Adverse Childhood Experiences and Health Insurance Coverage Gaps Among Adults

ABSTRACT Adults exposed to adverse childhood experiences (ACEs) may have greater risks of experiencing gaps in health insurance coverage. We used data from the 2021 California Health Interview Survey to determine if ACEs exposure was associated with part‐year and year‐round uninsurance among adults ages 26–64. The primary outcome was health insurance coverage at the time of the survey. The primary exposure was the number of ACEs respondents experienced before age 18. Based on a sample of 15,966 eligible respondents, we estimated 6% experienced part‐year uninsurance, 7% experienced year‐round uninsurance, and 70% experienced at least 1 ACE, including 24% exposed to 4 or more ACEs. On multivariable analysis, exposure to 3 versus no ACEs was associated with higher relative risk of part‐year uninsurance (relative risk ratio [RRR]: 1.87; 95% confidence interval [CI]: 1.31, 2.66) or year‐round uninsurance (RRR: 1.83; 95% CI: 1.21, 2.77) rather than having continuous private coverage. We observed no dose‐response gradient in part‐year or year‐round uninsurance with exposure to an increasing number of ACEs, and no association between exposure to 4+ ACEs and risk of uninsurance. Further research is needed to understand what adulthood stressors may increase the risk of coverage disruption.