School of Public Health, Xiamen University, Xiamen, China.
School of Public Health, Xiamen University, Xiamen, China
BMJ Open. 2022 Jun 10;12(6):e060477. doi: 10.1136/bmjopen-2021-060477.
To identify the heterogeneity of adverse childhood experiences (ACEs) as well as their association with cognitive function in an elderly Chinese population.
A retrospective cohort study.
The data were from the latest wave of the China Health and Retirement Longitudinal Study and a total of 7222 participants aged ≥60 were included.
Latent class analysis was used to identify the classes characterised by 11 types of ACEs. Cognitive function was measured by the Mini-Mental State Examination (MMSE) and cognitive impairment was defined by education-specific threshold MMSE scores. Logistic models were constructed to examine the relationship between ACE classes and cognitive impairment. Several childhood and adulthood confounding factors were considered.
Three ACE latent classes were identified. Of them, 76.09% were in the 'Low ACEs' class, 15.43% were in the 'Household dysfunction' class and 8.49% were in the 'Child maltreatment' class. The people in the 'Low ACEs' class seemed to have better childhood family financial situations and higher education levels. The population in the 'Household dysfunction' class tended to live in rural areas and have a higher proportion of men, whereas people in the 'Child maltreatment' class showed a significantly higher proportion of women and higher levels of chronic diseases. 'Child maltreatment' was related to a higher risk of cognitive impairment (OR=1.37, 95% CI: 1.12 to 1.68), while the risk of 'Household dysfunction' was not significantly different from that of the 'Low ACEs' participants (OR=1.06, 95% CI: 0.90 to 1.26).
The findings supported differences in cognitive function in elderly Chinese people exposed to different types of ACEs.
在中国老年人群体中，确定不良童年经历（ACEs）的异质性及其与认知功能的关联。
回顾性队列研究。
数据来自中国健康与退休纵向研究的最新一波调查，共纳入 7222 名年龄≥60 岁的参与者。
采用潜在类别分析确定 11 种 ACE 类型特征的类别。认知功能通过简易精神状态检查（MMSE）进行测量，认知障碍定义为教育特定阈值 MMSE 得分。构建逻辑模型来检验 ACE 类别与认知障碍之间的关系。考虑了几个儿童期和成年期的混杂因素。
确定了三个 ACE 潜在类别。其中，76.09%的人属于“低 ACEs”类别，15.43%的人属于“家庭功能障碍”类别，8.49%的人属于“儿童虐待”类别。“低 ACEs”类别的人似乎有更好的童年家庭经济状况和更高的教育水平。“家庭功能障碍”类别的人群倾向于居住在农村地区，男性比例更高，而“儿童虐待”类别的人群女性比例明显更高，慢性病水平也更高。“儿童虐待”与认知障碍的风险增加相关（OR=1.37，95%CI：1.12 至 1.68），而“家庭功能障碍”的风险与“低 ACEs”参与者无显著差异（OR=1.06，95%CI：0.90 至 1.26）。
研究结果支持在中国老年人中，暴露于不同类型 ACEs 的个体认知功能存在差异。
