Cumulative adverse childhood experiences and parent-reported allergic conditions and asthma among U.S. children: A nationally representative study.

Abstract

Allergic diseases are common chronic conditions in childhood, yet the role of adverse childhood experiences (ACEs) in their development remains incompletely understood at the population level. Using pooled data from the 2016-2023 National Survey of Children's Health, a nationally representative survey of U.S. children aged 0-17 years, we examined associations between ACEs and parent-reported allergic conditions and asthma, including parent-reported disease severity (moderate-to-severe). ACEs were assessed across nine parent-reported domains and summarized as a cumulative score. Weighted logistic regression and restricted cubic spline models were performed to estimate associations between ACEs and allergic outcomes, with subgroup analyses by age and sociodemographic characteristics. A total of 290,599 children were included (M [SD] age = 8.62 [5.16] years; 51.17% male), representing 61.5 million children. The weighted prevalence was 20.09% for allergic conditions and 7.18% for asthma. Compared with no ACEs, exposure to ≥4 ACEs was associated with higher odds of parent-reported allergic conditions (OR = 1.85; 95% CI [1.68, 2.04]) and asthma (OR = 2.08; 95% CI [1.79, 2.41]). Associations were strongest in early childhood. Among children aged 0-2 years, those exposed to ≥4 ACEs had 2.6-fold higher odds of allergic conditions (OR = 2.64; 95% CI [1.65, 4.23]) and nearly fivefold increased odds of asthma (OR = 4.71; 95% CI [2.24, 9.91]), compared to those with no ACEs. In item-level analyses, caregiver mental illness and experiences of racial discrimination showed the strongest associations with allergic outcomes. These findings highlight early-life adversity as an important social determinant of allergic disease and the need for early identification and prevention strategies. (PsycInfo Database Record (c) 2026 APA, all rights reserved).