Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Am J Prev Med. 2009 Nov;37(5):389-96. doi: 10.1016/j.amepre.2009.06.021.
Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood.
This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood.
Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 17,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age < or =65 years and at age < or =75 years was estimated across the number of categories of ACEs using multivariable-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009.
Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI=56.2, 65.1, vs 79.1 years, 95% CI=78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n=526) of those who died during follow-up were aged < or =75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI=1.06, 2.83) times more likely to die when aged < or =75 years and 2.4 (95% CI=1.30, 4.39) times more likely to die when aged < or =65 years.
ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death.
童年创伤压力源与众多负面健康行为和结果、医疗保健利用以及整体健康状况之间存在强烈的分级关系，这引发了一个问题，即这些不良的童年经历（ACEs）是否与成年期过早死亡有关。
本研究旨在确定 ACE 是否与成年期过早死亡的风险增加有关。
1995-1997 年期间，从 17337 名年龄>18 岁的成年人中收集了健康行为、健康状况和 ACE 暴露的基线调查数据。ACE 包括虐待（情绪、身体、性）；目睹家庭暴力；父母分居或离婚；以及在有精神疾病、药物滥用或被送进监狱的家庭成员的家庭中长大。ACE 评分（儿童期创伤性应激暴露的八个类别的整数计数）用作累积暴露的衡量标准。通过从国家死亡索引搜索中获取的死亡率记录，在随访评估（从基线预约日期到 2006 年 12 月 31 日）期间确定死亡。使用标准方法计算预期寿命损失（YLL）和潜在寿命损失（YPLL）。使用多变量调整的 Cox 比例风险回归，根据 ACE 类别的数量估算所有原因导致的< =65 岁和< =75 岁的死亡相对风险。分析于 2009 年 1 月至 2 月进行。
总体而言，有 1539 人在随访期间死亡；粗死亡率为 91.0/1000；年龄调整后的死亡率为 54.7/1000。有六个或更多 ACE 的人平均比没有 ACE 的人早死近 20 年（60.6 岁，95%CI=56.2，65.1，vs. 79.1 岁，95%CI=78.4，79.9）。有六个或更多 ACE 的人每例死亡的平均 YLL 几乎是没有 ACE 的人的三倍（25.2 岁）（9.2 岁）。在随访期间死亡的人中，约有三分之一（n=526）在死亡时年龄< =75 岁，占 4792 YPLL。在多变量调整后，有六个或更多 ACE 的成年人< =75 岁时死亡的风险增加 1.7 倍（95%CI=1.06，2.83），< =65 岁时死亡的风险增加 2.4 倍（95%CI=1.30，4.39）。
ACE 与过早死亡的风险增加有关，尽管 ACE 类别的数量与过早死亡的风险增加之间没有观察到分级增加。风险的增加仅部分由 ACE 相关的已记录健康和社会问题解释，这表明 ACE 可能通过其他可能的机制导致过早死亡。
