State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.
Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.
Child Abuse Negl. 2021 Jul;117:105079. doi: 10.1016/j.chiabu.2021.105079. Epub 2021 May 1.
Adverse Childhood Experiences (ACEs) may have long-lasting effects on late life health, probably through life-course mediators. However, whether such effects still exist when these mediators have been appropriately controlled is unclear.
To estimate the controlled direct effect of ACEs on Activities of Daily Life (ADL) disability in middle-aged people and examine the gender-difference of this effect.
We used data from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of persons aged 45+ years.
ACEs were measured by the Adverse Childhood Experiences International Questionnaire and number of ACEs was classified as 0, 1, 2 and 3+, while ADL disability was measured using the Katz Index. Gender-specific controlled direct effects of ACEs on the incidence of ADL disability were estimated by marginal structural model (MSM) with stabilized inverse-probability-of-treatment weights of mediators (unhealthy behaviors, chronic diseases and depression).
4,544 males and 4,767 females were included. Gender differences existed in most categories of ACEs, and about 10 % participants had 3+ ACEs. Participants who had 3+ ACEs had 39 % and 59 % higher risk of ADL disability than those with 0 ACEs among males and females, respectively. After controlling for the mediators, the direct effect was slightly increased in males (risk ratio (RR) = 1.45, p < 0.001) but decreased in females (RR=1.28, p < 0.05).
Precautions targeted in reducing ACEs may be beneficial in preventing ADL disability, but gender-specific prevention should be considered.
童年逆境经历（ACEs）可能对晚年健康产生持久影响，可能通过生命过程中的中介因素。然而，当这些中介因素得到适当控制时，这种影响是否仍然存在尚不清楚。
估计 ACEs 对中年人日常生活活动（ADL）残疾的直接控制效应，并检验这种效应的性别差异。
我们使用了中国健康与退休纵向研究的数据，这是一项针对 45 岁及以上人群的全国代表性纵向调查。
ACEs 通过儿童期逆境国际问卷进行测量，ACEs 的数量分为 0、1、2 和 3+，而 ADL 残疾则通过 Katz 指数进行测量。通过中介（不健康行为、慢性疾病和抑郁）的稳定逆处理概率加权的边际结构模型（MSM），估计 ACEs 对 ADL 残疾发生率的性别特异性直接效应。
共纳入 4544 名男性和 4767 名女性。在大多数 ACEs 类别中存在性别差异，约 10%的参与者有 3+ ACEs。在男性和女性中，有 3+ ACEs 的参与者发生 ADL 残疾的风险分别比没有 ACEs 的参与者高 39%和 59%。在控制了中介因素后，男性的直接效应略有增加（风险比（RR）=1.45，p<0.001），但女性的直接效应降低（RR=1.28，p<0.05）。
针对减少 ACEs 的预防措施可能有助于预防 ADL 残疾，但应考虑针对性别差异的预防措施。
