Internal Medicine Residency Program, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
BMC Public Health. 2024 Sep 27;24(1):2615. doi: 10.1186/s12889-024-20125-4.
Limited data exists on trends in prevalence of adverse childhood experiences (ACE) at the national level and sociodemographic correlates of having ACEs. This study examined trends in ACE prevalence and sociodemographic correlates in US adults over 14 years using nationally representative data.
Data on 447,162 adults from the Behavioral Risk Factor Surveillance System (BRFSS) across four timepoints (2009-2010; 2011-2012; 2019-2020; 2021-2022) was analyzed and weighted for population estimates. The primary outcome was ACEs with 3 groups used (0 vs. 1 + ACEs; <4 vs. 4 + ACEs; 0 vs. 1 vs. 2 vs. 3 vs. 4 + ACEs). Sociodemographic factors included age, sex, race/ethnicity, employment, education, marital status, income and insurance status. Prevalence trends were examined by estimating prevalence of ACE groupings (0/1+; <4/4+; 0,1,2,3,4+) across the four timepoints and trend analysis was performed to determine if the differences over time were statistically significant. Unadjusted and adjusted prevalence ratios were estimated using log-binomial regression models with ACE groupings as the outcome and timepoints as the primary independent variable with sociodemographic factors as covariates.
Across the four time points, prevalence of ACEs was higher across groupings of ACEs by time. For ACEs 1+, prevalence was 62.2% (2009-2010); 62.2% (2011-2012); 64.5% (2019-2020); and 67.2% (2021-2022). For ACEs 4+, prevalence was 17.4% (2009-2010); 18.1% (2011-2012); 20.4% (2019-2020); and 22.6% (2021-2022). Prevalence of ACE 1 + was higher for older adults, Non-Hispanic Black adults, Non-Hispanic Other adults, and those with higher education. Prevalence of 4 + ACEs was higher for females, and lower for those with higher education and those with higher annual incomes.
This study shows an increased prevalence of having ACEs over a 14-year period and identified independent sociodemographic correlates of having ACEs in a nationally representative study. Targeted interventions are needed to reduce burden of ACEs using population-based approaches.
关于全国范围内不良儿童经历（ACE）的流行趋势以及 ACE 发生的社会人口学相关性，现有数据有限。本研究使用全国代表性数据，对 14 年以上美国成年人 ACE 流行趋势和社会人口学相关性进行了研究。
使用行为风险因素监测系统（BRFSS）的 447162 名成年人的数据（2009-2010 年；2011-2012 年；2019-2020 年；2021-2022 年），分析并对人口估计进行加权。主要结果是 ACE，使用 3 组（0 与 1+ ACEs；<4 与 4+ ACEs；0 与 1 与 2 与 3 与 4+ ACEs）。社会人口学因素包括年龄、性别、种族/民族、就业、教育、婚姻状况、收入和保险状况。通过估计四个时间点的 ACE 分组（0/1+；<4/4+；0、1、2、3、4+）的流行趋势来检查流行趋势，并进行趋势分析以确定随着时间的推移是否存在统计学显著差异。使用 ACE 分组作为结局，时间点作为主要自变量，社会人口学因素作为协变量的对数二项回归模型来估计未调整和调整后的流行率比。
在四个时间点中，ACE 分组的 ACE 流行率随时间的推移而增加。ACE1+的患病率为 62.2%（2009-2010 年）；62.2%（2011-2012 年）；64.5%（2019-2020 年）；67.2%（2021-2022 年）。ACE4+的患病率为 17.4%（2009-2010 年）；18.1%（2011-2012 年）；20.4%（2019-2020 年）；22.6%（2021-2022 年）。年龄较大、非西班牙裔黑人、非西班牙裔其他人以及受教育程度较高的成年人 ACE1+的患病率更高。4+ACE 患病率较高的是女性，而受教育程度较高和年收入较高的女性患病率较低。
本研究表明，在 14 年期间 ACE 的流行率有所增加，并在一项具有全国代表性的研究中确定了 ACE 发生的独立社会人口学相关性。需要采用基于人群的方法来实施有针对性的干预措施，以减轻 ACE 的负担。
