Associations between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population

Round 1

Reviewer 1 Report

This study presents a connection between experiences of adversity in childhood and ED utilization later in adulthood. The target population is defined as the low-income population. Based on this study, an informal social support can be protective. The authors suggest that building upstream prevention and incorporating trauma-informed strategies can potentially decrease use of the ED in this population. This effort can consequently lead to better health care and improved health outcomes. As authors have also mentioned, this study faced some limitations, and future research is needed to follow for substantiate the findings, as if connections exist between experiences of adversity in childhood and ED utilization. Besides, the mechanisms underlying this connection is not known yet. 

The paper is well written and easy to follow. the topic is interesting and valuable, too.

The authors are encouraged to add a few speculation on the potential mechanisms underlying the connection, and if this can be affected by various confounding factors, such as geographical location, gender, culture, education, etc. These points will help in the next studies and points to consider for design.

Author Response

This study presents a connection between experiences of adversity in childhood and ED utilization later in adulthood. The target population is defined as the low-income population. Based on this study, an informal social support can be protective. The authors suggest that building upstream prevention and incorporating trauma-informed strategies can potentially decrease use of the ED in this population. This effort can consequently lead to better health care and improved health outcomes. As authors have also mentioned, this study faced some limitations, and future research is needed to follow for substantiate the findings, as if connections exist between experiences of adversity in childhood and ED utilization. Besides, the mechanisms underlying this connection is not known yet.

The paper is well written and easy to follow. the topic is interesting and valuable, too.

Author response: We thank the reviewer for this positive comment on our paper and appreciate their review.

The authors are encouraged to add a few speculation on the potential mechanisms underlying the connection, and if this can be affected by various confounding factors, such as geographical location, gender, culture, education, etc. These points will help in the next studies and points to consider for design.

Author response: We thank the reviewer for this comment. We have added a few statements about the potential confounding effects of different demographics/geography on our hypothesized mechanism.

Reviewer 2 Report

Dear Authors,

Thank you for the opportunity to review your manuscript titled, "Associations Between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population." I found the manuscript to be very well-developed and written. It was a pleasure to review your work. I have neither substantive or minor edits for your consideration. Congratulations on completing such important work for the public health and healthcare fields.

Author Response

Thank you for the opportunity to review your manuscript titled, "Associations Between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population." I found the manuscript to be very well-developed and written. It was a pleasure to review your work. I have neither substantive or minor edits for your consideration. Congratulations on completing such important work for the public health and healthcare fields.

Author response: We thank the reviewer for this positive comment on our paper and appreciate their review.