收入不平等与美国儿童不良童年经历的差异效应。

Income Inequality and the Differential Effect of Adverse Childhood Experiences in US Children.

机构信息

University of California Los Angeles Center for Healthier Children, Families and Communities, Los Angeles, Calif; Department of Pediatrics, University of California Los Angeles Geffen School of Medicine, Los Angeles, Calif; Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health; and Department of Public Policy, University of California Los Angeles Luskin School of Public Affairs, Los Angeles, Calif.

Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill.

出版信息

Acad Pediatr. 2017 Sep-Oct;17(7S):S70-S78. doi: 10.1016/j.acap.2016.11.007.

DOI:10.1016/j.acap.2016.11.007

PMID:28865663

Abstract

OBJECTIVE

Adverse childhood experiences (ACEs) can affect health and development across the life course. Despite a general understanding that adversity is associated with lower income, we know less about how ACEs manifest at different income levels and how these income-related patterns affect children's health and development.

METHODS

Data from the 2011 to 2012 National Survey of Children's Health were used to examine the prevalence of 9 ACEs in US children, across 4 levels of household income, and in relationship to 5 parent-reported measures of child health. Bivariate analyses and multivariable logistic regression models were used to examine the associations between number of ACEs and children's health outcomes on the basis of the 4 income groups.

RESULTS

When partitioned according to income strata, the proportion of children who experienced ACEs showed a steep income gradient, particularly for children who experienced ≥4 ACEs. The linear gradient across income groups was less pronounced for each specific ACE, with several ACEs (experience of divorce, drug and alcohol exposure, parental mental illness) showing high reported prevalence in all but the highest income group. Multivariate analysis showed a consistent income-related gradient for each of the health outcomes. However, higher income was not necessarily found to be a protective factor against ACEs.

CONCLUSIONS

ACEs are distributed across the income ladder and not just concentrated below the poverty level. This suggests that a more comprehensive policy strategy that includes targeted as well as universal interventions is warranted.

摘要

目的

童年逆境经历（ACEs）会影响整个生命周期的健康和发展。尽管人们普遍认为逆境与收入较低有关，但我们对 ACEs 在不同收入水平下的表现以及这些与收入相关的模式如何影响儿童的健康和发展了解较少。

方法

利用 2011 年至 2012 年的全国儿童健康调查数据，研究了美国儿童在家庭收入的 4 个水平上经历 9 种 ACE 的比例，以及与 5 项父母报告的儿童健康测量指标的关系。采用双变量分析和多变量逻辑回归模型，根据 4 个收入组，检查 ACE 数量与儿童健康结果之间的关联。

结果

按照收入阶层划分时，经历 ACE 的儿童比例呈急剧的收入梯度，特别是经历≥4 个 ACE 的儿童。每个特定 ACE 的收入组线性梯度不明显，一些 ACE（经历离婚、药物和酒精暴露、父母精神疾病）除了最高收入组外，报告的发生率都很高。多变量分析显示，每个健康结果都存在一致的收入相关梯度。然而，较高的收入并不一定是 ACE 的保护因素。