Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Mass; Dalla Lana School of Public Health, University of Toronto, Ont.
Division of Emergency Medicine, Boston Children's Hospital, Mass.
Am J Med. 2019 May;132(5):605-613. doi: 10.1016/j.amjmed.2018.12.022. Epub 2019 Jan 9.
While cardiovascular disease is the leading cause of death, its determinants include unhealthy behaviors and clinical risk factors and are recognized as the "actual causes" of death. Risk likely accumulates over the life course, and adverse childhood experiences may increase the risk of "actual causes" of death. The objectives of the study are to determine the prevalence and test the association of adverse childhood experiences among unhealthy behaviors and risk factors as a primordial risk factor among young adults.
Data were extracted from the 2009 and 2011 Behavioural Risk Factor Surveillance System. Individuals ages 18-99 years provided complete information on adverse childhood experiences, health behaviors, and risk factors. Adverse childhood experiences were categorized and evaluated as cumulative burden. Multivariable logistic models, including stratified analysis for young adults, tested the association of adverse childhood experiences burden with unhealthy behaviors and risk factors.
Among 45,482 study participants, 52% report one adverse childhood experience and 25% report 2 adverse childhood experience categories. Among the total study population, 37% report violence/emotional abuse, 34% report neglect, and 12% report sexual abuse. Even one adverse childhood experience is strongly associated with hypertension, dyslipidemia, and diabetes, and while the association increases in a dose-response (P trend < .001) for all, it is especially more pronounced among the younger adults, with minimal attenuation of effects in the fully adjusted models.
The prevalence of adverse childhood experiences in this study population is high. Even one adverse childhood experience is strongly and independently associated with cardiovascular risk factors, with implications for primordial prevention. Future studies are needed to develop screening and treatment strategies targeted to this high-risk group, especially among young adults.
虽然心血管疾病是导致死亡的主要原因，但它的决定因素包括不健康的行为和临床风险因素，被认为是死亡的“实际原因”。风险可能在整个生命过程中积累，而不良的童年经历可能会增加“实际原因”死亡的风险。本研究的目的是确定在年轻成年人中，作为原始风险因素，不健康行为和危险因素中不良童年经历的流行情况，并检验其相关性。
数据来自 2009 年和 2011 年的行为风险因素监测系统。18-99 岁的个体提供了关于不良童年经历、健康行为和危险因素的完整信息。将不良童年经历进行分类并评估为累积负担。多变量逻辑模型，包括对年轻成年人的分层分析，检验了不良童年经历负担与不健康行为和危险因素的相关性。
在 45482 名研究参与者中，52%的人报告有一次不良童年经历，25%的人报告有两种不良童年经历类别。在总研究人群中，37%的人报告有暴力/情感虐待，34%的人报告有忽视，12%的人报告有性虐待。即使只有一次不良童年经历，也与高血压、血脂异常和糖尿病密切相关，而且这种相关性呈剂量反应（P 趋势<.001），所有这些都在完全调整模型中更为明显，尤其是在年轻成年人中，影响的衰减程度最小。
在本研究人群中，不良童年经历的发生率很高。即使只有一次不良童年经历，也与心血管危险因素有很强的独立相关性，这对原始预防具有重要意义。需要进一步研究，以制定针对这一高风险群体，特别是年轻成年人的筛查和治疗策略。
