Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg Research article Impact of adverse childhood experiences on quality-adjusted life expectancy in the U.S. population Haomiao Jia a , Erica I. Lubetkin b, * a Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, NY, USA b Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA ARTICLEINFO Keywords: Adverse childhood experiences (ACEs) Health-related quality-of-life (HRQOL) Quality-adjusted life expectancy (QALE) ABSTRACT Background: Adverse childhood experiences (ACEs) adversely impact morbidity and mortality. Objective: To quantify burden of disease associated with ACEs among U.S. adults by estimating quality-adjusted life expectancy (QALE) according to number of ACEs reported. Participants and setting: Data from respondents’ adverse experiences occurring before age 18 were collected in nine states through the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS). Methods: We estimated health-related quality of life (HRQOL) scores from BRFSS data. We constructed life tables from the Compressed Mortality Files to calculate QALE, a generalization of life expectancy that weights expected years of life lived with the HRQOL score, according to number of ACEs. Results: The QALE for an 18-year-old person reporting 0, 1–2, and 3+ ACEs was 55.1, 53.4, and 45.6 years, respectively. Reporting 3+ ACEs was associated with a 9.5-year decrease (17%) in QALE. The adverse impact of ACEs are present according to age, gender, and race/ethnicity subgroups. The impact of 3+ ACEs on QALE was nearly 3-fold greater for women than men (13.2 vs. 4.7-year decrease). By contrast, an 18-year-old reporting 1–2 ACEs experienced a small de- crease in QALE (1.7 years). Conclusions: Reporting 3+ ACEs led to a significant burden of disease, as assessed by QALE loss, to a similar degree as many other well-established behavioral risk factors and chronic conditions. Providers and policymakers should focus on efforts to prevent ACEs, initiate early detection of and interventions to minimize the impact of an ACE, and reduce the likelihood of engaging in maladaptive risky behaviors. 1. Introduction One of the overarching goals of the Healthy People 2030 framework entails promoting healthy development, healthy behaviors, and well-being across all life stages (U.S. Department of Health & Human Services & Office of Disease Prevention & Health Promotion, 2018). An abundance of evidence indicates that adverse experiences during childhood may impact subsequent health and well-being (Garner, Shonkoff, Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics, 2012; Anda et al., 2006; Braveman & Barclay, 2009; Felitti et al., 1998). Adverse childhood experiences (ACEs) are characterized by psychological, physical, and sexual forms of abuse as well as household dysfunction, such as exposure to mental illness or substance abuse, during childhood (Felitti et al., 1998). During 2011–2014, more than 61% of the United States adult population reported exposure to at least one type of ACE, with nearly 25% https://doi.org/10.1016/j.chiabu.2020.104418 Received 30 August 2019; Received in revised form 5 February 2020; Accepted 10 February 2020 ⁎ Corresponding author at: Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, 10031, USA. E-mail addresses: hj2198@columbia.edu (H. Jia), lubetkin@med.cuny.edu (E.I. Lubetkin). Child Abuse & Neglect 102 (2020) 104418 0145-2134/ © 2020 Elsevier Ltd. All rights reserved. T