Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening.
Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening.
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DOI：
10.1001/jamapediatrics.2020.5602
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发表时间：
2021-04-01
期刊：
影响因子：
26.1
通讯作者：
Danese A
中科院分区：
文献类型：
--
作者：
Baldwin JR;Caspi A;Meehan AJ;Ambler A;Arseneault L;Fisher HL;Harrington H;Matthews T;Odgers CL;Poulton R;Ramrakha S;Moffitt TE;Danese A
儿童不良经历筛查能否准确预测个体日后出现健康问题的风险？在2个基于人群的出生队列（共2927人）中，年龄为20岁，相距20000公里，ACE评分与健康问题的平均组间差异相关，独立于临床医生可用的其他信息。然而，ACE评分在预测个人健康问题方面的准确性较低。ACE分数可以预测平均组差异，在以后的健康问题，但是，ACE分数有穷人的准确性，在确定个人在未来的健康问题的高风险。儿童期不良经历（ACE）是人群健康问题的公认危险因素。然而，目前尚不清楚ACE筛查是否能准确识别出日后出现健康问题的个体。检测ACE筛查对日后健康问题的预测准确性。这项研究包括两个出生队列：环境风险（E-Risk）纵向双胞胎研究观察了2232名1994年至1995年期间出生的参与者，直到他们年满18岁（2012-2014年）;达尼丁多学科健康与发展研究观察了1037名1972年至1973年出生的参与者，直到他们45岁年（2017-2019年）。统计分析时间为2018年5月28日至2020年7月29日。通过两个队列的重复访谈和观察，在儿童期前瞻性测量ACE。还通过38岁时的访谈回顾性测量了达尼丁队列的ACE。在18岁时评估E-风险组和45岁时评估达尼丁队列的健康结局。心理健康问题进行了评估，通过临床访谈使用诊断访谈时间表。通过访谈、人体测量和血液采集评估身体健康问题。在2009年的2232名E-Risk参与者中（1051名女孩[52%]）被纳入分析。在1037名达尼丁队列参与者中，918名（460名男孩[50%]）被纳入分析。在E风险中，ACE评分较高的儿童日后出现健康问题的风险更大（任何精神健康问题：每增加一次ACE的相对风险为1.14 [95%CI，1.10-1.18];任何身体健康问题：每增加一次ACE的相对风险为1.09 [95%CI，1.07-1.12]）。ACE评分与健康问题相关，独立于临床医生通常可获得的其他信息（即性别、社会经济劣势和健康问题史）。然而，ACE评分在预测个体日后健康问题风险方面的准确性较差（任何心理健康问题：受试者工作特征曲线下面积，0.58 [95%CI，0.56-0.61];任何身体健康问题：受试者工作特征曲线下面积，0.60 [95%CI，0.58-0.63];机会预测：受试者工作特征曲线下面积，0.50）。使用前瞻性和回顾性ACE测量，结果在达尼丁队列中一致。这项研究表明，虽然ACE评分可以预测健康的平均组差异，他们预测个人的风险，以后的健康问题的准确性差。因此，基于ACE筛查的针对性干预措施可能无法有效预防不良健康结果。这项队列研究使用来自2个出生队列的数据来测试不良童年经历筛查对以后健康问题的预测准确性。
Can screening for adverse childhood experiences (ACEs) accurately predict individual risk for later health problems? In 2 population-based birth cohorts (with a total of 2927 individuals) growing up 20 years and 20 000 km apart, ACE scores were associated with mean group differences in health problems independent of other information available to clinicians. However, ACE scores had low accuracy in predicting health problems at the individual level. ACE scores can forecast mean group differences in later health problems; however, ACE scores have poor accuracy in identifying individuals at high risk for future health problems. Adverse childhood experiences (ACEs) are well-established risk factors for health problems in a population. However, it is not known whether screening for ACEs can accurately identify individuals who develop later health problems. To test the predictive accuracy of ACE screening for later health problems. This study comprised 2 birth cohorts: the Environmental Risk (E-Risk) Longitudinal Twin Study observed 2232 participants born during the period from 1994 to 1995 until they were aged 18 years (2012-2014); the Dunedin Multidisciplinary Health and Development Study observed 1037 participants born during the period from 1972 to 1973 until they were aged 45 years (2017-2019). Statistical analysis was performed from May 28, 2018, to July 29, 2020. ACEs were measured prospectively in childhood through repeated interviews and observations in both cohorts. ACEs were also measured retrospectively in the Dunedin cohort through interviews at 38 years. Health outcomes were assessed at 18 years in E-Risk and at 45 years in the Dunedin cohort. Mental health problems were assessed through clinical interviews using the Diagnostic Interview Schedule. Physical health problems were assessed through interviews, anthropometric measurements, and blood collection. Of 2232 E-Risk participants, 2009 (1051 girls [52%]) were included in the analysis. Of 1037 Dunedin cohort participants, 918 (460 boys [50%]) were included in the analysis. In E-Risk, children with higher ACE scores had greater risk of later health problems (any mental health problem: relative risk, 1.14 [95% CI, 1.10-1.18] per each additional ACE; any physical health problem: relative risk, 1.09 [95% CI, 1.07-1.12] per each additional ACE). ACE scores were associated with health problems independent of other information typically available to clinicians (ie, sex, socioeconomic disadvantage, and history of health problems). However, ACE scores had poor accuracy in predicting an individual’s risk of later health problems (any mental health problem: area under the receiver operating characteristic curve, 0.58 [95% CI, 0.56-0.61]; any physical health problem: area under the receiver operating characteristic curve, 0.60 [95% CI, 0.58-0.63]; chance prediction: area under the receiver operating characteristic curve, 0.50). Findings were consistent in the Dunedin cohort using both prospective and retrospective ACE measures. This study suggests that, although ACE scores can forecast mean group differences in health, they have poor accuracy in predicting an individual’s risk of later health problems. Therefore, targeting interventions based on ACE screening is likely to be ineffective in preventing poor health outcomes. This cohort study uses data from 2 birth cohorts to test the predictive accuracy of adverse childhood experience screening for later health problems.
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影响因子：
4.5
作者：
Kelly-Irving M;Lepage B;Dedieu D;Lacey R;Cable N;Bartley M;Blane D;Grosclaude P;Lang T;Delpierre C
通讯作者：
Delpierre C
影响因子：
6.6
作者：
Meehan, Alan J.;Latham, Rachel M.;Danese, Andrea
通讯作者：
Danese, Andrea
影响因子：
2.1
作者：
Carter, RE;Lipsitz, SR;Tilley, BC
通讯作者：
Tilley, BC
影响因子：
4.8
作者：
Finkelhor, David
通讯作者：
Finkelhor, David
影响因子：
--
作者：
Milne, Barry J.;Caspi, Avshalom;Moffitt, Terrie E.
通讯作者：
Moffitt, Terrie E.