Literature suggests that early patterns of aggressive behavior in both girls and boys are predictive of a variety of health risks in adulthood. However, longitudinal examination of predictive links between childhood aggression and negative adult physical health outcomes and overall medical service usage has not been done. The purpose of the present investigation is to extend the current body of knowledge regarding the long-term negative physical health sequelae of aggression observed in childhood, by examining direct and indirect paths (through educational attainment) from childhood aggression and other behavioral characteristics to poor physical health in middle adulthood. This study was carried out within the Concordia Longitudinal Risk Project, a study of over 4,000 individuals recruited as children in the 1970s from inner-city schools in Montreal. Childhood aggression was found to directly and positively predict medical service usage, as well as medical visits due to lifestyle-related illnesses and injuries, with indirect paths through educational attainment also present. The findings from this study suggest that childhood aggression may be an identifiable precursor of poor health and increased service usage in adulthood and are relevant to preventative intervention.