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The impact of ACE<\/jats:styled-content>s on patients with autoimmune disease is unknown. The present study was undertaken to compare the prevalence of ACE<\/jats:styled-content>s in patients with systemic lupus erythematosus (SLE<\/jats:styled-content>) to a population\u2010based survey estimate and to investigate relationships between ACE<\/jats:styled-content>s and SLE<\/jats:styled-content> outcomes.<\/jats:p><\/jats:sec>Methods<\/jats:title>Data derived from the California Lupus Epidemiology Study (CLUES<\/jats:styled-content>), a sample of adult patients with SLE<\/jats:styled-content>. Participants completed a 10\u2010item ACE<\/jats:styled-content> questionnaire covering 3 domains (abuse, neglect, household challenges). We estimated ACE<\/jats:styled-content> prevalence in 269 CLUES<\/jats:styled-content> participants compared to geographically matched respondents from the 2015 California Behavioral Risk Factor Surveillance System (BRFSS<\/jats:styled-content>), which was standardized to CLUES<\/jats:styled-content> participant characteristics (age, sex, race\/ethnicity). We examined associations of patient\u2010reported and physician\u2010assessed health status measures with overall ACE<\/jats:styled-content> levels and domains using multivariable linear regression, controlling for sociodemographics, nephritis, and juvenile\u2010onset SLE<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>Although specific domains varied, overall ACE<\/jats:styled-content> levels were similar for CLUES<\/jats:styled-content> and BRFSS<\/jats:styled-content> respondents. Among SLE<\/jats:styled-content> patients, 63.2% had \u22651 ACE<\/jats:styled-content>, and 19.3% had \u22654. ACE<\/jats:styled-content>s were more prevalent in those who were older, women, Latino or African American, and without college degrees, but not in those with lupus nephritis. In adjusted models, higher ACE<\/jats:styled-content> levels and ACE<\/jats:styled-content> domains were associated with worse patient\u2010reported SLE<\/jats:styled-content> activity, depression, and health status but were not significantly associated with physician\u2010assessed SLE<\/jats:styled-content> activity, damage, or severity.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Given the association between ACE<\/jats:styled-content> levels and important patient\u2010reported outcomes in SLE<\/jats:styled-content>, our study reinforces the need for prevention of ACE<\/jats:styled-content>s in childhood and for clinical interventions to promote resilience among adults who have experienced 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