November 05, 2019
2 min read

CDC: Many leading causes of death associated with adverse childhood experiences

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Melissa T. Merrick
Photo of Anne Schuchat 
Anne Schuchat

More than 15% of adults in the United States reported four or more adverse childhood experiences, or ACEs, according to a new CDC report. These events are significantly associated with poorer health and contribute to at least five of the top 10 causes of death in the U.S., the authors reported.

According to Melissa T. Merrick, PhD, senior epidemiologist in the CDC’s Division of Violence Prevention, and colleagues, ACEs can cause toxic stress responses that create both immediate and long-term physical and psychological health impacts by changing gene expression, as well as brain connectivity and function. Additionally, ACEs have been shown to affect the immune system and organ function, delay the development of healthy coping strategies and life opportunities and cause premature death, they wrote.

Merrick and colleagues gathered data from 25 states that reported ACEs to the Behavioral Risk Factor Surveillance System between 2015 and 2017. Participants self-reported several health conditions, including coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease (COPD), cancers other than skin cancer, kidney disease, diabetes, depression, overweight or obesity, being a current smoking, or drinking heavily. Participants also reported whether they had completed high school, were unemployed and if they had health insurance.

According to the study, there are eight types of ACEs, including physical, emotional and sexual abuse and five types of household challenges: household member substance misuse, incarceration, mental illness, parental divorce and witnessing intimate partner violence.

Of those who reported ACEs, 15.6% reported four or more types.

“The effects of ACEs add up,” Anne Schuchat, MD, principal deputy director of the CDC, said in a news conference. “That means that the more types of ACEs a person has, the higher their risk for negative outcomes, which can limit their opportunities their whole lives.

According to the researchers, ACEs were significantly associated with not only poorer health outcomes but health risk behaviors and socioeconomic challenges. These effects were most predominant among women, American Indian and Alaska Natives and black respondents.

“While ACEs are strongly associated with a host of negative outcomes, not everyone who experiences ACEs will go on to have poor outcomes,” Schuchat said. “Children’s positive experiences, relationships or other protective factors and interventions can strengthen resilience and reduce behavioral health consequences, even after ACEs have occurred. It will take all of us working together to change environments and behaviors to stop ACEs from happening in the first place and to lessen the harms for people who have experienced ACEs.”


According to Merrick and colleagues, 1.7% of cases of obesity and overweight could be prevented if ACEs were eliminated, and there would be a 23.9% reduction in heavy drinking. There would be a 44.1% reduction in depression and 27% reduction in COPD.

Schuchat noted that when applied to national disease estimates from 2017, 1.9 million cases of coronary heart disease, 2.5 million cases of overweight and obesity and 21 million cases of depression could have been avoided by addressing and preventing ACEs. She said preventing ACEs could have kept 1.5 million students from dropping out of school.

“The bottom line is this: Adverse childhood experiences produce toxic stress that can impact people all their lives, but ACEs are potentially preventable by creating safe, stable, nurturing relationships and environments for all children, families and communities,” Schuchat said. – by Katherine Bortz


Merrick MT, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6844e1.

Disclosures: The authors report no relevant financial disclosures.