Adverse Childhood Experiences and the Risk of Premature Mortality

Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
American journal of preventive medicine (Impact Factor: 4.53). 11/2009; 37(5):389-96. DOI: 10.1016/j.amepre.2009.06.021
Source: PubMed


Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood.
This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood.
Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 17,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age < or =65 years and at age < or =75 years was estimated across the number of categories of ACEs using multivariable-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009.
Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI=56.2, 65.1, vs 79.1 years, 95% CI=78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n=526) of those who died during follow-up were aged < or =75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI=1.06, 2.83) times more likely to die when aged < or =75 years and 2.4 (95% CI=1.30, 4.39) times more likely to die when aged < or =65 years.
ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death.

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Available from: Henning Tiemeier, Oct 06, 2015
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    • "Exposure to adverse childhood experiences (ACEs) such as child abuse and neglect impact a child's socioemotional development (Toth & Manly, 2011). Research has demonstrated a clear relationship between ACEs and a variety of health behaviors and outcomes in adulthood, including premature mortality (Brown et al., 2009), alcoholism (Dube et al., 2001), drug abuse, depression (Chapman et al., 2004), suicide, heart disease, obesity (Williamson, Thompson, Anda, Dietz, & Felitti, 2002), cancer, and chronic lung disease, among others (Felitti et al., 1998). However, more immediate effects that focus on the relationship between ACEs and behavioral health among early childhood samples is limited (Burke, Hellman, Scott, Weems, & Carrion, 2011). "
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    ABSTRACT: Exposure to adverse childhood experiences (ACEs) such as child abuse and neglect impact a child's socioemotional development. Drawing from the methods employed in the Adverse Childhood Experiences (ACE; Felitti et al., ) Study, the present study utilized data from the National Survey of Child and Adolescent Well-Being to examine the prevalence of ACEs among children birth to 6 years, and the relationship of ACEs to emotional and behavioral outcomes 59 to 97 months after the close of investigation or assessment. Logistic regression also was used to examine the cumulative impact of ACEs on child behavior outcomes. By the age of 6, approximately 70% of children experienced three or more ACEs, and there were strong relationships between ACEs. Numerous ACEs were associated with long-term behavioral problems, and results supported a dose-response effect. Three or greater ACEs more than quadrupled the risk of experiencing internalizing problems, and almost quadrupled the risk of experiencing either externalizing or total problems at 59 to 97 months' postinvestigation. Based on these findings, it is crucial for both early screening/assessment and increased collaboration between child welfare and early intervention programs. © 2014 Michigan Association for Infant Mental Health.
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    • ") und körperliche Erkrankungen dar (Felitti et al., 1998) und ist mit einem niedrigen sozioökonomischen Status assoziiert (Zielinski, 2009). Danach starben Erwachsene mit sechs oder mehr kritischen Kindheitserfahrungen im Schnitt 20 Jahre früher als Menschen ohne diese Erfahrungen (Brown et al., 2009). "
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    • "Early life stress (ELS) is the exposure to childhood events that challenge a child's emotional and physical well-being, exceeding their ability to cope with the events (Gunnar and Quevedo, 2007; Pechtel and Pizzagalli, 2010). Some of these stressors can include abuse, neglect, social deprivation, or household dysfunction (Brown et al., 2009). Further, although acute instances of stress can activate the body's stress response resources in a beneficial manner, high and especially chronic levels of stress can perturb typical brain development (Pechtel and Pizzagalli, 2010). "
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