Racial Differences in Associations Between Adverse Childhood Experiences and Physical, Mental, and Behavioral Health

INTRODUCTION: Adverse childhood experiences (ACEs) are associated with poor adulthood health, with individuals experiencing multiple ACEs at greatest risk. Multiracial people have high mean ACEs scores and elevated risk of several outcomes, but are infrequently the focus of health equity research. This study aimed to determine whether this group should be targeted for prevention efforts. METHODS: We analyzed Waves 1 (1994-95), 3 (2001-02), and 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (n = 12,372) in 2023, estimating associations between four or more ACEs and physical (metabolic syndrome, hypertension, asthma), mental (anxiety, depression), and behavioral (suicidal ideation, drug use) outcomes. We estimated risk ratios for each outcome in modified Poisson models with a race × ACEs interaction, adjusted for hypothesized confounders of the ACE-outcome relationships. We used the interaction contrast to estimate excess cases per 1,000 individuals for each group relative to Multiracial participants. RESULTS: Excess case estimates of asthma were significantly smaller for White (−123 cases, 95% CI: −251, −4), Black (−141, 95% CI: −285, −6), and Asian (−169, 95% CI: −334, −7) participants compared to Multiracial participants. Black (−100, 95% CI: −189, −10), Asian (−163, 95% CI: −247, −79) and Indigenous (−144, 95% CI: −252, −42) participants had significantly fewer excess cases of and weaker (p < 0.001) relative scale association with anxiety compared to Multiracial participants. CONCLUSIONS: Adjusted associations between ACEs and asthma or anxiety appear stronger for Multiracial people than other groups. ACEs are universally harmful but may contribute disproportionately to morbidity in this population.