Children of Caregivers with Abuse-Related ACEs have Higher Infection Rate and Higher Infection-Related Healthcare Utilization.

Abstract

Background: Abuse-related caregiver adverse childhood experiences (ACEs) have been found to be associated with increased pediatric oral antibiotic prescriptions. However, no studies have examined links between such ACEs and frequency of infections or infection-related healthcare utilization.

Methods: We conducted a retrospective cohort study including patients from two pediatric primary care sites, serving predominantly non-Hispanic Black, publicly-insured pediatric patients. Outcomes were number of infectious diagnoses (0, 1, or ≥2) and infection-related clinical encounters in children 0-4 years old. The presence of any abuse-related caregiver ACEs (physical, verbal, or sexual abuse experienced directly or witnessed by the caregiver) was our exposure of interest. Chi-squared and negative binomial regression analyses were used to determine associations with frequency of infections and infection-related encounters, respectively. Pertinent covariates included a census tract-level material community deprivation index (linked to geocoded addresses) and answers to a standardized social risk screen.

Results: We included 1,970 children 0-4 years old (49% female, 78% Black, 2.6% Hispanic). Children of caregivers with abuse-related ACEs had a higher rate of having ≥2 infectious diagnoses (37%) compared to their counterparts without abuse-related ACEs (29%, p=0.010). The presence of any abuse-related caregiver ACE was associated with a 15% higher rate of infection-related clinical encounters (IRR 1.15, 95%CI 1.0048-1.32) when adjusting for community deprivation and social risk screen responses.

Conclusions: Children 0-4 years with caregivers reporting abuse-related ACEs have a higher rate of infections and infection-related healthcare utilization. Future studies are needed to evaluate underlying biological and behavioral mechanisms for these observations.