Dube Shanta R, Felitti Vincent J, Dong Maxia, Giles Wayne H, Anda Robert F
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA.
Prev Med. 2003 Sep;37(3):268-77. doi: 10.1016/s0091-7435(03)00123-3.
We examined the relationship of the number of adverse childhood experiences (ACE score) to six health problems among four successive birth cohorts dating back to 1900 to assess the strength and consistency of these relationships in face of secular influences the 20th century brought in changing health behaviors and conditions. We hypothesized that the ACE score/health problem relationship would be relatively "immune" to secular influences, in support of recent studies documenting the negative neurobiologic effects of childhood stressors on the developing brain.
A retrospective cohort study of 17,337 adult health maintenance organization (HMO) members who completed a survey about childhood abuse and household dysfunction, as well as their health. We used logistic regression to examine the relationships between ACE score and six health problems (depressed affect, suicide attempts, multiple sexual partners, sexually transmitted diseases, smoking, and alcoholism) across four successive birth cohorts: 1900-1931, 1932-1946, 1947-1961, and 1962-1978.
The ACE score increased the risk for each health problem in a consistent, strong, and graded manner across four birth cohorts (P < 0.05). For each unit increase in the ACE score (range: 0-8), the adjusted odds ratios (ORs) for depressed affect, STDs, and multiple sexual partners were increased within a narrow range (ORs: 1.2-1.3 per unit increase) for each of the birth cohorts; the increase in risk for suicide attempts was stronger but also in a narrow range (ORs: 1.5-1.7).
Growing up with ACEs increased the risk of numerous health behaviors and outcomes for 20th century birth cohorts, suggesting that the effects of ACEs on the risk of various health problems are unaffected by social or secular changes. Research showing detrimental and lasting neurobiologic effects of child abuse on the developing brain provides a plausible explanation for the consistency and dose-response relationships found for each health problem across birth cohorts, despite changing secular influences.
我们研究了不良童年经历的数量（ACE 得分）与可追溯至 1900 年的四个连续出生队列中的六种健康问题之间的关系，以评估在 20 世纪带来的健康行为和状况变化的长期影响面前，这些关系的强度和一致性。我们假设 ACE 得分与健康问题之间的关系相对“不受”长期影响，这与最近记录童年应激源对发育中大脑的负面神经生物学影响的研究一致。
对 17337 名成年健康维护组织（HMO）成员进行回顾性队列研究，这些成员完成了一项关于童年虐待和家庭功能障碍以及他们健康状况的调查。我们使用逻辑回归来研究 ACE 得分与四个连续出生队列（1900 - 1931 年、1932 - 1946 年、1947 - 1961 年和 1962 - 1978 年）中的六种健康问题（抑郁情绪、自杀未遂、多个性伴侣、性传播疾病、吸烟和酗酒）之间的关系。
在四个出生队列中，ACE 得分以一致、强烈且分级的方式增加了每种健康问题的风险（P < 0.05）。对于 ACE 得分每增加一个单位（范围：0 - 8），每个出生队列中抑郁情绪、性传播疾病和多个性伴侣的调整后比值比（OR）在较窄范围内增加（每单位增加的 OR：1.2 - 1.3）；自杀未遂风险的增加更强，但也在较窄范围内（OR：1.5 - 1.7）。
在有不良童年经历的环境中长大增加了 20 世纪出生队列出现多种健康行为和结果的风险，这表明不良童年经历对各种健康问题风险的影响不受社会或长期变化的影响。尽管长期影响不断变化，但研究表明儿童虐待对发育中大脑有有害且持久的神经生物学影响，这为每个出生队列中每种健康问题所发现的一致性和剂量反应关系提供了合理的解释。
