A Penn Physician Reminds us of the Kaiser ACE Study & Ongoing Implications for Patients

Kaiser Permanente’s adverse childhood experience (ACE) study found that nearly two-thirds of its study participants had experienced an adverse childhood experience. Based on the study it can be projected that those patients with more than four ACEs are at a materially higher risk for seven of the top 10 leading causes of death including heart attack reports Dr. Jeffrey R. Martin, MD, chair of Penn Medicine Lancaster General Health’s Department of Family and Community Medicine.

The CDC- Kaiser ACE Study

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) study is one of the largest investigations of childhood abuse and neglect and household challenges and later-life health and well-being. Originally conducted at Kaiser Permanente from 1995 to 1997 with two waves of data collection. Over 17,000 Health Maintenance Organizations (HMO) members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors.

Major findings included that nearly two-thirds of study participants reported at least one ACE and more than one in five reported three or more ACEs.

Relevance on Practice and Research Today

Dr. Jeffrey R. Martin of Penn Medicine Lancaster General Health’s Department of Family and Community Medicine discusses in Lancaster Online how with one patient, a dark 50-year-old family secret involving sexual abuse led to a lifetime of ailments for his 55-year-old patient. From a hospitalization in his teens for a “stomach ailment” to failed relationships and substance abuse-caused Hepatitis C infection to poorly controlled insulin-dependent diabetes. The story is not uncommon. We have known for two decades now that ACEs (child abuse, sexual abuse, etc.) are associated with an increased risk of chronic disease in adulthood. Those who have experienced four or more ACEs are at severe risk for heart disease, diabetes, emphysema, and suicide. Those with six or more ACEs have a life expectancy of 20 years less than the average in America.

Dr. Martin reminds the reader that ACEs not only increase the chance of chronic medical and/or behavioral health conditions but they will also increase the financial burden on individuals to treat those problems. We know from many studies that financial insecurity feeds the health care crisis. Upon a decision of food and shelter or drug copays, the latter is typically picked as a matter of survival.

Not an Automatic Outcome

Dr. Martin emphasizes that the patient history of trauma doesn’t automatically guarantee a condemned future of bad health. Clearly if patients are engaged and encouraged to share and work through past experiences the process, while not taking away what happened in the past, can offer more elements for a care team to work with the patient—holistically- to “tap into areas of resiliency and provide more effective and better quality health care.”


Dr. Jeffrey R. Martin, Penn Medicine Lancaster General Health’s Department of Family and Community Medicine