DOI: 10.1177/00333549261488342 ISSN: 0033-3549

Temporal Trends and Social Inequalities in Adverse Childhood Experiences Among Children in the United States, 2016-2023

Jalal Uddin, Muhammad Zakir Hossin, Saleh Al Morshed Sadid, Campbell Smith, Drishti Deepchand, Mohammad Hajizadeh
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Objective:

Temporal changes in specific adverse childhood experiences (ACEs) and related inequalities remain unclear. We examined trends and social inequalities in age-standardized ACE prevalence among US children from 2016 through 2023.

Methods:

Data were drawn from the National Survey of Children’s Health (n = 309 425; ages 0-17 y). Age-standardized prevalence was estimated for 9 ACEs and 2 summary measures (any ACE and ≥4 ACEs). Differences in ACE prevalence were examined across key social and demographic characteristics, including children’s sex, race and ethnicity, parental nativity, parental education, and family income.

Results:

From 2016 through 2023, the prevalence of financial hardship (from 25.3% to 13.8%), parental divorce (from 24.5% to 20.7%), parental imprisonment (from 7.9% to 5.6%), any ACE (from 46.0% to 37.4%), and ≥4 ACEs (from 6.1% to 4.8%) showed statistically significant declines (all P for trend < .001). In contrast, the prevalence of parental mental illness (from 7.8% to 8.3%) and race and ethnicity–related discrimination (ranging from 3.6% to 4.4%) increased modestly. Black children consistently had higher ACE prevalence than non-Hispanic White children, particularly for discrimination (ranging from 9.1% to 14.9%), financial hardship (from 17.5% to 36.2%), and parental imprisonment (from 9.4% to 15.8%) during 2016-2023. Racial and ethnic and nativity gaps in parental imprisonment and financial hardship narrowed over time, although substantial differences remained. Across all years, children from lower-income and lower-education families consistently experienced higher ACE prevalence than their more advantaged counterparts.

Conclusions:

Despite modest reductions in some ACEs, social differences in ACEs persisted over time. Findings highlight the continued concentration of ACEs among socioeconomically disadvantaged children, underscoring the need for structural and policy interventions targeting upstream social determinants.

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