Skip to main content

ASU researchers set price tag on illness linked to childhood trauma

Morrison Institute estimates $260 million in 2019 Medicare costs from adverse childhood experiences

April 23, 2021

A new study done at Arizona State University has, for the first time, quantified the health-care cost of women in Arizona who experienced trauma as children, pegging the amount at $260 million for 2019.

The research, done by the Morrison Institute for Public Policy, showed that exposure to three or more “adverse childhood experiences,” or ACEs, such as drug abuse or violence in their homes, was associated with $260 million in Medicaid spending – about 16% of the total for 2019.

The work is important because researchers have long known about the poor health outcomes associated with adverse childhood experiences, but policymakers typically need to see hard numbers on cost benefits before making changes.

“The purpose of the study is to determine the association between ACEs in Arizona and health outcomes later in life and the cost of these outcomes,” said Erica Quintana, senior policy analyst at the Morrison Institute and one of the authors of the report, which is titled “Cost of Adverse Childhood Experiences in Arizona.”

“I hope this report gives people some numbers and language to talk about ACEs in terms of cost, and that we can facilitate discussion on how preventing ACEs or reducing the number of ACEs might save money and suffering in terms of health care.”

Adverse childhood experiences are traumatic events that happen before age 18 and include emotional, physical, or sexual abuse; physical or emotional neglect; domestic violence; parental substance abuse; household mental illness; divorce; or imprisoned family members.

Adverse childhood experiences are common. The Morrison report found that about two-thirds of Arizona adults surveyed in 2018 reported they had at least one ACE.

A famous study in 1998 found that the more ACEs a person experienced, the higher the likelihood that they would have chronic illness as an adult, such as heart disease, cancer or diabetes.

Because those illnesses are among the most expensive to treat, some states have tried to pinpoint the health care costs generated by people with childhood trauma. But every state that’s done so has used different criteria for determining the cost.

The Morrison Institute report is the first to estimate the cost in Arizona, and Quintana cautioned that the $260 million figure is conservative and that the total cost is likely much higher.

“This is only the amount paid by Medicare,” Quintana said during a webinar on April 22 that discussed the results.

“This doesn’t include copays, deductibles, private insurance or lost work production or wages.”

The Morrison Institute researchers arrived at the $260 million figure this way:

  • The prevalence of ACEs in Arizona was determined using data from the 2014, 2016 and 2018 Behavioral Risk Factor Surveillance SystemThe BRFSS is a partnership between federal and state governments to collect data on health practices, quality of life, health conditions and barriers to health care..
  • They found that in 2018, 35% of respondents reported no ACEs; 20% had one ACE; 15% had two ACEs, and 30% had three or more ACEs.
  • The final report includes only women because the male Behavioral Risk Factor Surveillance System sample size was not large enough.
  • Then, the researchers looked at the diseases that are among the most common causes of death in Arizona: heart disease, chronic lower respiratory disease, stroke and diabetes.
  • Using a statistical model, the team estimated the proportion of the disease cases that are likely associated with women being exposed to three or more ACEs. For heart disease, 17%; chronic lower respiratory disease (which is bronchitis or chronic obstructive pulmonary disease), 16%; stroke, 15%, and diabetes, 10%.
  • Then the researchers used Medicaid data to approximate the annual cost of each disease. Spending to treat heart disease accounted for more than two-thirds of the total — $176 million.
  • The webinar included several health-care experts who weighed in on the results.

Amy Shoptaugh, a pediatrician and the director of the Center for Resiliency and Wellbeing at Phoenix Children’s Hospital, said that quantifying the cost of childhood trauma is important.

“If we are able to prevent ACEs and treat it early, we don’t know what the outcome is. We can’t show what the return on investment is for that. To put a number on that is difficult and that makes it hard to change policy,” she said.

“You won’t know how much money you’re saving.”

Shoptaugh said that positive experiences can “buffer” the effects of adverse childhood experiences. That’s why it’s important for people to realize that experiencing an ACE does not necessarily mean a person will have a poor health outcome.

“Someone might have one ACE but no buffer, or seven ACES and many buffers,” she said.

Parent education is one way to help prevent adverse childhood experiences, according to Sandi Cimino, a certified ACEs trainer and certified trauma support specialist.

“We don’t normalize parent education. It’s seen as something for people who are required by the courts to go to a parenting class,” she said.

“Parent education is often seen as punitive and something for when things go wrong. But everyone needs help at some point with parenting.”

Cimino said that when she talks to parents about resiliency, she often tells them to imagine that their child’s life is a journey.

“You’re packing that child’s suitcase. What is the one thing you would pack in their suitcase to take with them and how do you teach them that?”

Top image courtesy of

More Health and medicine


Dad and son smiling and discussing

Developing tools for positive parenting in face of 21st-century challenges

Top ASU psychology professors with expertise in trauma-informed parenting interventions have joined with the Child Mind Institute to develop videos and tools to directly help families dealing with…

Woman wearing a maroon cap and gown in an audience of similarly dressed people, smiling next to another woman.

Faculty mentor guides 3-time ASU alum to career in health law

Though she began her academic career at Arizona State University with designs of becoming a doctor, the relationship Mary Saxon formed with her health care disparities course instructor — who also…

Students in a classroom building air filters.

New research: DIY air filters work better than commercial HEPA filters for fraction of cost

We spend about 90% of our time indoors, breathing in air that can contain particulate matter like dust, wildfire smoke, volatile organic compounds, carbon dioxide and exhaled aerosols that may…