Heterogeneity in adverse childhood experiences and heart disease among U.S. Black Women and Men.

Abstract

Objectives: Exposure to adverse childhood experiences (ACE) accounts for up to 1.9 million heart disease cases. This study extends research by examining the association between heart disease and four-forms of ACE heterogeneity (i.e. counts, scores, clusters, and individually) among Black men and women.

Design: Data come from the 2019-2022 Behavioral Risk Factor Surveillance System's ACE supplement (n = 30,746). Latent class analysis of eleven ACEs - verbal, physical, or sexual abuse; experiencing divorced parents, rape, or sexual coercion; or living in a household with domestic violence, imprisonment, drug use, alcohol abuse, or mental illness - identified seven-classes. Multiple gender-stratified binary logistic regressions estimated adjusted odds of heart disease based on ACE counts, scores, individual events, and the seven-classes, which reflected: (1) domestic violence and alcohol abuse, (2) sexual violence, (3) abusive parents, (4) universal ACEs, (5) non-sexual ACEs, (6) few ACEs, and (7) household imprisonment/substance abuse.

Results: Odds of heart disease were higher for women and men with more ACE exposures (i.e. counts and universal-ACEs classification), and when exposed specifically to sexual violence, household drug use, and mental illness. Exceeding the threshold of two-plus ACEs increased odds of heart disease for women but not men. Women's and men's odds of heart disease were higher when experiencing physical/verbal abuse and household imprisonment, respectively.

Conclusion: ACE heterogeneity factors into heart disease patterns for Black men and women with important implications for intersectional screening, intervention, and the advancement of health equity.