Adverse Childhood Experiences and Health-Related Outcomes: An Intersectional Analysis of Race/Ethnicity, Economic Status, and Sex

Adverse childhood experiences (ACEs) are distributed unequally across population subgroups in the U.S. with economically disadvantaged and historically marginalized populations bearing a disproportionate burden. It is unclear, however, whether the health-related consequences of ACEs differ among population subgroups. This study aims to examine whether associations between ACEs and health-related outcomes vary based on race/ethnicity, sex, and economic status. Data for this secondary data analysis were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health) from Wave I to V. Fixed-effects regression models and Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) modeling were applied to assess the extent to which associations between ACEs and health-related outcomes vary along with the independent and intersectional influence of sex, race/ethnicity, economic status. Associations between ACEs and health were stronger among individuals who were White and from higher-income households than individuals who were Black and from lower-income households. Associations between ACEs and depression were stronger among female than male participants and among individuals from higher-income than lower-income households. MAIHDA results indicated that all strata with four-plus ACEs had poorer outcomes than all strata with less than four ACEs. Economic status had a stronger stratifying influence than race/ethnicity and sex. The findings underscore that the harmful effects of ACEs appear to vary across social groups, results that may be used to target ACEs prevention and intervention efforts. Future research on health disparities should employ quantitative intersectional approaches such as MAIHDA.