Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study
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DOI：
10.1016/j.amepre.2019.04.001
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发表时间：
2019-06-01
影响因子：
5.5
通讯作者：
Marks, James S.
中科院分区：
文献类型：
--
作者：
Felitti, Vincent J.;Anda, Robert F.;Marks, James S.
背景资料：健康风险行为和疾病的关系，在成年期的广度暴露于儿童期的情绪，身体，或性虐待，家庭功能障碍，在childhood.Methods：一份关于不良童年经历的问卷邮寄给13,494成年人谁完成了标准化的医疗评估，在一个大型HMO，9,508（70.5%）回答。研究了七类不良童年经历：心理，身体或性虐待;对母亲的暴力;或与滥用药物，精神病或自杀或曾经入狱的家庭成员生活在一起。然后将这些不良童年经历的类别数量与成年风险行为，健康状况和疾病的测量进行比较。Logistic回归被用来调整人口因素的影响之间的关联的累积数量的类别的儿童暴露（范围：0-7）和危险因素的主要死亡原因在成人life.Results：超过一半的受访者报告至少有一个，四分之一的报告>= 2类儿童暴露。我们发现，儿童期暴露的类别数量与所研究的每种成人健康风险行为和疾病之间存在分级关系（P <0.001）。与没有经历过任何童年接触的人相比，经历过四种或四种以上童年接触的人，酗酒、吸毒、抑郁和自杀企图的健康风险增加了4至12倍;吸烟、自我评估健康状况不佳、有50个以上性伴侣和性传播疾病的风险增加了2至4倍;缺乏运动和严重肥胖的人数增加了1.4到1.6倍。儿童期不良暴露类别的数量与成人疾病的存在分级关系，包括缺血性心脏病、癌症、慢性肺病、骨折和肝病。不良的童年经历的七个类别是密切相关的，多个类别的儿童期暴露的人可能有多种健康风险因素在以后的生活中，我们发现了一个强大的分级关系的广度暴露于虐待或家庭功能障碍在童年和多种危险因素的几个主要原因在成年人的死亡。(C)2019年美国预防医学杂志。爱思唯尔公司出版All rights reserved.
Background: The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described.Methods: A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life.Results: More than half of respondents reported at least one, and one-fourth reported >= 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, >= 50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.Conclusions: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.