challenges ranged from 3.8% (lack of health insurance) to 14.9% (unemployment).