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/s0749-3797(98)00017-8
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发表时间：
1998-05-01
影响因子：
5.5
通讯作者：
Marks, JS
中科院分区：
文献类型：
--
作者：
Felitti, VJ;Anda, RF;Marks, JS
背景：健康风险行为和成年后疾病与童年时期遭受情感、身体或性虐待的程度以及童年时期家庭功能障碍的关系以前没有被描述过。方法：向13494名在大型HMO完成标准化医疗评估的成年人邮寄一份关于童年不良经历的问卷；9508人（70.5%）回应。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；或者与滥用药物、患有精神疾病、有自杀倾向或曾经入狱的家庭成员住在一起。然后将这些不良童年经历的类别数量与成人风险行为、健康状况和疾病的测量进行比较。使用逻辑回归来调整人口因素对儿童暴露类别累积数量（范围：0-7）与成年生活主要死亡原因风险因素之间关联的影响。结果：超过一半的受访者报告了至少一种，四分之一的受访者报告了大于或等于两类儿童暴露。我们发现儿童暴露的类别数量与所研究的每一种成人健康风险行为和疾病之间存在等级关系（P < 0.001）。经历过四种或四种以上童年暴露的人，与没有经历过的人相比，酗酒、药物滥用、抑郁和自杀未遂的健康风险增加了4至12倍；吸烟、自我评价健康状况不佳、性伴侣人数大于或等于50人、性传播疾病增加2- 4倍；缺乏运动和严重肥胖的人数增加了1.4到1.6倍。儿童不良暴露类别的数量与成人疾病的存在呈分级关系，包括缺血性心脏病、癌症、慢性肺病、骨骼骨折和肝脏疾病。这七类不良童年经历是密切相关的，有多种童年经历的人在以后的生活中可能有多种健康风险因素。结论：我们发现儿童时期遭受虐待或家庭功能障碍的程度与成人死亡的几个主要原因的多种危险因素之间存在很强的分级关系。
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 greater than or equal to 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, greater than or equal to 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.