Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
BMC Public Health. 2023 Oct 18;23(1):2036. doi: 10.1186/s12889-023-16935-7.
The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors.
The study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994-2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035).
During the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM.
The findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.
儿童期逆境与死亡率之间的关联鲜有探讨，而关于任何可能的超额死亡率是否可以预防的问题则研究得更少。本研究在一般人群的代表性样本中，检验了特定儿童期逆境与成年期早逝和潜在可预防死亡（PPAM）之间的关联。此外，我们还检验了这些关联是否可能被各种成人社会经济、心理社会和行为因素所中介。
该研究使用了来自加拿大统计局的国家人口健康调查（NPHS-1994）与加拿大生命统计数据库（CVSD 1994-2014）的链接数据。NPHS 访谈回顾性评估了儿童时期长期住院、父母离婚、父母长期失业、长期创伤、父母滥用药物、身体虐待和因做错事而被送回家的经历。使用现有的 PPAM 定义，即 75 岁之前被认为可预防或可治疗的死因。竞争原因生存模型用于检验在 18 至 74 岁的受访者中，特定儿童期逆境与成年期 PPAM 的关联（-rounded n=11035）。
在 20 年的随访期间，5.4%的样本因潜在可预防的原因过早死亡。儿童期逆境对死亡率有不同的影响。身体虐待（年龄调整后的亚危险比；SHR 1.44；95%CI 1.03，2.00）和被送回家（年龄调整后的 SHR 2.26；95%CI 1.43，3.57）与 PPAM 显著相关。当调整成年因素（即吸烟、健康自评差、抑郁、社会支持低和收入低）后，这些关联减弱，提示可能存在中介效应。其他研究中的逆境与 PPAM 无关。
这些发现表明，儿童期身体虐待和被送回家的心理后果以及随后不良健康行为的发生可能导致潜在可预防死亡的风险增加。确定的潜在中介因素为未来的研究提供了方向，以便使用合适的数据进行因果中介分析，并确定旨在预防潜在可预防原因导致的过早死亡的干预措施。其他形式的逆境，主要与家庭功能障碍有关，可能不是死亡率这一远端健康结果的决定因素。
