Abstract Body: Background
Previous research has shown adverse childhood experiences (ACEs) – traumatic events such as witnessing domestic violence and experiencing physical abuse before age 18 – are associated with poorer cardiovascular health (CVH) in childhood. However, this association may be confounded by childhood home environment and other social determinants of health (SDOH). We explored this relationship using propensity score matching to control for selection bias.

Methods
We conducted a propensity score (PS)-matched analysis in the Young Hearts study, a Chicago-based pediatric cohort study. We included participants aged 1-17y (N = 6,487) with available ACEs and behavioral CVH (bCVH) data (diet, exercise, nicotine exposure, sleep, and BMI). Participants self-reported whether the child was exposed to any of 17 possible ACEs. We calculated bCVH scores (0-100) using an age-appropriate adaptation of the Life’s Essential 8 framework. PS matching balanced the sample on key SDOH, including parental education, child sex, child race and ethnicity, birth year, and number of adults and children at home. Then, linear regression assessed the association of ACEs with bCVH scores.

Results
The PS-matched sample included 3263 children without ACEs and 3078 children with at least 1 ACE. Individuals with >=1 ACE had significantly lower bCVH scores than those without ACEs (-4.72; 95% CI -5.36, -4.09) (Figure). Among individual CVH metrics, ACEs were most strongly associated with diet (-8.40, 95% CI = -9.65, -7.15) and physical activity (-5.48, 95% CI = -6.91, -4.05).

Conclusion
This study highlights the significant impact of ACEs on children’s CVH. The use of propensity score matching to reduce SDOH-related confounding suggests that efforts to prevent the ACEs themselves would likely be complementary to important efforts to improve adverse SDOH. These findings underscore the need for early identification of and intervention for children experiencing ACEs to improve and preserve CVH.