Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey.
Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey.
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DOI：
10.1093/pubmed/fdu065
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
Lowey H
中科院分区：
文献类型：
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作者：
Bellis MA;Hughes K;Leckenby N;Hardcastle KA;Perkins C;Lowey H
ACE(不良童年经历)研究通常考察童年压力源和成人健康损害行为之间的联系。使用增强的ACE调查方法，我们检查了ACE对非传染性疾病的影响，并纳入了英格兰过早死亡率的替代指标。进行了具有全国代表性的调查(n=3885，年龄18-69岁，2013年4月至7月)。社会人口学控制的比例风险分析审查了ACE类别数量(<；18岁；例如虐待儿童和家庭功能障碍，如家庭暴力)与癌症、糖尿病、中风、呼吸系统疾病、肝脏/消化系统疾病和心血管疾病之间的关系。兄弟姐妹(n=6983)死亡率作为过早死亡率的衡量指标也进行了类似的分析。其中，46.4%的受访者报告了≥1，8.3%的受访者报告了≥4 A。疾病的发展与ACE的增加密切相关(例如，危险比，HR，0对≥4 ACE；癌症，2.38(1.48-3.83)；糖尿病，2.99(1.9-4.72)；中风，5.79(2.43-13.80，均P<；0.001)。携带≥4 ACEs的个体(与没有ACEs的个体相比)在70岁之前罹患任何疾病的几率是后者的2.76倍。死亡率调整后的HR与ACE密切相关(≥为4比0；HR为1.97(1.39-2.79)，P<；0.001)。截然不同的人生轨迹与暴露于更高水平的A有关。预防ACE的干预措施是可用的，但很少大规模实施。在整个生命过程中处理由此产生的健康成本是不可持续的。
ACE (adverse childhood experience) studies typically examine the links between childhood stressors and adult health harming behaviours. Using an enhanced ACE survey methodology, we examine impacts of ACEs on non-communicable diseases and incorporate a proxy measure of premature mortality in England. A nationally representative survey was undertaken (n = 3885, aged 18–69, April–July 2013). Socio-demographically controlled proportional hazards analyses examined the associations between the number of ACE categories (<18 years; e.g. child abuse and family dysfunction such as domestic violence) and cancer, diabetes, stroke, respiratory, liver/digestive and cardiovascular disease. Sibling (n = 6983) mortality was similarly analysed as a measure of premature mortality. Of the total, 46.4% of respondents reported ≥1 and 8.3% ≥4 ACEs. Disease development was strongly associated with increased ACEs (e.g. hazard ratios, HR, 0 versus ≥4 ACEs; cancer, 2.38 (1.48–3.83); diabetes, 2.99 (1.90–4.72); stroke, 5.79 (2.43–13.80, all P < 0.001). Individuals with ≥4 ACEs (versus no ACEs) had a 2.76 times higher rate of developing any disease before age 70 years. Adjusted HR for mortality was strongly linked to ACEs (≥4 versus 0 ACEs; HR, 1.97 (1.39–2.79), P < 0.001). Radically different life-course trajectories are associated with exposure to increased ACEs. Interventions to prevent ACEs are available but rarely implemented at scale. Treating the resulting health costs across the life course is unsustainable.