Shu Yanling, Zhang Zheng, Wang Hengyu, Wang Chunling, Dou Linfei, Wang Wenhua, Zhang Lei, Bi Jianing, Wu Mingyang
Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.
Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.
BMC Public Health. 2025 May 27;25(1):1950. doi: 10.1186/s12889-025-23192-3.
Despite extensive research into the health effects of adverse childhood experiences (ACEs), there remains a need for nationally representative data to assess the associations between ACEs and both adult health and behaviors, focusing on the mediating role of socioeconomic inequality.
Using data from the 2019-2022 Behavioral Risk Factor Surveillance System (BRFSS) (N = 249,186 adults), ACE exposure was categorized into five groups (0, 1, 2, 3, and 4 or more ACEs). Socioeconomic inequality was assessed based on income levels. Binary logistic regression was employed to quantify the associations of ACEs/socioeconomic inequality with adult health and behaviors. Mediation models were used to evaluate the mediating effect of socioeconomic inequality on the relationships of continuous ACE scores with adult health and behaviors.
Each unit increase in ACE score was associated with a 4-34% increase in the odds of adverse health outcomes or unhealthy behaviors. Compared to participants with no ACE exposure, those with ≥ 4 ACEs exhibited a higher likelihood of experiencing asthma, arthritis, cancer, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, disability, depression, more days of poor physical and mental health, and engagement in drinking, smoking and high-risk HIV behavior, with odds ratios ranging from 1.26 (95% CI: 1.22-1.31) for diabetes to 4.87 (95% CI: 4.72-5.02) for depression. Socioeconomic inequality mediated more than 5% of associations between ACE scores and diabetes, disability, COPD, and CVD.
This study reveals a broad spectrum of negative health impacts associated with ACE exposure, with socioeconomic inequality demonstrating a significant mediating effect on these associations. The findings emphasize the need for public health interventions targeting both ACEs and socioeconomic inequality to alleviate the burden of chronic diseases and improve adult health conditions.
尽管对童年不良经历（ACEs）对健康的影响进行了广泛研究，但仍需要具有全国代表性的数据来评估ACEs与成人健康及行为之间的关联，重点关注社会经济不平等的中介作用。
利用2019 - 2022年行为风险因素监测系统（BRFSS）的数据（N = 249,186名成年人），将ACE暴露分为五组（0、1、2、3以及4种或更多ACEs）。基于收入水平评估社会经济不平等。采用二元逻辑回归来量化ACEs/社会经济不平等与成人健康及行为之间的关联。使用中介模型来评估社会经济不平等对ACE连续得分与成人健康及行为关系的中介作用。
ACE得分每增加一个单位，不良健康结局或不健康行为的几率就会增加4% - 34%。与未经历ACEs的参与者相比，经历≥4种ACEs的参与者患哮喘、关节炎、癌症、心血管疾病（CVD）、慢性阻塞性肺疾病（COPD）、糖尿病、残疾、抑郁症的可能性更高，身心健康不佳的天数更多，且饮酒、吸烟和高危HIV行为的发生率更高，糖尿病的优势比为1.26（95%CI：1.22 - 1.31），抑郁症为4.87（95%CI：4.72 - 5.02）。社会经济不平等在ACE得分与糖尿病、残疾、COPD和CVD之间的关联中起到了超过5%的中介作用。
本研究揭示了与ACE暴露相关的广泛负面健康影响，社会经济不平等对这些关联具有显著的中介作用。研究结果强调需要针对ACEs和社会经济不平等采取公共卫生干预措施，以减轻慢性病负担并改善成人健康状况。
