Adverse childhood experiences (ACEs) and school absenteeism are both linked to poor health and educational outcomes. However, little is known about whether ACEs contribute to school absenteeism for health reasons. We examined the association between ACEs and health–related school absenteeism in a nationally representative sample.

This cross-sectional study used data from the 2021 to 2022 National Health Interview Survey. Parents of participants reported on 7 ACEs and missed school days in the past 12 months due to illness, injury, or disability (“health-related absences”). Weighted logistic regressions tested whether exposure to ACEs was associated with any health-related absences as well as health–related chronic absenteeism (defined as missing at least 10% of school days), adjusting for covariates. We then tested whether general health status mediated the relationship between ACEs and absenteeism.

The unweighted sample included 10,794 youth ages 6 to 17. One quarter (24.3%) reported 1 or more ACE, and participants had 3.24 health-related absences on average. Exposure to at least 1 ACE was associated with increased odds of health-related absenteeism (Adjusted Odds Ratio (AOR) 1.53, 95% Confidence Interval (CI) 1.35–1.73) and health–related chronic absenteeism (AOR 2.43, 95% CI 1.80–3.28). General health status accounted for 6.9% of the relationship between ACEs and any health-related absenteeism and 13.1% of the relationship between ACEs and health–related chronic absenteeism (P < .001).

ACEs are associated with health-related absenteeism, and this association is partially mediated by general health status. Health systems and schools might focus jointly on preventing and mitigating the health and life course risks associated with both ACEs and absenteeism.

adverse childhood experiences

chronic absenteeism

health-related absenteeism

school health

© 2025 The Authors. Published by Elsevier, Inc. on behalf of Academic Pediatric Association.