Adverse Childhood Experiences and the Risk of Premature Mortality

Article (PDF Available)inAmerican journal of preventive medicine 37(5):389-96 · November 2009with62 Reads
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.
    • "Taken alone, these findings might suggest a heterogeneity explanation, but our subsequent analyses show this is not the case. Studies of adverse experiences and premature mortality rarely disaggregate specific cause of death (e.g., Brown et al., 2009). Our disaggregated analysis revealed the primary cause of premature mortality among victims of violent crime to be violent death. "
    [Show abstract] [Hide abstract] ABSTRACT: We examined risk of male premature mortality associated with recent criminal victimization. Prior victimization is among the most consistent predictors of future risk but the explanation of repeat victimization remains elusive. Two general perspectives frame this debate. According to the state-dependence perspective, repeat victimization is forged through intervening processes connecting an initial with a subsequent violent victimization. According to the risk-heterogeneity perspective, this association is spurious because all victimization events for a person result from underlying individual traits. Research on health outcomes and premature mortality provides related, but often overlooked, conceptual assumptions about the co-occurring health burden of preventable injuries and disease. We extend and apply each of these perspectives in the current study to assess the nature and sources of repeat violent victimization. Data were from the Izhevsk (Russia) Family Study, a large-scale population-based case-control study. Cases (n = 1750) were all male deaths aged 25–54 living in Izhevsk between October 2003 and October 2005. Controls (n = 1750) were randomly selected from a city population register. Key independent variables were prior year prevalence of violent, property, and residential victimization. We used logistic regression to estimate mortality odds ratios. Results provided evidence for state dependence. We found that (i) after controlling for indicators of risk heterogeneity men who had been victims of violence (but not property or residential crime) within the past year were 2.6 times more likely than those who had not to die prematurely; and (ii) the only type of death for which risk was higher was homicide. Aggr. Behav. 9999:1–14, 2016.
    Full-text · Article · Sep 2016
    • "The health impact of traumatic experience is well documented. Studies based on the original 17,000 Kaiser Permanente patients that participated in the study showed a dose response, graded relationship between ACE scores (the number of categories of childhood experiences of trauma) and each of the adult health risk behaviors and diseases that were studied (Brown, Anda, Tiemeier, Felitti, Edwards, Croft & Giles, 2009). For instance, persons who had experienced four or more categories of childhood exposure were 4 to 12 times more likely to have increased health risks for alcoholism, drug abuse, depression, and suicide attempt. "
    Full-text · Chapter · Jun 2016 · Aggressive Behavior
    • "Rather than being rare, childhood adversities are pervasive events in epidemiologic samples, and their co-occurrence in the same individual seems to be the norm instead of the exception [8][9][10] . Such clustering of negative life events has been implicated in long-term medical outcomes (e.g., physical inactivity, severe obesity, hypertension, and headache) as well as psychiatric outcomes [3, 5,[11][12][13][14]. For instance, childhood adversities have been associated with a worse course of psychiatric disorders, such as depressive disorders [15], and with higher rates of suicidality [16]. "
    File · Dataset · May 2016 · Aggressive Behavior
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