Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention-25 States, 2015-2017
Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention-25 States, 2015-2017
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DOI：
10.15585/mmwr.mm6844e1
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发表时间：
2019-11-08
影响因子：
33.9
通讯作者：
Mercy, James A.
中科院分区：
文献类型：
--
作者：
Merrick, Melissa T.;Ford, Derek C.;Mercy, James A.
导言：儿童时期的不良经历，如暴力受害、在家庭中滥用药物或目睹亲密伴侣的暴力，都与成人发病率和死亡率的主要原因有关。因此，减少不良童年经历对于避免成年后的多重负面健康和社会经济后果至关重要。方法：收集了2015-2017年间25个州的行为危险因素监测系统数据，其中包括国家增加的不良童年经历项目。结果是冠心病、中风、哮喘、慢性阻塞性肺疾病、癌症(不包括皮肤癌)、肾脏疾病、糖尿病、抑郁症、超重或肥胖、目前吸烟、酗酒、高中毕业率低、失业和缺乏医疗保险的自我报告状态。对年龄组、种族/民族和性别进行调整的Logistic回归模型被用来计算人群归因分数，代表与预防不良童年经历相关的潜在结局的减少。结果：在研究人群中，近六分之一(15.6%)的成年人报告了四种或更多类型的不良童年经历。不良童年经历与较差的健康结果、健康危险行为和社会经济挑战显著相关。根据人群归因比例显示，观察病例数量的潜在减少百分比从超重或肥胖的1.7%到酗酒的23.9%，慢性阻塞性肺疾病的27.0%，抑郁症的44.1%。结论和对公共卫生实践的影响：预防不良童年经历的努力也可能预防成人的慢性病、抑郁症、健康危险行为和负面的社会经济后果。各国可以利用从现有最佳证据中得出的综合公共卫生办法，在儿童遭遇逆境开始之前就加以预防。通过为健康社区创造条件并将重点放在初级预防上，有可能降低儿童不良经历的风险，同时也减轻那些已经受到这些经历影响的人的后果。
Introduction: Adverse childhood experiences, such as violence victimization, substance misuse in the household, or witnessing intimate partner violence, have been linked to leading causes of adult morbidity and mortality. Therefore, reducing adverse childhood experiences is critical to avoiding multiple negative health and socioeconomic outcomes in adulthood.Methods: Behavioral Risk Factor Surveillance System data were collected from 25 states that included state-added adverse childhood experience items during 2015-2017. Outcomes were self-reported status for coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, cancer (excluding skin cancer), kidney disease, diabetes, depression, overweight or obesity, current smoking, heavy drinking, less than high school completion, unemployment, and lack of health insurance. Logistic regression modeling adjusting for age group, race/ethnicity, and sex was used to calculate population attributable fractions representing the potential reduction in outcomes associated with preventing adverse childhood experiences.Results: Nearly one in six adults in the study population (15.6%) reported four or more types of adverse childhood experiences. Adverse childhood experiences were significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges. Potential percentage reductions in the number of observed cases as indicated by population attributable fractions ranged from 1.7% for overweight or obesity to 23.9% for heavy drinking, 27.0% for chronic obstructive pulmonary disease, and 44.1% for depression.Conclusions and implications for public health practice: Efforts that prevent adverse childhood experiences could also potentially prevent adult chronic conditions, depression, health risk behaviors, and negative socioeconomic outcomes. States can use comprehensive public health approaches derived from the best available evidence to prevent childhood adversity before it begins. By creating the conditions for healthy communities and focusing on primary prevention, it is possible to reduce risk for adverse childhood experiences while also mitigating consequences for those already affected by these experiences.