The Relationship Between Adverse Childhood Experiences and Health Care Use in the Manitoba IBD Cohort Study

Abstract

Background

We aimed to determine the prevalence of adverse childhood experiences (ACEs) in persons with inflammatory bowel disease (IBD) and whether having ACEs was associated with health care utilization post-IBD diagnosis.

Method

Three hundred forty-five participants from the population-based Manitoba IBD Cohort Study self-reported ACEs (ie, physical abuse, sexual abuse, death of a very close friend or family member, severe illness or injury, upheaval between parents, and any other experience thought to significantly impacts one’s life or personality) at a median of 5.3 years following IBD diagnosis. Cohort study data were linked to administrative health databases that captured use of hospitals, physician visits, and prescription drugs; use was classified as IBD-related and non-IBD-related. Mean annual estimates of health care use were produced for the 60-month period following the ACE report. Generalized linear models (GLMs) with generalized estimating equations (GEEs) with and without covariate adjustment were fit to the data.

Results

The prevalence of at least 1 ACE was 74.2%. There was no statistically significant association between having experienced an ACE and health care use. However, unadjusted mean annual non-IBD-related general practitioner visits were significantly higher for participants exposed to physical and sexual abuse than those not exposed. Selected adjusted rates of IBD-related health care use were lower for participants who reported exposure to an upheaval between parents and high perceived trauma from ACEs.

Conclusion

The estimated prevalence of at least 1 self-reported ACE in persons with diagnosed IBD was high. Health care use among those who experienced ACEs may reflect the impact s of ACE on health care anxiety.

Abstract

Three quarters of adults with IBD experienced at least one adverse childhood experience. There was no significant association between having experienced an ACE and adult health care use overall. However, selected rates of IBD-related healthcare use later in life were lower for participants who reported exposure to an upheaval between parents and high perceived trauma from ACEs.