Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Pediatric Infect Dis Soc. 2024 Nov 4;13(10):523-532. doi: 10.1093/jpids/piae097.
Higher caregiver-adverse childhood experiences (ACEs) have been associated with multiple adverse pediatric outcomes. However, no studies have examined links between caregiver ACEs and infectious outcomes like antibiotic prescriptions or infection-related clinical encounters.
We conducted a retrospective cohort study including patients from 2 pediatric primary care sites, serving predominantly non-Hispanic Black, publicly insured populations. Our outcomes were antibiotic prescriptions and infection-related ambulatory clinical encounters for children 0-3 years old. We captured these outcomes and additional covariates (demographics, health-related social risk screen results, and Socioeconomic Deprivation Index scores linked to geocoded street addresses) from the electronic health record. High (≥4) or low (≤3) caregiver ACEs, and individual ACE question answers, were our exposures. Multivariable logistic regression was used to determine associations with any antibiotic use. Cox proportional hazards regression was used to assess the time to first antibiotic exposure and first infection-related visit.
A total of 1465 children 0-3 years were included (50.0% female, 75.0% Black, and 2.6% Hispanic). High caregiver ACEs were not associated with pediatric antibiotic exposure. The presence of caregiver-witnessed parental abuse was associated with a higher likelihood of any antibiotic exposure (odds ratio [OR 1.90]; 95% confidence interval [CI] 1.2, 3.2) and time to first antibiotic exposure (hazard ratio [HR] 1.77; 95% CI 1.23, 2.56). Sexual abuse of the caregiver was associated with time to first infection-related clinical visit (HR 1.27; 95% CI 1.05, 1.53).
Certain caregiver ACEs were associated with pediatric antibiotic use and infection-related visits. Future studies need to evaluate underlying mechanisms and test effective clinical responses.
较高的照顾者不良童年经历（ACEs）与多种儿科不良结局有关。然而，尚无研究检查照顾者 ACEs 与抗生素处方或感染相关临床就诊等感染结局之间的联系。
我们进行了一项回顾性队列研究，纳入了来自 2 个儿科初级保健机构的患者，这些机构主要为非西班牙裔黑人、公共保险人群服务。我们的结局是 0-3 岁儿童的抗生素处方和感染相关的门诊临床就诊。我们从电子健康记录中捕获了这些结局和其他协变量（人口统计学信息、与健康相关的社会风险筛查结果以及与地理编码街道地址相关的社会经济剥夺指数评分）。高（≥4）或低（≤3）照顾者 ACEs 以及各个 ACE 问题的答案是我们的暴露因素。多变量逻辑回归用于确定与任何抗生素使用相关的关联。Cox 比例风险回归用于评估首次抗生素暴露和首次感染相关就诊的时间。
共纳入 1465 名 0-3 岁儿童（50.0%为女性，75.0%为黑人，2.6%为西班牙裔）。高照顾者 ACEs 与儿科抗生素暴露无关。照顾者目睹的父母虐待与抗生素暴露的可能性更高相关（优势比 [OR] 1.90；95%置信区间 [CI] 1.2，3.2）和首次抗生素暴露的时间（风险比 [HR] 1.77；95% CI 1.23，2.56）。照顾者的性虐待与首次感染相关的临床就诊时间相关（HR 1.27；95% CI 1.05，1.53）。
某些照顾者 ACEs 与儿科抗生素使用和感染相关就诊有关。未来的研究需要评估潜在的机制并测试有效的临床应对措施。
