Department of Psychology, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
Department of Psychology, West Virginia University, WV, USA.
Child Abuse Negl. 2023 Oct;144:106386. doi: 10.1016/j.chiabu.2023.106386. Epub 2023 Aug 3.
Adverse Childhood Experiences (ACEs) have been associated with mortality risk in adulthood. It is unclear, however, whether ACEs perpetrated beyond parents may be associated with mortality risk, if the risk is accumulative or plateaus at a certain frequency, whether associations differ dependent on ACE types, whether types interact with one another, or if observed effects differ by sex.
To examine associations between ACEs and mortality risk.
6319 participants (age range 25-74 years, mean [SD] 46.91 [12.95] years; 51.6 % female) followed from 1995/96 to 2018 as part of the survey of Midlife Development in the United States.
ACE variables were self-reported exposure to 20 ACE types from five categories: physical abuse, emotional abuse, socioeconomic disadvantage, adverse family structure, and poor health at age 16 years. Cox proportional hazards models were used to estimate mortality risk.
ACEs were accumulatively associated with increased mortality risk in adjusted models (HR = 1.033; p ≤ .001, 95 % CI, 1.014-1.053). The association was linear. Only physical abuse (HR = 1.05; p = .024, 95 % CI, 1.01-1.10) remained significantly predictive of increased mortality risk adjusting for other types. No interaction by sex or amongst ACE types was observed.
ACEs may be cumulatively associated with increased mortality risk, such that each individual ACE increases risk. Physical abuse may be an important ACE type within a mortality risk context. Individual ACE types warrant further study as each type may have their own differential impact on mortality risk.
不良儿童经历（ACEs）与成年人的死亡风险有关。然而，尚不清楚父母以外的 ACE 是否与死亡风险有关，如果风险是累积的，还是在一定频率下趋于平稳，是否与 ACE 类型有关，是否存在类型之间的相互作用，或者观察到的效应是否因性别而异。
研究 ACEs 与死亡风险之间的关系。
6319 名参与者（年龄在 25-74 岁之间，平均[SD]为 46.91[12.95]岁；51.6%为女性）自 1995/96 年至 2018 年作为美国中年发展调查的一部分进行随访。
ACE 变量是自我报告的暴露于五类 20 种 ACE 类型：身体虐待、情感虐待、社会经济劣势、不良家庭结构和 16 岁时的健康不良。使用 Cox 比例风险模型估计死亡风险。
在调整后的模型中，ACE 与死亡率风险的增加呈累积相关（HR=1.033；p≤.001，95%CI，1.014-1.053）。这种关联是线性的。只有身体虐待（HR=1.05；p=0.024，95%CI，1.01-1.10）在调整其他类型后仍然显著预测死亡率风险增加。没有观察到性别之间或 ACE 类型之间的相互作用。
ACEs 可能与死亡率风险的增加呈累积相关，即每一个 ACE 都会增加风险。身体虐待可能是死亡风险背景下的一个重要 ACE 类型。每个 ACE 类型都值得进一步研究，因为每种类型可能对死亡率风险有自己的不同影响。
