Ward Krista, Ryan-Ibarra Suzanne, Smith Monica, Sanchez-Vaznaugh Emma V
Life Chiropractic College West, 25001 Industrial Blvd Hayward, CA 94545, USA.
Health Net, 4191 E. Commerce Way, Sacramento, CA, USA.
Prev Med Rep. 2022 May 13;27:101826. doi: 10.1016/j.pmedr.2022.101826. eCollection 2022 Jun.
A growing number of studies have found associations between adverse childhood experiences (ACEs) and adult well-being, with disparities between subpopulations. Limited research exists about the association between ACEs and cognitive disability, and variations by race and ethnicity. This study reports a cross-sectional analysis of 2019 Behavioral Risk Factor Surveillance System (BRFSS) data (n = 93 692) conducted in 2021. Logistic regression models examined the association between ACEs and cognitive disability (as defined by serious difficulty concentrating, remembering or making decisions because of a physical, mental, or emotional condition) and whether the association varied by race and ethnicity, adjusting for demographics, (age, gender, marital status), socioeconomic factors (income and education), and perceived general health. Exposures to 1, 2, 3, and 4 or more ACEs were associated with elevated odds of cognitive disability; the association varied by race and ethnicity (p for interaction less than 0.05). In stratified analyses, ACEs were positively associated with cognitive disability among the American Indian/Alaskan Native group, though significant only among those reporting 4 ACEs or more (OR: 2.89; 95% CI 1.25, 6.66). A dose response was observed for Black, White and Hispanic groups though the association was larger among Hispanic respondents. The elevated odds of cognitive disability associated with ACEs warrant additional research to understand mechanisms underlying this relationship across racial and ethnic groups. Additionally, interventions to prevent cognitive disability may benefit from considering ACEs across all populations, particularly among those with highest prevalence.
越来越多的研究发现童年不良经历（ACEs）与成人幸福感之间存在关联，且不同亚人群之间存在差异。关于ACEs与认知障碍之间的关联以及种族和族裔差异的研究有限。本研究报告了对2021年进行的2019年行为危险因素监测系统（BRFSS）数据（n = 93692）的横断面分析。逻辑回归模型检验了ACEs与认知障碍（定义为由于身体、心理或情绪状况导致注意力难以集中、记忆或做决定存在严重困难）之间的关联，以及这种关联是否因种族和族裔而异，并对人口统计学因素（年龄、性别、婚姻状况）、社会经济因素（收入和教育）以及自我感知的总体健康状况进行了调整。暴露于1次、2次、3次以及4次或更多次ACEs与认知障碍的较高几率相关；这种关联因种族和族裔而异（交互作用p值小于0.05）。在分层分析中，ACEs与美国印第安人/阿拉斯加原住民群体中的认知障碍呈正相关，不过仅在报告有4次或更多次ACEs的人群中具有显著性（OR：2.89；95%CI 1.25，6.66）。在黑人、白人和西班牙裔群体中观察到了剂量反应，尽管西班牙裔受访者中的关联更大。与ACEs相关的认知障碍几率升高值得进一步研究，以了解不同种族和族裔群体中这种关系的潜在机制。此外，预防认知障碍的干预措施可能会受益于考虑所有人群中的ACEs，尤其是在患病率最高的人群中。
