Cunningham Timothy J, Ford Earl S, Croft Janet B, Merrick Melissa T, Rolle Italia V, Giles Wayne H
Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Int J Chron Obstruct Pulmon Dis. 2014 Sep 26;9:1033-42. doi: 10.2147/COPD.S68226. eCollection 2014.
Adverse childhood experiences (ACEs) before age 18 have been repeatedly associated with several chronic diseases in adulthood such as depression, heart disease, cancer, diabetes, and stroke. We examined sex-specific relationships between individual ACEs and the number of ACEs with chronic obstructive pulmonary disease (COPD) in the general population.
Data from 26,546 women and 19,015 men aged ≥18 years in five states of the 2011 Behavioral Risk Factor Surveillance System were analyzed. We used log-linear regression to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals (CIs) for the relationship of eight ACEs with COPD after adjustment for age group, race/ethnicity, marital status, educational attainment, employment, asthma history, health insurance coverage, and smoking status.
Some 63.8% of women and 62.2% of men reported ≥1 ACE. COPD was reported by 4.9% of women and 4.0% of men. In women, but not in men, there was a higher likelihood of COPD associated with verbal abuse (PR =1.30, 95% CI: 1.05, 1.61), sexual abuse (PR =1.69, 95% CI: 1.36, 2.10), living with a substance abusing household member (PR =1.49, 95% CI: 1.23, 1.81), witnessing domestic violence (PR =1.40, 95% CI: 1.14, 1.72), and parental separation/divorce (PR =1.47, 95% CI: 1.21, 1.80) during childhood compared to those with no individual ACEs. Reporting ≥5 ACEs (PR =2.08, 95% CI: 1.55, 2.80) compared to none was associated with a higher likelihood of COPD among women only.
ACEs are related to COPD, especially among women. These findings underscore the need for further research that examines sex-specific differences and the possible mechanisms linking ACEs and COPD. This work adds to a growing body of research suggesting that ACEs may contribute to health problems later in life and suggesting a need for program and policy solutions.
18岁之前的童年不良经历（ACEs）一再与成年后的几种慢性疾病相关，如抑郁症、心脏病、癌症、糖尿病和中风。我们研究了普通人群中个体ACEs以及ACEs数量与慢性阻塞性肺疾病（COPD）之间的性别特异性关系。
分析了2011年行为危险因素监测系统五个州中26546名年龄≥18岁的女性和19015名男性的数据。在对年龄组、种族/族裔、婚姻状况、教育程度、就业情况、哮喘病史、医疗保险覆盖范围和吸烟状况进行调整后，我们使用对数线性回归来估计八种ACEs与COPD关系的患病率比（PRs）及其相应的95%置信区间（CIs）。
约63.8%的女性和62.2%的男性报告有≥1次ACEs。报告患有COPD的女性为4.9%，男性为4.0%。在女性中，而非男性中，与童年时期没有个体ACEs的人相比，遭受言语虐待（PR =1.30，95%CI：1.05，1.61）、性虐待（PR =1.69，95%CI：1.36，2.10）、与滥用药物的家庭成员同住（PR =1.49，95%CI：1.23，1.81）、目睹家庭暴力（PR =1.40，95%CI：1.14，1.72）以及父母分居/离婚（PR =1.47，95%CI：1.21，1.80）的人患COPD的可能性更高。仅在女性中，报告有≥5次ACEs（PR =2.08，95%CI：1.55，2.80）与没有ACEs相比，患COPD的可能性更高。
ACEs与COPD相关，尤其是在女性中。这些发现强调了进一步研究的必要性，该研究应检查性别特异性差异以及ACEs与COPD之间的可能机制。这项工作增加了越来越多的研究成果，表明ACEs可能导致晚年的健康问题，并表明需要制定相关计划和政策解决方案。
