Association of Adverse Childhood Experiences and Catastrophic Health Expenditures in China: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Abstract

Abstract Background: Associations between adverse childhood experiences (ACEs) and catastrophic health expenditures (CHEs) among middle-aged or older Chinese individuals have not been well documented. In addition, the role of chronic diseases is not entirely clear. This study was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS) to examine association of ACEs with hospital visits and medical expenditures and the mediating effect of chronic diseases. Methods: Negative binomial regression models were used to assess associations of the ACEs with the number of outpatient visits and inpatient hospital days. Logistic regression models were used to assess associations between the ACEs and catastrophic health expenditures (CHEs). The influence of chronic diseases is discussed by mediating analysis. Results: The prevalence of each ACE indicator ranges from 0.27% (incarcerated household member) to 31.5% (emotional neglect). Moreover, 75.18% were exposed to at least one ACE. Our main analysis identified a significant dose–response relationship for the cumulative ACE scores and the number of outpatient visits (p-trend < 0.001), inpatient hospital days (p-trend < 0.001), and CHEs (p-trend < 0.001). After adjusting for chronic diseases, the dose-response relationship between ACEs and inpatient hospital days was not significant (p-trend = 0.305), but was still significant with outpatient visits and catastrophic health expenditures. Conclusions:Populations with more ACEs are predisposed to chronic diseases, which consequently lead to higher medical expenditures and incur greater economic burdens. It is necessary to formulate corresponding policies to provide catastrophe health services and financial risk protection for different numbers and types of chronic diseases.