Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
Institute of Academic Anaesthesia, Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK.
BMC Med. 2024 Aug 15;22(1):315. doi: 10.1186/s12916-024-03505-w.
Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity.
We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose-response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528).
From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose-response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity (p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies (I = 76.9%, Cochran Q = 102, p < 0.001).
This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.
不良童年经历（ACEs）与一系列健康结果有关，包括多种疾病。在这项系统评价和荟萃分析中，我们旨在确定、综合和量化目前与 ACEs 和多种疾病相关的证据。
我们从建库到 2023 年 7 月 20 日在七个数据库中进行了检索：APA PsycNET、CINAHL Plus、Cochrane CENTRAL、Embase、MEDLINE、Scopus 和 Web of Science。我们选择了研究儿童期（<18 岁）发生的不良事件以及成年期（≥18 岁）多种疾病评估的研究。仅评估成年期不良事件或儿童健康结果的研究被排除在外。使用 ROBINS-E 工具评估偏倚风险。使用患病率和剂量-反应荟萃分析方法对定量数据进行综合分析。本综述已在 PROSPERO（CRD42023389528）上预先注册。
从 15586 条记录中，有 25 项研究符合纳入标准（总参与者=372162 人）。≥1 项 ACE 暴露的患病率为 48.1%（95%CI 33.4 至 63.1%）。多种疾病的患病率为 34.5%（95%CI 23.4 至 47.5%）。有 8 项研究提供了足够的数据进行剂量-反应荟萃分析（总参与者=197981 人）。ACE 暴露与多种疾病之间存在显著的剂量依赖性关系（p<0.001），每增加一次 ACE 暴露，多种疾病的可能性增加 12.9%（95%CI 7.9 至 17.9%）。然而，纳入的研究存在异质性（I=76.9%，Cochran Q=102，p<0.001）。
这是第一项综合 ACEs 和多种疾病文献的系统评价和荟萃分析，显示了大量参与者之间的剂量依赖性关系。它整合和增强了广泛的文献，表明 ACEs 与个体长期健康状况、危险健康行为和其他不良健康结果之间存在关联。
