Project Title

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

Authors' Affiliations

Glory Okwori, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Elaine Loudermilk, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University Steven Stewart, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University Delaney Lawson, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University Megan Quinn, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University

Faculty Sponsor’s Department

Biostatistics & Epidemiology

Type

Oral Competitive

Classification of First Author

Graduate Student-Doctoral

Project's Category

Public Health, Mental Health, Child Health, Health Care Management

Abstract Text

Introduction: Adverse childhood experiences (ACEs) have been considered a significant risk factor for poorer adult outcomes. Considering the studies linking ACEs to chronic diseases in adulthood as well as the increasing prevalence for these chronic conditions, exposure to childhood traumas represents a significant economic burden in the United States which has not been explored. This study provides the first examination of the attributable burden and costs of conditions associated with exposure to ACEs in Tennessee (TN) and Virginia (VA) during 2017.

Methods: This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data for TN and VA in 2017. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis ) and two risk factors (smoking and drinking ) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between individuals exposed to ACEs and the risk factors with the chronic diseases. The population attributable risk (PAR) were estimated for the ACEs related diseases and risk factors. These estimates were combined with published estimates of health care expenses and Disability Adjusted-Life-Years (DALYs).

Results: Among those who had experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who had experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs exposure resulted in a burden of about 115,00 years and 125,000 years in terms of DALYs in TN and VA respectively. The total health spending associated with ACEs based on PARs was about $650 million ($158.15 per adult) and $942 million ($305.02 per adult) in TN and VA respectively. Depression accounted for the largest combined sum of health care spending (TN - $448,105,983, VA – $633,225,398). With DALYs valued at $235,855 in 2017 dollars, the monetized cost of DALYs attributable to ACEs was over $27 billion, $6615 per exposed adult Tennessean. The monetized loss due to DALYs represents over $30 billion (in 2017 dollars) , $9,737 per exposed adult in Virginia.

Conclusions: This study emphasizes the need to reduce ACEs which can be utilized to inform interventions to reduce the impact of ACEs in Tennessee and Virginia. Medical conditions attributable to childhood traumas can result in increased utilization of hospital services, psychiatric care, as well as care related to chronic conditions, which includes increased primary and specialty care utilization as well as the cost of medications. While medical expenses represent a significant burden, reduced quality of life resulting from ACE attributable conditions also represents a burden in disability adjusted life years (DALYs) and premature morbidity. As resources are limited and the burden of ACEs shown here is very high, there is the need for a wide range of prevention and treatment strategies to mitigate these effects.

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Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

Introduction: Adverse childhood experiences (ACEs) have been considered a significant risk factor for poorer adult outcomes. Considering the studies linking ACEs to chronic diseases in adulthood as well as the increasing prevalence for these chronic conditions, exposure to childhood traumas represents a significant economic burden in the United States which has not been explored. This study provides the first examination of the attributable burden and costs of conditions associated with exposure to ACEs in Tennessee (TN) and Virginia (VA) during 2017.

Methods: This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data for TN and VA in 2017. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis ) and two risk factors (smoking and drinking ) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between individuals exposed to ACEs and the risk factors with the chronic diseases. The population attributable risk (PAR) were estimated for the ACEs related diseases and risk factors. These estimates were combined with published estimates of health care expenses and Disability Adjusted-Life-Years (DALYs).

Results: Among those who had experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who had experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs exposure resulted in a burden of about 115,00 years and 125,000 years in terms of DALYs in TN and VA respectively. The total health spending associated with ACEs based on PARs was about $650 million ($158.15 per adult) and $942 million ($305.02 per adult) in TN and VA respectively. Depression accounted for the largest combined sum of health care spending (TN - $448,105,983, VA – $633,225,398). With DALYs valued at $235,855 in 2017 dollars, the monetized cost of DALYs attributable to ACEs was over $27 billion, $6615 per exposed adult Tennessean. The monetized loss due to DALYs represents over $30 billion (in 2017 dollars) , $9,737 per exposed adult in Virginia.

Conclusions: This study emphasizes the need to reduce ACEs which can be utilized to inform interventions to reduce the impact of ACEs in Tennessee and Virginia. Medical conditions attributable to childhood traumas can result in increased utilization of hospital services, psychiatric care, as well as care related to chronic conditions, which includes increased primary and specialty care utilization as well as the cost of medications. While medical expenses represent a significant burden, reduced quality of life resulting from ACE attributable conditions also represents a burden in disability adjusted life years (DALYs) and premature morbidity. As resources are limited and the burden of ACEs shown here is very high, there is the need for a wide range of prevention and treatment strategies to mitigate these effects.

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