Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA; Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; University of Wisconsin, Milwaukee, Joseph Zilber School of Public Health, 1240 N 10th Street Milwaukee, WI 53205, USA.
Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA; Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
J Affect Disord. 2019 Apr 15;249:20-25. doi: 10.1016/j.jad.2019.02.016. Epub 2019 Feb 6.
Diabetes is a leading cause of death in the US. Adverse childhood experiences (ACEs) have also been linked to increased mortality. ACEs are associated with the development of diabetes however the amplified effect on mortality has not been studied.
Data from Midlife development in the United States (MIDUS), from 1995 to 1996 (Wave 1), 2004-2006 (Wave 2), and 2011-2014 (Wave 3) were used with a total of 3023 participants. Survey Cox proportional hazards regression models were used to calculate all-cause mortality. Univariate and multivariable Cox models were performed for the four combinations of diabetes and ACE categories, with estimation of hazard ratio completed for each.
After adjusting for covariates and comorbidity burden, 'ACE only' was not significantly different in mortality compared to 'no diabetes and no ACE'. 'Diabetes only' had a 78% higher mortality (HR 1.78, 95% CI 1.04-3.04) compared to 'no diabetes and no ACE'. 'Diabetes and ACE' had a 132% higher mortality (HR 2.32, 95% CI 1.64-3.28) compared to 'no diabetes and no ACE'.
ACE and diabetes measures are self-report, and while longitudinal a temporal relationship cannot be established. Therefore, future research should collect prospective data to investigate mechanisms for this association based on observational data.
Results showed a strong association between 'diabetes and ACE' and mortality with a pronounced difference between both 'ACE only' and 'diabetes only' after 20-year follow-up. These results suggest an amplified effect of diabetes and ACE on mortality for adults who have experienced ACEs.
糖尿病是美国的主要死因。不良的童年经历（ACEs）也与死亡率的增加有关。ACEs 与糖尿病的发生有关，但它们对死亡率的放大效应尚未得到研究。
使用了 1995 年至 1996 年（第 1 波）、2004 年至 2006 年（第 2 波）和 2011 年至 2014 年（第 3 波）期间美国中年发展（MIDUS）的数据，共有 3023 名参与者。使用调查 Cox 比例风险回归模型计算全因死亡率。对糖尿病和 ACE 类别四组组合进行单变量和多变量 Cox 模型，为每组完成危险比估计。
在调整了协变量和合并症负担后，“仅 ACE”与“无糖尿病且无 ACE”相比，死亡率无显著差异。“仅糖尿病”的死亡率比“无糖尿病且无 ACE”高 78%（HR 1.78，95%CI 1.04-3.04）。“糖尿病和 ACE”的死亡率比“无糖尿病且无 ACE”高 132%（HR 2.32，95%CI 1.64-3.28）。
ACE 和糖尿病的测量是自我报告的，虽然是纵向的，但无法确定时间关系。因此，未来的研究应该收集前瞻性数据，根据观察数据调查这种关联的机制。
结果表明，“糖尿病和 ACE”与死亡率之间存在很强的关联，在 20 年的随访后，“仅 ACE”和“仅糖尿病”之间存在显著差异。这些结果表明，经历过 ACE 的成年人的糖尿病和 ACE 对死亡率有放大效应。
