RELATIONSHIP OF CHILDHOOD ABUSE AND HOUSEHOLD DYSFUNCTION TO MANY OF THE LEADING CAUSES OF DEATH IN ADULTS - THE ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY
Vj. Felitti et al., RELATIONSHIP OF CHILDHOOD ABUSE AND HOUSEHOLD DYSFUNCTION TO MANY OF THE LEADING CAUSES OF DEATH IN ADULTS - THE ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY, American journal of preventive medicine, 14(4), 1998, pp. 245-258
Citations number
68
Categorie Soggetti
Medicine, General & Internal","Public, Environmental & Occupation Heath
Background: The relationship of health risk behavior and disease in ad
ulthood to the breadth of exposure to childhood emotional, physical, o
r sexual abuse, and household dysfunction during childhood has not pre
viously been described. Methods: A questionnaire about adverse childho
od experiences was mailed to 13,494 adults who had completed a standar
dized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seve
n categories of adverse childhood experiences were studied: psychologi
cal, physical, or sexual abuse; violence against mother; or living wit
h household members who were substance abusers, mentally ill or suicid
al, or ever imprisoned. The number of categories of these adverse chil
dhood experiences was then compared to measures of adult risk behavior
, health status, and disease. Logistic regression was used to adjust f
or effects of demographic factors on the association between the cumul
ative number of categories of childhood exposures (range: 0-7) and ris
k factors for the leading causes of death in adult life. Results: More
than half of respondents reported at least one, and one-fourth report
ed greater than or equal to 2 categories of childhood exposures. We fo
und a graded relationship between the number of categories of childhoo
d exposure and each of the adult health risk behaviors and diseases th
at were studied (P < .001). Persons who had experienced four or more c
ategories of childhood exposure, compared to those who had experienced
none, had 4- to 12-fold increased health risks for alcoholism, drug a
buse, depression, and suicide attempt; a 2- to 4-fold increase in smok
ing, poor self-rated health, greater than or equal to 50 sexual interc
ourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fo
ld increase in physical inactivity and severe obesity. The number of c
ategories of adverse childhood exposures showed a graded relationship
to the presence of adult diseases including ischemic heart disease, ca
ncer, chronic lung disease, skeletal fractures, and liver disease. The
seven categories of adverse childhood experiences were strongly inter
related and persons with multiple categories of childhood exposure wer
e Likely to have multiple health risk factors later in life. Conclusio
ns: We found a strong graded relationship between the breadth of expos
ure to abuse or household dysfunction during childhood and multiple ri
sk factors for several of the leading causes of death in adults.