Adverse Childhood Experiences Are Associated With Childhood-Onset Arthritis in a National Sample of US Youth: An Analysis of the 2016 National Survey of Children's Health (Journal of Peds)

Objectives: To determine whether there is an association between adverse childhood experiences (ACEs) and childhood-onset arthritis, comparing youth with arthritis to both healthy youth and youth with other acquired chronic physical diseases (OCPD); and to examine whether ACEs are associated with disease-related characteristics among children with arthritis.

Study design: In a cross-sectional analysis of data from the 2016 National Survey of Children's Health we examined whether ACEs were associated with having arthritis versus either being healthy or having a non-rheumatologic OCPD. ACE scores were categorized as 0, 1, 2-3, ≥4 ACEs. Multinomial logistic regression models examined associations between ACEs and health status while adjusting for age, sex, race/ethnicity, and poverty status. Among children with arthritis, associations between ACEs and disease-related characteristics were assessed by Pearson chi-square analyses.

Results: Compared with children with no ACEs, children with 1, 2-3, and ≥4 ACEs had increased odds of having arthritis versus being healthy (adjusted OR for ≥4 ACEs: 9.4, 95% CI 4.0, 22.1) and versus OCPD (adjusted OR for ≥4 ACEs: 3.7, 95% CI 1.7, 8.1). Among children with arthritis, ACEs were associated with worse physical impairment.

Conclusions: Children with higher numbers of ACEs are more likely to have arthritis, when arthritis status is compared either to being healthy, or to having OCPD. Further studies are needed to determine the direction of the association between ACEs and childhood arthritis, its impact on disease course, and potential intervention targets that might mitigate these effects.