Division of Nephrology, Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of General Internal Medicine, Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin.
Am J Prev Med. 2020 Aug;59(2):e49-e57. doi: 10.1016/j.amepre.2020.04.005.
Evidence suggests that individuals with a history of adverse childhood experiences have higher odds of developing kidney disease than individuals with no adverse childhood experiences. However, no study has examined the influence of coexisting adverse childhood experiences and kidney disease on mortality risk. This study uses a longitudinal survey of adults to examine the influence of coexisting adverse childhood experiences and decreased renal function on all-cause mortality in a sample of U.S. adults.
A total of 1,205 adults participating in the Midlife Development in the United States series between 1995 and 2014 were used for this analysis performed in 2019. A total of 6 types of adverse childhood experiences were available in the data set, which were combined to create a dichotomous variable with any adverse experience counted as yes. Decreased renal function was defined as an estimated glomerular filtration rate <60 milliliter/minute/1.73 m. The main outcome was all-cause mortality. Cox proportional hazards models were performed to examine 4 combinations of adverse childhood experiences and decreased renal function associated with overall survival (neither, adverse childhood experiences only, decreased renal function only, or both) controlling for covariables.
In fully adjusted models, adverse childhood experiences and decreased renal function were associated with increased all-cause mortality relative to neither (hazard ratio=2.85, 95% CI=1.30, 6.25). Decreased renal function only and adverse childhood experiences only were not significantly associated with all-cause mortality (hazard ratio=1.14, 95% CI=0.64, 2.04 and hazard ratio=1.55, 95% CI=0.44, 5.41, respectively). When using decreased renal function as the reference group, coexisting adverse childhood experiences and decreased renal function was associated with a 64% increased risk of all-cause mortality, though this relationship was not statistically significant.
Coexistence of adverse childhood experiences and decreased renal function is associated with higher all-cause mortality than seen in individuals with neither adverse childhood experiences nor decreased renal function and may be associated with higher all-cause mortality than seen in individuals with decreased renal function alone. Future research is needed to better understand this potential association.
有证据表明，有不良童年经历的个体比没有不良童年经历的个体更容易患上肾脏疾病。然而，尚无研究探讨共存的不良童年经历和肾脏疾病对死亡率的影响。本研究使用一项对成年人的纵向调查，在美国成年人样本中检验共存的不良童年经历和肾功能下降对全因死亡率的影响。
本研究使用了 1995 年至 2014 年期间参加美国中期生活发展研究的 1205 名成年人的数据进行分析，该分析于 2019 年进行。该数据集提供了 6 种不良童年经历，将其组合成一个二元变量，任何不良经历都计为是。肾功能下降定义为估算肾小球滤过率<60 毫升/分钟/1.73 平方米。主要结局是全因死亡率。使用 Cox 比例风险模型，在控制协变量的情况下，检验与整体生存相关的 4 种不良童年经历和肾功能下降的组合（均无、仅不良童年经历、仅肾功能下降、或两者均有）。
在完全调整的模型中，与均无不良童年经历和肾功能下降相比，不良童年经历和肾功能下降与全因死亡率增加相关（风险比=2.85，95%置信区间=1.30，6.25）。仅肾功能下降和仅不良童年经历与全因死亡率无显著相关性（风险比=1.14，95%置信区间=0.64，2.04 和风险比=1.55，95%置信区间=0.44，5.41，分别）。当以肾功能下降为参照组时，共存的不良童年经历和肾功能下降与全因死亡率增加 64%相关，但这种关系无统计学意义。
共存的不良童年经历和肾功能下降与全因死亡率增加相关，高于既无不良童年经历又无肾功能下降的个体，且可能高于仅肾功能下降的个体。需要进一步研究以更好地了解这种潜在关联。
