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Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population
To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population. Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Sou...
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| Published in: | Journal of health care for the poor and underserved 2019-01, Vol.30 (2), p.749-767 |
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| container_end_page | 767 |
| container_issue | 2 |
| container_start_page | 749 |
| container_title | Journal of health care for the poor and underserved |
| container_volume | 30 |
| creator | Hargreaves, Margaret K Mouton, Charles P Liu, Jianguo Zhou, Yuan E Blot, William J |
| description | To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population.
Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Southeastern states. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were computed.
The percentages reporting emergency room visits and doctor's office visits, with high chronic disease index scores, rose monotonically (ptrend |
| doi_str_mv | 10.1353/hpu.2019.0054 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6833954</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2233076950</sourcerecordid><originalsourceid>FETCH-LOGICAL-c460t-f8ee51456728d29091b322c7f89861e8a8716ba712a7c5534f52ed2db2d7f64b3</originalsourceid><addsrcrecordid>eNpdkctr3DAQh01paB7tsdci6KUXb_S0pUshLGkSWGihyVnI8rjWYkuuZCdt__rKTbp9MAcNzMdvNHxF8ZrgDWGCnffTsqGYqA3Ggj8rTojgsqxkpZ7nHnNVUizVcXGa0h5jzBhnL4pjRgjLuDopbi_ae4gJ0LZ3Q9uH0KLLbxNEB95CQsa36BrMMPdoayKgu9kN7oeZXfDIeWTQLjyUN96GEdCnMC3Dr9HL4qgzQ4JXT-9Zcffh8nZ7Xe4-Xt1sL3al5RWey04CCMJFVVPZUoUVaRiltu6kkhUBaWRNqsbUhJraCsF4Jyi0tG1oW3cVb9hZ8f4xd1qaEVoLfo5m0FN0o4nfdTBO_zvxrtdfwr2uJGNK8Bzw7ikghq8LpFmPLlkYBuMhLElTyighMldG3_6H7sMSfT5vpRiuKyVwpspHysaQUoTu8BmC9epLZ1969aVXX5l_8_cFB_q3oAzww9o92HlcEvzZXFMumNKfV-mrc6IoxpQR9hMe2qCz</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2233076950</pqid></control><display><type>article</type><title>Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Project Muse:Jisc Collections:Project MUSE Journals Agreement 2024:Premium Collection</source><source>Social Science Premium Collection (Proquest) (PQ_SDU_P3)</source><source>Sociology Collection</source><source>PAIS Index</source><source>Sociological Abstracts</source><creator>Hargreaves, Margaret K ; Mouton, Charles P ; Liu, Jianguo ; Zhou, Yuan E ; Blot, William J</creator><creatorcontrib>Hargreaves, Margaret K ; Mouton, Charles P ; Liu, Jianguo ; Zhou, Yuan E ; Blot, William J</creatorcontrib><description>To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population.
Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Southeastern states. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were computed.
The percentages reporting emergency room visits and doctor's office visits, with high chronic disease index scores, rose monotonically (ptrend<.001) with rising ACE score. Odds ratios (CIs) for those with four or more vs. zero ACEs were 1.37 (95% CI 1.27-1.47) for 1-10 times and 1.80 (95% CI 1.29-2.52) for more than 10 times ER visits, 1.37 (95% CI 1.18-1.59) for over 10 doctor's visits, and 2.29 (95% CI 2.06-2.54) for three or more chronic diseases.
High ACE levels were associated with greater chronic disease burden and greater health care utilization in adulthood. Long-lasting effects from ACE on the health care of underserved populations are indicated. There is an urgent need to train health care providers, patients, and their families on ACE effects and treatments for better health care outcomes.</description><identifier>ISSN: 1049-2089</identifier><identifier>ISSN: 1548-6869</identifier><identifier>EISSN: 1548-6869</identifier><identifier>DOI: 10.1353/hpu.2019.0054</identifier><identifier>PMID: 31130549</identifier><language>eng</language><publisher>United States: Johns Hopkins University Press</publisher><subject><![CDATA[Adult ; Adults ; Adverse childhood experiences ; Adverse Childhood Experiences - statistics & numerical data ; African Americans ; Aged ; Child abuse & neglect ; Childhood ; Childhood experiences ; Childhood factors ; Children ; Childrens health ; Chronic Disease - epidemiology ; Chronic Disease - therapy ; Chronic illnesses ; Clinical outcomes ; Community centers ; Community health services ; Confidence intervals ; Disease ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital - statistics & numerical data ; Family medical history ; Female ; Health care ; Health care facilities ; Health care industry ; Health care policy ; Health facilities ; Health services utilization ; Health status ; Households ; Humans ; Income ; Low income groups ; Male ; Medical personnel ; Middle Aged ; Office Visits - statistics & numerical data ; Patient Acceptance of Health Care - statistics & numerical data ; Patients ; Population ; Poverty ; Poverty - statistics & numerical data ; Primary care ; Questionnaires ; Southeastern United States - epidemiology ; Surveys and Questionnaires ; Treatment methods ; Underserved populations ; Utilization ; Visits]]></subject><ispartof>Journal of health care for the poor and underserved, 2019-01, Vol.30 (2), p.749-767</ispartof><rights>Copyright © Meharry Medical College.</rights><rights>Copyright Johns Hopkins University Press May 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c460t-f8ee51456728d29091b322c7f89861e8a8716ba712a7c5534f52ed2db2d7f64b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2233076950?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,12846,21394,21395,27344,27866,27924,27925,30999,33611,33612,33774,34530,34531,43733,44115</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31130549$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hargreaves, Margaret K</creatorcontrib><creatorcontrib>Mouton, Charles P</creatorcontrib><creatorcontrib>Liu, Jianguo</creatorcontrib><creatorcontrib>Zhou, Yuan E</creatorcontrib><creatorcontrib>Blot, William J</creatorcontrib><title>Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population</title><title>Journal of health care for the poor and underserved</title><addtitle>J Health Care Poor Underserved</addtitle><description>To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population.
Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Southeastern states. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were computed.
The percentages reporting emergency room visits and doctor's office visits, with high chronic disease index scores, rose monotonically (ptrend<.001) with rising ACE score. Odds ratios (CIs) for those with four or more vs. zero ACEs were 1.37 (95% CI 1.27-1.47) for 1-10 times and 1.80 (95% CI 1.29-2.52) for more than 10 times ER visits, 1.37 (95% CI 1.18-1.59) for over 10 doctor's visits, and 2.29 (95% CI 2.06-2.54) for three or more chronic diseases.
High ACE levels were associated with greater chronic disease burden and greater health care utilization in adulthood. Long-lasting effects from ACE on the health care of underserved populations are indicated. There is an urgent need to train health care providers, patients, and their families on ACE effects and treatments for better health care outcomes.</description><subject>Adult</subject><subject>Adults</subject><subject>Adverse childhood experiences</subject><subject>Adverse Childhood Experiences - statistics & numerical data</subject><subject>African Americans</subject><subject>Aged</subject><subject>Child abuse & neglect</subject><subject>Childhood</subject><subject>Childhood experiences</subject><subject>Childhood factors</subject><subject>Children</subject><subject>Childrens health</subject><subject>Chronic Disease - epidemiology</subject><subject>Chronic Disease - therapy</subject><subject>Chronic illnesses</subject><subject>Clinical outcomes</subject><subject>Community centers</subject><subject>Community health services</subject><subject>Confidence intervals</subject><subject>Disease</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Family medical history</subject><subject>Female</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Health care industry</subject><subject>Health care policy</subject><subject>Health facilities</subject><subject>Health services utilization</subject><subject>Health status</subject><subject>Households</subject><subject>Humans</subject><subject>Income</subject><subject>Low income groups</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Middle Aged</subject><subject>Office Visits - statistics & numerical data</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Patients</subject><subject>Population</subject><subject>Poverty</subject><subject>Poverty - statistics & numerical data</subject><subject>Primary care</subject><subject>Questionnaires</subject><subject>Southeastern United States - epidemiology</subject><subject>Surveys and Questionnaires</subject><subject>Treatment methods</subject><subject>Underserved populations</subject><subject>Utilization</subject><subject>Visits</subject><issn>1049-2089</issn><issn>1548-6869</issn><issn>1548-6869</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><sourceid>ALSLI</sourceid><sourceid>BHHNA</sourceid><sourceid>HEHIP</sourceid><sourceid>M2S</sourceid><recordid>eNpdkctr3DAQh01paB7tsdci6KUXb_S0pUshLGkSWGihyVnI8rjWYkuuZCdt__rKTbp9MAcNzMdvNHxF8ZrgDWGCnffTsqGYqA3Ggj8rTojgsqxkpZ7nHnNVUizVcXGa0h5jzBhnL4pjRgjLuDopbi_ae4gJ0LZ3Q9uH0KLLbxNEB95CQsa36BrMMPdoayKgu9kN7oeZXfDIeWTQLjyUN96GEdCnMC3Dr9HL4qgzQ4JXT-9Zcffh8nZ7Xe4-Xt1sL3al5RWey04CCMJFVVPZUoUVaRiltu6kkhUBaWRNqsbUhJraCsF4Jyi0tG1oW3cVb9hZ8f4xd1qaEVoLfo5m0FN0o4nfdTBO_zvxrtdfwr2uJGNK8Bzw7ikghq8LpFmPLlkYBuMhLElTyighMldG3_6H7sMSfT5vpRiuKyVwpspHysaQUoTu8BmC9epLZ1969aVXX5l_8_cFB_q3oAzww9o92HlcEvzZXFMumNKfV-mrc6IoxpQR9hMe2qCz</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Hargreaves, Margaret K</creator><creator>Mouton, Charles P</creator><creator>Liu, Jianguo</creator><creator>Zhou, Yuan E</creator><creator>Blot, William J</creator><general>Johns Hopkins University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7RV</scope><scope>7TQ</scope><scope>7U3</scope><scope>7X7</scope><scope>7XB</scope><scope>8C1</scope><scope>8FI</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHHNA</scope><scope>BHPHI</scope><scope>BSCPQ</scope><scope>CCPQU</scope><scope>DHY</scope><scope>DON</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>HEHIP</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PATMY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>PYCSY</scope><scope>Q9U</scope><scope>UXAQP</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190101</creationdate><title>Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population</title><author>Hargreaves, Margaret K ; Mouton, Charles P ; Liu, Jianguo ; Zhou, Yuan E ; Blot, William J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c460t-f8ee51456728d29091b322c7f89861e8a8716ba712a7c5534f52ed2db2d7f64b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Adverse childhood experiences</topic><topic>Adverse Childhood Experiences - statistics & numerical data</topic><topic>African Americans</topic><topic>Aged</topic><topic>Child abuse & neglect</topic><topic>Childhood</topic><topic>Childhood experiences</topic><topic>Childhood factors</topic><topic>Children</topic><topic>Childrens health</topic><topic>Chronic Disease - epidemiology</topic><topic>Chronic Disease - therapy</topic><topic>Chronic illnesses</topic><topic>Clinical outcomes</topic><topic>Community centers</topic><topic>Community health services</topic><topic>Confidence intervals</topic><topic>Disease</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Family medical history</topic><topic>Female</topic><topic>Health care</topic><topic>Health care facilities</topic><topic>Health care industry</topic><topic>Health care policy</topic><topic>Health facilities</topic><topic>Health services utilization</topic><topic>Health status</topic><topic>Households</topic><topic>Humans</topic><topic>Income</topic><topic>Low income groups</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Middle Aged</topic><topic>Office Visits - statistics & numerical data</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Patients</topic><topic>Population</topic><topic>Poverty</topic><topic>Poverty - statistics & numerical data</topic><topic>Primary care</topic><topic>Questionnaires</topic><topic>Southeastern United States - epidemiology</topic><topic>Surveys and Questionnaires</topic><topic>Treatment methods</topic><topic>Underserved populations</topic><topic>Utilization</topic><topic>Visits</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hargreaves, Margaret K</creatorcontrib><creatorcontrib>Mouton, Charles P</creatorcontrib><creatorcontrib>Liu, Jianguo</creatorcontrib><creatorcontrib>Zhou, Yuan E</creatorcontrib><creatorcontrib>Blot, William J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>PAIS Index</collection><collection>Social Services Abstracts</collection><collection>Health & Medicine (ProQuest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Sociological Abstracts</collection><collection>ProQuest Natural Science Collection</collection><collection>Black Studies Center</collection><collection>ProQuest One Community College</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>Sociology Collection</collection><collection>ProQuest Consumer Health Database</collection><collection>ProQuest Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database (ProQuest)</collection><collection>ProQuest research library</collection><collection>Sociology Database (ProQuest)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Environmental Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>Environmental Science Collection</collection><collection>ProQuest Central Basic</collection><collection>ProQuest Black Studies</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of health care for the poor and underserved</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hargreaves, Margaret K</au><au>Mouton, Charles P</au><au>Liu, Jianguo</au><au>Zhou, Yuan E</au><au>Blot, William J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population</atitle><jtitle>Journal of health care for the poor and underserved</jtitle><addtitle>J Health Care Poor Underserved</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>30</volume><issue>2</issue><spage>749</spage><epage>767</epage><pages>749-767</pages><issn>1049-2089</issn><issn>1548-6869</issn><eissn>1548-6869</eissn><abstract>To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population.
Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Southeastern states. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were computed.
The percentages reporting emergency room visits and doctor's office visits, with high chronic disease index scores, rose monotonically (ptrend<.001) with rising ACE score. Odds ratios (CIs) for those with four or more vs. zero ACEs were 1.37 (95% CI 1.27-1.47) for 1-10 times and 1.80 (95% CI 1.29-2.52) for more than 10 times ER visits, 1.37 (95% CI 1.18-1.59) for over 10 doctor's visits, and 2.29 (95% CI 2.06-2.54) for three or more chronic diseases.
High ACE levels were associated with greater chronic disease burden and greater health care utilization in adulthood. Long-lasting effects from ACE on the health care of underserved populations are indicated. There is an urgent need to train health care providers, patients, and their families on ACE effects and treatments for better health care outcomes.</abstract><cop>United States</cop><pub>Johns Hopkins University Press</pub><pmid>31130549</pmid><doi>10.1353/hpu.2019.0054</doi><tpages>19</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1049-2089 |
| ispartof | Journal of health care for the poor and underserved, 2019-01, Vol.30 (2), p.749-767 |
| issn | 1049-2089 1548-6869 1548-6869 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6833954 |
| source | Applied Social Sciences Index & Abstracts (ASSIA); Project Muse:Jisc Collections:Project MUSE Journals Agreement 2024:Premium Collection; Social Science Premium Collection (Proquest) (PQ_SDU_P3); Sociology Collection; PAIS Index; Sociological Abstracts |
| subjects | Adult Adults Adverse childhood experiences Adverse Childhood Experiences - statistics & numerical data African Americans Aged Child abuse & neglect Childhood Childhood experiences Childhood factors Children Childrens health Chronic Disease - epidemiology Chronic Disease - therapy Chronic illnesses Clinical outcomes Community centers Community health services Confidence intervals Disease Emergency medical care Emergency medical services Emergency Service, Hospital - statistics & numerical data Family medical history Female Health care Health care facilities Health care industry Health care policy Health facilities Health services utilization Health status Households Humans Income Low income groups Male Medical personnel Middle Aged Office Visits - statistics & numerical data Patient Acceptance of Health Care - statistics & numerical data Patients Population Poverty Poverty - statistics & numerical data Primary care Questionnaires Southeastern United States - epidemiology Surveys and Questionnaires Treatment methods Underserved populations Utilization Visits |
| title | Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population |
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