Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Lancet. 2020 Aug 15;396(10249):489-497. doi: 10.1016/S0140-6736(20)30621-8.
Childhood is a sensitive period with rapid brain development and physiological growth, and adverse events in childhood might interfere with these processes and have long-lasting effects on health. In this study, we aimed to describe trajectories of adverse childhood experiences and relate these to overall and cause-specific mortality in early adult life.
For this population-based cohort study, we used unselected annually updated data from Danish nationwide registers covering more than 1 million children born between 1980 and 1998. We distinguished between three different dimensions of childhood adversities: poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics such as maternal separation. We used a group-based multi-trajectory clustering model to define the different trajectories of children aged between 0 and 16 years. We assessed the associations between these trajectories and mortality rates between 16 and 34 years of age using a Cox proportional hazards model and an Aalen hazards difference model.
Between Jan 1, 1980 and Dec 31, 2015, 2 223 927 children were included in the Danish Life Course cohort. We excluded 1 064 864 children born after 1998, 50 274 children who emigrated before their 16th birthday, and 11 161 children who died before their 16th birthday, resulting in a final sample of 1 097 628 children. We identified five distinct trajectories of childhood adversities. Compared with children with a low adversity trajectory, those who had early-life material deprivation (hazard ratio 1·38, 95% CI 1·27-1·51), persistent deprivation (1·77, 1·62-1·93), or loss or threat of loss (1·80, 1·61-2·00) had a moderately higher risk of premature mortality. A small proportion of children (36 081 [3%]) had multiple adversities within all dimensions and throughout the entire childhood. This group had a 4·54 times higher all-cause mortality risk (95% CI 4·07-5·06) than that of children with a low adversity trajectory, corresponding to 10·30 (95% CI 9·03-11·60) additional deaths per 10 000 person-years. Accidents, suicides, and cancer were the most common causes of death in this high adversity population.
Almost half of Danish children in our study experienced some degree of adversity, and this was associated with a moderately higher risk of mortality in adulthood. Among these, a small group of children had multiple adversities across social, health, and family-related dimensions. This group had a markedly higher mortality risk in early adulthood than that of other children, which requires public health attention.
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儿童期是大脑快速发育和生理生长的敏感时期，儿童期的不良事件可能会干扰这些过程，并对健康产生持久影响。本研究旨在描述儿童期不良经历的轨迹，并将其与成年早期的总死亡率和特定原因死亡率相关联。
本研究为基于人群的队列研究，使用丹麦全国登记处每年更新的、覆盖 1980 年至 1998 年期间出生的 100 多万名儿童的未选择数据。我们区分了儿童期逆境的三个不同维度：贫困和物质匮乏、家庭内的丧失或丧失威胁，以及母亲分离等家庭动态方面。我们使用基于群组的多轨迹聚类模型来定义 0 至 16 岁儿童的不同轨迹。我们使用 Cox 比例风险模型和 Aalen 风险差异模型评估这些轨迹与 16 至 34 岁之间的死亡率之间的关联。
1980 年 1 月 1 日至 2015 年 12 月 31 日，纳入了丹麦生活历程队列的 223927 名儿童。我们排除了 1998 年后出生的 1064864 名儿童、16 岁生日前移民的 50274 名儿童和 16 岁生日前死亡的 11161 名儿童，最终样本为 1097628 名儿童。我们确定了儿童期逆境的五个不同轨迹。与低逆境轨迹的儿童相比，那些在生命早期经历物质匮乏（危险比 1.38，95%CI 1.27-1.51）、持续匮乏（1.77，1.62-1.93）或丧失或面临丧失的儿童（1.80，1.61-2.00）有更高的过早死亡风险。一小部分儿童（36081 [3%]）在所有维度和整个儿童期都经历了多种逆境。与低逆境轨迹的儿童相比，这组儿童的全因死亡率风险高 4.54 倍（95%CI 4.07-5.06），相当于每 10000 人年额外有 10.30 人（95%CI 9.03-11.60）死亡。意外、自杀和癌症是该高逆境人群中最常见的死亡原因。
我们研究中的近一半丹麦儿童经历了某种程度的逆境，这与成年后死亡率的中度升高有关。在这些儿童中，一小部分儿童在社会、健康和家庭相关方面经历了多种逆境。这组儿童在成年早期的死亡率风险明显高于其他儿童，需要引起公共卫生关注。
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