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儿科初级保健中幼儿不良童年经历相关的身体、心理健康与发育状况及社会人口学特征

Physical, Mental Health and Developmental Conditions, and Sociodemographic Characteristics Associated With Adverse Childhood Experiences Among Young Children in Pediatric Primary Care.

作者信息

Sterling Stacy, Chi Felicia, Lin Judy, Padalkar Padmaja, Vinayagasundaram Uma, Iturralde Esti, Young-Wolff Kelly, Metz Verena E, Herz Arnd, Negusse Rahel, Jackson-Morris Melanie, Espinas Paul

出版信息

J Pediatr Health Care. 2021 Sep-Oct;35(5):491-499. doi: 10.1016/j.pedhc.2021.04.009. Epub 2021 Jul 3.

Abstract

INTRODUCTION

To examine associations between patient characteristics and adverse childhood experiences (ACEs) in a population-based sample of pediatric primary care patients, using electronic health records and clinical, administrative data.

METHOD

An observational study was conducted in an integrated health care delivery system. Children ages 1-5 years (N = 13,370) were screened for ACEs at routine well-child visits between September 1, 2018 and May 31, 2019 in three pediatrics clinics. Multivariate models examined associations between patient characteristics (age, gender, race/ethnicity, insurance type, neighborhood income and education level, physical, mental health and developmental diagnoses, weight status) and any ACEs, and ≥ 3 ACEs exposure.

RESULTS

Prevalence and severity of ACE exposure varied by race/ethnicity. Older age, Medicaid insurance, epilepsy/seizure disorder, sleeping disorders, adjustment disorders, and feeding disorders were associated with higher odds of ACEs exposure, higher-income with lower odds.

DISCUSSION

Understanding relationships between ACEs and patient features can provide information to clinicians for early detection and appropriate interventions.

摘要

引言

利用电子健康记录以及临床和管理数据,在以人群为基础的儿科初级保健患者样本中,研究患者特征与童年不良经历(ACEs)之间的关联。

方法

在一个综合医疗保健服务系统中开展了一项观察性研究。2018年9月1日至2019年5月31日期间,在三家儿科诊所对1至5岁的儿童(N = 13370)进行了常规健康儿童检查,筛查ACEs。多变量模型研究了患者特征(年龄、性别、种族/民族、保险类型、社区收入和教育水平、身体、心理健康和发育诊断、体重状况)与任何ACEs以及≥3次ACEs暴露之间的关联。

结果

ACEs暴露的患病率和严重程度因种族/民族而异。年龄较大、参加医疗补助保险、患有癫痫/癫痫发作障碍、睡眠障碍、适应障碍和喂养障碍与ACEs暴露几率较高相关,高收入与较低几率相关。

讨论

了解ACEs与患者特征之间的关系可为临床医生提供早期发现和适当干预的信息。

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