Social Stratification of ACE Biomarkers: A Story of Perpetual Inequality

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 8. The Life Course and Health I

Abstract

ACEs, or adverse childhood experiences, are deviations from the expected environment before age 18. When left unaddressed, their pervasiveness and expansive nature culminate in adverse health, social, and behavioral outcomes. Fundamental cause theory and Marxist theories attribute these adverse outcomes to societal structural inequality, wherein economic dominance is reinforced and compounded over time. Life course theory and cumulative disadvantage theory consider the longitudinal perspectives; LCT considers early resources dictation of future outcomes, and cumulative disadvantage theory explains the underlying mechanisms of inequality. Together, driving future disparities. Bronfenbrenner’s ecological systems theory explains how each theory interacts at varying levels of analysis. Using NHANES data from 2021-2023, we grouped proxies for ACEs to include SES, mental and household stress, household family structure, household substance abuse, and health. To measure the biological impact of ACEs, we used measures of 5-methyltetrahydrofolate, an active form of folate involved in DNA methylation. After exploring a binary variable, we conducted an ordinal logistic regression, comparing critically low (1-9 nmol/L), severely low (10-19 nmol/L), moderately low (20-29 nmol/L), marginally low (30-39 nmol/L), and normal (40 nmol/L and above), suggesting robustness. In order of strength, our predictors are self-related health, Medicaid, CHIP, Medigap use, savings exceeding 20k, depression, education, and income poverty ratio. Effects appear nonlinear, with widening gaps across the scale disproportionately affecting the tails. We observed a confluence of low SES and low health having a multiplicative effect. Future research will explore our other ACE proxies and SHBG and DHEA biomarkers. Findings contribute to our understanding of health disparities, lend legitimacy to necessary reform and policy changes, and could result in a ripple effect on medical education, improved overall public health, and substantially reduce medical spending at every level, creating a healthier, better-adjusted, and more socially equitable society, starting with the most vulnerable group, children.

Authors

• Sheena R Martin, Valdosta State University

• Ellis Scott Logan, Valdosta State University