# Association of adverse childhood experiences with health service use and catastrophic health expenditures in China: evidence from the China Health and Retirement Longitudinal Study

## TL;DR

This study finds that childhood trauma in China is linked to higher health costs in adulthood, partly due to chronic diseases.

## Contribution

The study identifies a dose-response relationship between adverse childhood experiences and catastrophic health expenditures, mediated by chronic diseases.

## Key findings

- ACEs showed a significant dose-response relationship with catastrophic health expenditures (P for trend < 0.001).
- Chronic diseases partially mediated the relationship between ACEs and CHE (ACME = 0.000904, P = 0.03).
- No significant association was found between ACEs and hospital visits or inpatient days.

## Abstract

Associations between adverse childhood experiences (ACEs) and catastrophic health expenditures (CHEs) among middle-aged or older Chinese individuals remain inadequately documented. In addition, the role of chronic diseases is not entirely clear. This study used data from the China Health and Retirement Longitudinal Study (CHARLS) to investigate the association of ACEs with hospital visits and medical expenditures and the mediating effect of chronic diseases.

Data were collected from CHARLS in 2014 and 2015 (N = 11,072). Zero-inflated negative binomial regression was used to assess associations of the ACEs with the number of outpatient visits and inpatient hospital days. Logistic regression was used to assess associations between the ACEs and CHEs. The influence of chronic diseases was examined through mediation analysis.

The prevalence of each ACE indicator ranges from 0.27% (incarcerated household member) to 31.5% (emotional neglect). Our analysis revealed a significant dose-response relationship between cumulative ACE score and CHEs (P for trend < 0.001), but not for the number of outpatient visits and inpatient hospital days. The average causal mediation effects (ACME) and average direct effects (ADE) are presented. Chronic diseases served as a mediating factor between ACEs and CHE (ACME = 0.000904, P = 0.03; ADE = 0.00813, P < 0.001).

ACE has the capacity to predict CHE, and the findings of this study reinforce the potential pathway through which ACE may exert its influence on CHE via the burden of chronic diseases. Measures should be implemented to prevent ACEs and mitigate the risk of chronic diseases to lessen the economic burden on individuals and families as well as the adverse impact of national financial risk.

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.25-00012.