Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients
Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients
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DOI：
10.1186/1471-2458-8-198
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发表时间：
2008-06-04
影响因子：
4.5
通讯作者：
Giles, Wayne H.
中科院分区：
文献类型：
--
作者：
Anda, Robert F.;Brown, David W.;Giles, Wayne H.
背景：处方药约占国家卫生支出的11%。先前对不良童年经历（ACE）的研究，包括常见形式的儿童虐待和相关的创伤性压力源，已将其与许多健康问题联系起来。然而，这些经验的关系，处方药use.Method的数据是稀缺的：我们使用的ACE评分（整数计数的8个不同类别的ACE）作为一个衡量的累积暴露于创伤性应激反应在童年时期。我们前瞻性地评估了15,033例成人HMO患者的评分与处方药使用的关系结果：记录了近120万张处方;随着ACE评分的增加，处方率以分级方式增加（趋势p < 0.0001）。与ACE评分为0的人相比，评分= 5的人的比率增加了40%;在所有年龄组（18-44岁，45-64岁和65-89岁）中均观察到分级关系（趋势p < 0.01）。在使用的药物类别数量的上十分位数的风险中观察到分级关系;得分= 5的人的这种风险增加了2倍。结论：ACE可显著增加处方数量和用药种类，且可持续使用长达7 ~ 80年。处方药使用的增加主要是由记录在案的ACE相关的健康和社会问题介导的。
Background: Prescription drugs account for approximately 11% of national health expenditures. Prior research on adverse childhood experiences (ACEs), which include common forms of child maltreatment and related traumatic stressors, has linked them to numerous health problems. However, data about the relationship of these experiences to prescription drug use are scarce.Method: We used the ACE Score (an integer count of 8 different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. We prospectively assessed the relationship of the Score to prescription drug use in a cohort of 15,033 adult HMO patients (mean follow-up: 6.1 years) and assessed mediation of this relationship by documented ACE-related health and social problems.Results: Nearly 1.2 million prescriptions were recorded; prescriptions rates increased in a graded fashion as the ACE Score increased (p for trend < 0.0001). Compared to persons with an ACE Score of 0, persons with a Score = 5 had rates increased by 40%; graded relationships were seen for all age groups (18-44, 45-64, and 65-89 years) (p for trend < 0.01). Graded relationships were observed for the risk of being in the upper decile of number of classes of drugs used; persons with scores of = 5 had this risk increased 2-fold. Adjustment for ACE-related health problems reduced the strength of the associations by more than 60%.Conclusion: ACEs substantially increase the number of prescriptions and classes of drugs used for as long as 7 or 8 decades after their occurrence. The increases in prescription drug use were largely mediated by documented ACE-related health and social problems.