The impact of adverse childhood experiences on healthcare utilization in children

Afton M. Koball, Sarah Domoff

Research output: Contribution to journalArticle


Background: Adverse childhood experiences (ACEs) are related to long-term negative outcomes. The impact of these experiences on healthcare utilization in children has been understudied. Objective: To examine the impact of ACEs on children's healthcare utilization, medical diagnoses, and pharmacological treatment. Participants and setting: Children aged 6 months to 17 years who were screened for ACEs in the Behavioral Health Department or in primary care locations as part of an initial consultation visit and who had at least one subsequent healthcare visit during the study period were included in the study. Methods: Adverse childhood experiences were measured using the ACE screening questionnaire designed by Felitti et al. (1998). Data from the year following administration of the ACE screening tool were retrospectively extracted from the electronic health record. Results: Overall, 1,183 children met study inclusion criteria. Children with any reported ACEs were more likely to no show appointments (1−3 ACEs incidence rate ratio (IRR) [95 % confidence interval (CI)]: 1.40 [1.11–1.77]; 4+ ACEs IRR [95 % CI]: 1.41 [1.08–1.84]) and to use emergency services (1−3 ACEs IRR [95 % CI]: 1.24 [1.00–1.53]; 4+ ACEs: IRR [95 % CI]: 1.42 [1.11–1.81) than children with no ACEs. Those with 4+ ACEs used the telephone nurse advisor less frequently (1−3 ACEs IRR [95 % CI]: 0.67 [0.53–0.84]; 4+ ACEs IRR [95 % CI]: 0.69 [0.53–0.90]). Although ACE scores were associated with healthcare utilization, insurance status was more robustly associated with healthcare utilization than ACE score. Conclusions: Healthcare systems may employ results from this study to adopt trauma-informed care initiatives. Ensuring that all patients have insurance may be a first step toward improving healthcare utilization.

Original languageEnglish
StatePublished - 2021


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