Just Read: Inequality and Adverse Childhood Experiences (the study you haven’t heard of yet)

At #HBSEE @HBSExecED this week, learning about domestic and global inequality, gini coefficients and the like, and thinking about what the implication for health is.

And then this story was just published on NPR: 10 Questions Some Doctors Are Afraid To Ask : Shots – Health News : NPR

By coincidence (or not), my colleague Brigid McCaw (@BrigidMcCaw) asked me to read this new analysis from the Center for Youth Wellness. It shows the impact of Adverse Childhood Events by California county and statewide:

In California, 61.7% of adults have experienced at least one ACE and one in six, or 16.7%, have experienced four or more ACEs. The most common ACE among California adults is emotional (or verbal) abuse.

• 21% more likely to be below 250 percent of the Federal Poverty Level (FPL)
• 27% more likely to have less than a college degree
• 39% more likely to be unemployed


The report found that, compared to people with no ACEs, those reporting four or more ACEs are more likely to face greater physical and mental health, social and economic challenges. Among other outcomes, the study’s key findings indicate that they are:
• 2.4 times as likely to have chronic obstructive pulmonary disease; 1.9 times as
likely to have asthma; 1.7 times as likely to have kidney disease; and 1.5 times as
likely to have a stroke.
• 5.1 times as likely to suffer from depression, and 4.2 times as likely to be
diagnosed with Alzheimer’s or dementia.

ACE questions are now part of The California Behavioral Risk Factor Surveillance System (BRFSS), so these questions are now being asked regularly. You can take your own ACEs quiz at the NPR link above.


Back to the connection between health and inequality, it’s there, and to the point of what can be done about it, quote from Jeff Brenner, MD, from hotspotting fame:

“I can’t imagine, 10, 15 years from now, a health care system that doesn’t routinely use the ACE scores,” he says. “I just can’t imagine that.”

The Adverse Childhood Events Study was performed at Kaiser Permanente in San Diego by Dr. Vincent Felitti from 1995 to 1997. It is a piece of work that is just now being recognized for its impact. There’s tons more data about the impact on health here.

Ted Eytan, MD