Association Between Adverse Childhood Experiences and Dementia in Older Japanese Adults
Association Between Adverse Childhood Experiences and Dementia in Older Japanese Adults
复制标题
DOI：
10.1001/jamanetworkopen.2019.20740
复制
发表时间：
2020-02-07
影响因子：
13.8
通讯作者：
Kondo, Katsunori
中科院分区：
文献类型：
--
作者：
Tani, Yukako;Fujiwara, Takeo;Kondo, Katsunori
问题：童年时期的不良经历是否与晚年痴呆症的发病有关？结果在17412日本老年人的大规模队列研究中，不良童年经历的累积数量与发展痴呆症的风险增加有关。在日本老年人中，有3次或3次以上不良童年经历与痴呆症风险增加有关。重要性痴呆症在日本的患病率一直在增加。儿童贫困与认知障碍风险增加有关，这可能与个人的教育途径有关。然而，痴呆症与贫困和教育以外的不良童年经历之间的关联尚未得到很好的记录。目的研究1948年以前出生、二战期间和战后长大的日本人的不良童年经历与痴呆发作之间的关系。设计、设置和参与者对日本老年学评价研究的17412名参与者进行了3年（2013-2016）随访，这是一项针对65岁或以上成年人的基于人群的队列研究。2019年12月对数据进行了分析。主要结果和措施通过公共长期护理保险系统评估痴呆症发作。通过基线调查评估18岁以前的不良童年经历。七个不良的童年经历进行了评估：父母死亡，父母离婚，父母精神疾病，家庭暴力，身体虐待，心理忽视，心理虐待。参与者根据他们是否有0，1，2或3或更多的不良童年经历进行分类。考克斯回归模型被用来估计痴呆风险的风险比。结果在17412名参与者中（9281名女性[53.3%];平均[SD]年龄，73.5 [6.0]岁），在平均3.2年（范围，2.4-3.3年）的随访期间，703名参与者（312名男性和391名女性）发生痴呆。在所有参与者中，6804人（39.1%）年龄大于75岁; 10968人（63.0%）报告了0次不良童年经历，5129人（29.5%）报告了1次不良童年经历，964人（5.5%）报告了2次不良童年经历，351人（2.0%）报告了3次或更多不良童年经历。在对年龄、性别、儿童经济困难、营养环境和教育进行调整后，与那些没有不良童年经历的人相比，经历过3次或更多不良童年经历的参与者患痴呆症的风险更大（风险比，2.18; 95%CI，1.42-3.35）。在对成人社会人口学特征、社会关系、健康行为和健康状况进行连续调整后，该风险比有所减弱，但仍具有统计学显著性（1.78; 95%CI，1.15-2.75; P = .009）。结论和相关性本研究发现，有3个或更多的不良童年经历与老年人痴呆症的风险增加有关。本队列研究探讨了1948年以前出生的日本人的不良童年经历和痴呆症发病之间的关系。
Question Are adverse childhood experiences associated with the onset of dementia later in life? Findings In a large-scale cohort study of 17412 older Japanese adults, the cumulative number of adverse childhood experiences was associated with an increased risk of developing dementia. Meaning Having 3 or more adverse childhood experiences was associated with increased dementia risk among older Japanese adults.Importance The prevalence of dementia in Japan has been increasing. Childhood poverty has been associated with increased risk of cognitive impairment, possibly mediated by individuals' educational paths. However, the associations between dementia and adverse childhood experiences other than poverty and education have not been well documented. Objective To examine the association between adverse childhood experiences and dementia onset among Japanese individuals born before 1948 who grew up during and after World War II. Design, Setting, and Participants A 3-year (2013-2016) follow-up was performed of 17412 participants in the Japan Gerontological Evaluation Study, a population-based cohort study of adults aged 65 years or older. Data were analyzed in December 2019. Main Outcomes and Measures Dementia onset was assessed through the public long-term care insurance system. Adverse childhood experiences before the age of 18 years were assessed by survey at baseline. Seven adverse childhood experiences were assessed: parental death, parental divorce, parental mental illness, family violence, physical abuse, psychological neglect, and psychological abuse. Participants were classified according to whether they had 0, 1, 2, or 3 or more adverse childhood experiences. Cox regression models were used to estimate hazard ratios for the risk of dementia. Results Among 17412 participants (9281 women [53.3%]; mean [SD] age, 73.5 [6.0] years), dementia occurred in 703 participants (312 men and 391 women) during a mean follow-up of 3.2 years (range, 2.4-3.3 years). Among all participants, 6804 (39.1%) were older than 75 years; 10968 (63.0%) reported 0 adverse childhood experiences, 5129 (29.5%) reported 1 adverse childhood experience, 964 (5.5%) reported 2 adverse childhood experiences, and 351 (2.0%) reported 3 or more adverse childhood experiences. Participants who experienced 3 or more adverse childhood experiences had a greater risk of developing dementia compared with those who grew up without adverse childhood experiences, after adjustment for age, sex, childhood economic hardship, nutritional environment, and education (hazard ratio, 2.18; 95% CI, 1.42-3.35). After successive adjustment for adult sociodemographic characteristics, social relationships, health behavior, and health status, this hazard ratio was attenuated but remained statistically significant (1.78; 95% CI, 1.15-2.75; P = .009). Conclusions and Relevance This study found that having 3 or more adverse childhood experiences was associated with increased dementia risk among older Japanese adults.This cohort study examines the association between adverse childhood experiences and dementia onset among Japanese individuals born before 1948.