The relationship between adverse childhood experiences, healthcare utilization, cost of care and medical comorbidities

Afton M. Koball, Cary Rasmussen, Denyse Olson-Dorff, Judy Klevan, Luis Ramirez, Sarah E. Domoff

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Background: Prior research suggests that those experiencing adverse childhood experiences (ACEs) may be higher utilizers of the healthcare system. The frequency and financial impact of kept, cancelled and no-showed visits is largely unknown. Objective: To examine the impact of adverse childhood experiences (ACEs) on healthcare utilization in a sample of US adults. Participants and Setting: Two thousand thirty-eight adult patients who completed an ACE screening within the behavioral health department of a medium sized, Midwestern healthcare system during 2015–2017 were included. Methods: Data was extracted retrospectively from 1-year post ACE screen. Results: Individuals with high ACEs (4+) made more but kept fewer appointments than those with no or moderate (1–3) ACEs (p < 0.0001). Individuals with high ACES had more late-cancelled and no-showed appointments compared to those with no ACEs (p's < .0001). Relationships were significant even after controlling for age, gender, and insurance type. Those with high ACEs had the greatest impact on potential lost revenue given that they late-cancelled and no-showed more appointments. Those with high ACEs also had more medical comorbidities, medications, and needed care coordinator than those with moderate or no ACEs (p's < .05) Conclusions: Results from this study should be used to inform providers and health care systems on the effects of adversity on patterns of utilization of health care and encourage innovative strategies to better address the needs of these patients.

Original languageEnglish
Pages (from-to)120-126
Number of pages7
JournalChild Abuse and Neglect
StatePublished - Apr 2019


  • ACEs
  • Childhood trauma
  • Healthcare utilization
  • Medical comorbidity
  • Toxic stress


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