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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    • "Childhood maltreatment – including physical abuse, sexual abuse, witnessing domestic violence and neglect – has a highly adverse impact on physical and mental health and is strongly associated with both internalizing and externalizing behaviors later in life (Asgeirsdottir, Sigfusdottir, Gudjonsson, &amp; Sigurdsson, 2011;Brown et al., 2009;Gilbert et al., 2009;Goodwin &amp; Stein, 2004;Hart &amp; Rubia, 2012;Turner, Finkelhor, &amp; Ormrod, 2006). Psychopathology attributed to maltreatment is often severe and extensive, and has been specifically associated with mood and anxiety disorders (Branje, van Doorn, van der Valk, &amp; Meeus, 2009;Horwitz, Widom, McLaughlin, &amp; White, 2001;Turner et al., 2006), personality disturbance (Johnson, Cohen, Brown, Smailes, &amp; Bernstein, 1999;Luntz &amp; Widom, 1994), substance misuse (Asgeirsdottir et al., 2011;Harrison, Fulkerson, &amp; Beebe, 1997;Nelson et al., 2006) and psychosis in adulthood (Bebbington et al., 2011;Morgan &amp; Fisher, 2007). "
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    • "These adverse childhood experiences (ACE) include child abuse, exposure to parental intimate partner violence (IPV), and other types of family dysfunction which have been linked in a dose–response fashion to a range of adverse health outcomes which include: substance abuse, posttraumatic stress disorder, depression, cardiovascular disease, cancer , and premature mortality as well as adult perpetration of and victimization from family violence (D. W. Brown et al. 2009; CDC 2010; Cook et al. 2011; Felitti et al. 1998). Recently, researchers have also found associations between ETS and higher Body Mass Index (BMI), obesity, and type 2 diabetic risk (Rich- Edwards et al. 2010; Wegman and Stetler 2009). "
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    • "These adversities were scored as either present or absent, without regard to the frequency or severity of abuse, and the individual adversities were added together to develop an overall ACE score (Felitti et al., 1998). High-risk ACE scores (sometimes reported as 3 or more, sometimes reported as 4 or more) have repeatedly been linked to increased risk of adverse physical and behavioral health outcomes for both adults and adolescents (Anda et al., 2006; D. W. Brown et al., 2009; Dube et al., 2001; Felitti et al., 1998; Flaherty, 2009; Flaherty et al., 2013; Flaherty et al., 2009; Reavis et al., 2013). The existing literature on predictors of sexual trafficking is limited by relatively small sample sizes of sexually trafficked youth and a limited focus on family or caregiver characteristics that predict sexual exploitation. "
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