Adverse childhood experiences and access and utilization of health care
Adverse childhood experiences and access and utilization of health care
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DOI：
10.1093/pubmed/fdx155
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发表时间：
2018-12-01
影响因子：
4.4
通讯作者：
von Ehrenstein, Ondine S.
中科院分区：
文献类型：
--
作者：
Alcala, Hector E.;Valdez-Dadia, Annalyn;von Ehrenstein, Ondine S.
背景不良童年经历(ACE)与各种不良健康结局有关。然而，ACEs与卫生服务的可获得性和利用之间的关系在很大程度上被忽视了。方法本研究检验了2011年行为危险因素监测系统的数据(N=101527)。我们进行了Logistic回归分析，将9个A作为自变量，与过去一年中参保、拥有个人医疗保健提供者和接受医生检查的几率有关。结果在考虑了潜在的混杂因素后，所有的ACE都与过去一年中目前投保和接受医生检查的几率较低相关。身体虐待、情感虐待和家庭功能障碍的几项指标与拥有个人服务提供者的几率较低相关。结论我们的研究结果表明，ACEs可能通过哪些途径影响健康。对于有ACEs病史的个人，应考虑提供医疗保险和以了解创伤情况的方式提供护理。
Background Adverse childhood experiences (ACEs) have been associated with a variety of negative health outcomes. However, the association between ACEs and access and utilization of health care have been largely ignored.Methods This study examined data from the 2011 Behavioral Risk Factor Surveillance System (N = 101 527). We conducted logistic regression analyses, with nine ACEs as independent variables, in relation to the odds of being insured, having a personal health care provider and receiving a physician checkup in the past year. Unadjusted and adjusted multivariable models were estimated.Results After accounting for potential confounders, all ACEs were associated with lower odds of being currently insured and receiving a physician checkup in the past year. Physical abuse, emotional abuse and several measures of household dysfunction were associated with lower odds of having a personal provider.Conclusions Our findings suggest potential pathways by which ACEs may impact health. Provision of health insurance and providing care in a trauma-informed manner should be considered for individuals with a history of ACEs.