Physical, Mental Health and Developmental Conditions, and Sociodemographic Characteristics Associated With Adverse Childhood Experiences Among Young Children in Pediatric Primary Care

Abstract

Introduction To examine associations between patient characteristics and adverse childhood experiences (ACEs) in a population-based sample of pediatric primary care patients, using electronic health records and clinical, administrative data. Method An observational study was conducted in an integrated health care delivery system. Children ages 1–5 years (N = 13,370) were screened for ACEs at routine well-child visits between September 1, 2018 and May 31, 2019 in three pediatrics clinics. Multivariate models examined associations between patient characteristics (age, gender, race/ethnicity, insurance type, neighborhood income and education level, physical, mental health and developmental diagnoses, weight status) and any ACEs, and ≥ 3 ACEs exposure. Results Prevalence and severity of ACE exposure varied by race/ethnicity. Older age, Medicaid insurance, epilepsy/seizure disorder, sleeping disorders, adjustment disorders, and feeding disorders were associated with higher odds of ACEs exposure, higher-income with lower odds. Discussion Understanding relationships between ACEs and patient features can provide information to clinicians for early detection and appropriate interventions. To examine associations between patient characteristics and adverse childhood experiences (ACEs) in a population-based sample of pediatric primary care patients, using electronic health records and clinical, administrative data. An observational study was conducted in an integrated health care delivery system. Children ages 1–5 years (N = 13,370) were screened for ACEs at routine well-child visits between September 1, 2018 and May 31, 2019 in three pediatrics clinics. Multivariate models examined associations between patient characteristics (age, gender, race/ethnicity, insurance type, neighborhood income and education level, physical, mental health and developmental diagnoses, weight status) and any ACEs, and ≥ 3 ACEs exposure. Prevalence and severity of ACE exposure varied by race/ethnicity. Older age, Medicaid insurance, epilepsy/seizure disorder, sleeping disorders, adjustment disorders, and feeding disorders were associated with higher odds of ACEs exposure, higher-income with lower odds. Understanding relationships between ACEs and patient features can provide information to clinicians for early detection and appropriate interventions. Stacy Sterling, Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA. Felicia Chi, Senior Data Consultant, Division of Research, Kaiser Permanente Northern California, Oakland, CA. Judy Lin, Physician, Department of Pediatrics, Kaiser Permanente Medical Center, San Leandro, CA. Padmaja Padalkar, Physician, Department of Pediatrics, Kaiser Permanente Medical Center, San Jose, CA. Uma Vinayagasundaram, Physician, Department of Pediatrics, Kaiser Permanente Medical Center, Fremont, CA. Esti Iturralde, Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA. Kelly Young-Wolff, Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA. Verena E. Metz, Staff Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA. Arnd Herz, Physician, Department of Pediatrics, Kaiser Permanente Medical Center, Hayward, CA. Rahel Negusse, Research Associate, Division of Research, Kaiser Permanente Northern California, Oakland, CA. Melanie Jackson-Morris, Morris, Research Associate, Division of Research, Kaiser Permanente Northern California, Oakland, CA. Paul Espinas, Physician, Department of Pediatrics, Kaiser Permanente Medical Center, Hayward, CA.