Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, NY, USA.
Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA.
Child Abuse Negl. 2020 Apr;102:104418. doi: 10.1016/j.chiabu.2020.104418. Epub 2020 Feb 20.
Adverse childhood experiences (ACEs) adversely impact morbidity and mortality.
To quantify burden of disease associated with ACEs among U.S. adults by estimating quality-adjusted life expectancy (QALE) according to number of ACEs reported.
Data from respondents' adverse experiences occurring before age 18 were collected in nine states through the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS).
We estimated health-related quality of life (HRQOL) scores from BRFSS data. We constructed life tables from the Compressed Mortality Files to calculate QALE, a generalization of life expectancy that weights expected years of life lived with the HRQOL score, according to number of ACEs.
The QALE for an 18-year-old person reporting 0, 1-2, and 3+ ACEs was 55.1, 53.4, and 45.6 years, respectively. Reporting 3+ ACEs was associated with a 9.5-year decrease (17%) in QALE. The adverse impact of ACEs are present according to age, gender, and race/ethnicity subgroups. The impact of 3+ ACEs on QALE was nearly 3-fold greater for women than men (13.2 vs. 4.7-year decrease). By contrast, an 18-year-old reporting 1-2 ACEs experienced a small decrease in QALE (1.7 years).
Reporting 3+ ACEs led to a significant burden of disease, as assessed by QALE loss, to a similar degree as many other well-established behavioral risk factors and chronic conditions. Providers and policymakers should focus on efforts to prevent ACEs, initiate early detection of and interventions to minimize the impact of an ACE, and reduce the likelihood of engaging in maladaptive risky behaviors.
不良的童年经历（ACEs）会对发病率和死亡率产生不利影响。
通过估计报告 ACEs 数量的质量调整生命预期（QALE），量化美国成年人中与 ACEs 相关的疾病负担。
通过 2011 年和 2012 年的行为风险因素监测系统（BRFSS），在 9 个州收集了受访者在 18 岁之前发生的不良经历的数据。
我们从 BRFSS 数据中估计了与健康相关的生活质量（HRQOL）评分。我们根据 ACEs 的数量，从压缩死亡率文件中构建生命表来计算 QALE，这是一种对生命预期的推广，它根据 HRQOL 评分加权预期寿命。
报告 0、1-2 和 3+ACEs 的 18 岁个体的 QALE 分别为 55.1、53.4 和 45.6 年。报告 3+ACEs 与 QALE 减少 9.5 年（17%）相关。ACEs 的不利影响存在于年龄、性别和种族/民族亚组中。报告 3+ACEs 的个体的 QALE 比男性减少近 3 倍（13.2 年比 4.7 年）。相比之下，报告 1-2 ACEs 的 18 岁个体的 QALE 略有下降（1.7 年）。
报告 3+ACEs 导致疾病负担显著增加，正如许多其他已确立的行为风险因素和慢性疾病一样，可以通过 QALE 丧失来评估。提供者和政策制定者应专注于预防 ACEs 的努力，及早发现并采取干预措施以最小化 ACE 的影响，并减少采取不良风险行为的可能性。
