The relationship between adverse childhood experiences and healthcare use in the Manitoba IBD Cohort Study

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Witges, Kelcie
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Background: Adverse childhood experiences (ACEs) include child maltreatment and household dysfunction experiences. ACEs are risk factors for poor health outcomes. Inflammatory bowel disease (IBD) is a chronic inflammatory condition that also is associated with adverse health outcomes. We hypothesized that persons diagnosed with IBD and exposed to an ACE would exhibit greater healthcare use than persons with IBD never exposed to an ACE. Research Objectives: The objectives were to estimate the prevalence of ACEs in individuals diagnosed with IBD, test the association between the number and type of ACEs and healthcare use, and test the association between perceived level of trauma from ACEs and healthcare use. Methods: The cohort included 345 participants from the population-based Manitoba IBD Cohort Study. Self-reports of ACEs were linked to provincial administrative health data. IBD and non-IBD-related healthcare use measures included general and specialist physician visits, hospitalizations, length of hospital stay, and prescription drug use. Mean annual estimates of healthcare use measures were produced for the 60-month period following ACE report. Generalized linear models (GLMs) were used to test the association between healthcare use and ACEs. All models were adjusted for confounding covariates of demographics, IBD disease characteristics, behavioral risk factors, comorbid conditions, and perceived psychological stress. Results: The prevalence of at least one ACE in the study cohort was 74.2%. Mean annual estimates for non-IBD-related GP visits were significantly increased for cohort members exposed to physical and sexual abuse relative to those not exposed. The GLMs revealed significant decreases in IBD-related healthcare use for cohort members exposed to an upheaval between parents and who report high perceived trauma from ACEs. Conclusions: The estimated prevalence of at least one self-reported ACE in persons with diagnosed IBD was higher than estimates from other comparable sources, which may reflect the different types of ACEs included in this study. The long period of time between ACE exposure and healthcare use measurement may have contributed to the limited impact of ACEs on estimated healthcare use. Future research could further explore the associations amongst ACE exposure, perceived psychological stress, and other health outcomes.
Adverse Childhood Experiences, healthcare use, Inflammatory Bowel Disease, Crohn's Disease, ulcerative colitis, child maltreatment, household challenges