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首页> 美国卫生研究院文献>SSM - Population Health >Troubled childhoods cast long shadows: Childhood adversity and premature all-cause mortality in a Swedish cohort
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Troubled childhoods cast long shadows: Childhood adversity and premature all-cause mortality in a Swedish cohort

机译：陷入困境的童年蒙上了长长的阴影：瑞典人群中的童年逆境和过早的全因死亡率

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摘要

Experiences of childhood adversity are common and have profound health impacts over the life course. Yet, studying health outcomes associated with childhood adversity is challenging due to a lack of conceptual clarity of childhood adversity, scarce prospective data, and selection bias. Using a 65-year follow-up of a Swedish cohort born in 1953 (n = 14,004), this study examined the relationship between childhood adversity (ages 0–18) and premature all-cause mortality (ages 19–65). Childhood adversity was operationalized as involvement with child welfare services, household dysfunction, and disadvantageous family socioeconomic conditions. Survival models were used to estimate how much of the association between child welfare service involvement and mortality could be explained by household dysfunction and socioeconomic conditions. Results show that individuals who were involved with child welfare services had higher hazards of dying prematurely than their majority population peers. These risks followed a gradient, ranging from a hazard ratio of 3.08 (95% CI: 2.68–3.53) among those placed in out-of-home care, followed by individuals subjected to in-home services who demonstrated a hazard ratio of 2.53 (95% CI: 1.93–3.32), to a hazard ratio of 1.81 among those investigated and not substantiated (95% CI: 1.55–2.12). Associations between involvement with child welfare services and premature all-cause mortality were robust to adjustment for household dysfunction and disadvantageous family socioeconomic conditions. Neither household dysfunction nor socioeconomic conditions were related with mortality independent of child welfare services involvement. This study suggests that involvement with child welfare services is a viable proxy for exposure to childhood adversity and avoids pitfalls of self-reported or retrospective measures.
机译：童年时期的逆境经历很普遍，并且在一生中对健康产生深远的影响。然而，由于缺乏儿童期逆境的概念清晰性，缺乏前瞻性数据和选择偏见，因此研究与儿童期逆境有关的健康结果具有挑战性。通过对1953年出生的瑞典队列进行65年随访（n = 14,004），该研究检查了儿童逆境（0-18岁）与过早全因死亡率（19-65岁）之间的关系。童年逆境因参与儿童福利服务，家庭功能障碍和不利的家庭社会经济条件而开始运作。生存模型被用来估计儿童福利服务参与和死亡率之间的关联多少可以由家庭功能障碍和社会经济状况来解释。结果表明，与儿童福利服务有关的个人比大多数人口同龄人有更高的过早死亡风险。这些风险呈梯度变化，范围外的护理人员的危险比为3.08（95％CI：2.68-3.53），其次是在家中服役的个人的危险比为2.53（ 95％CI：1.93–3.32），被调查且未证实的危险比为1.81（95％CI：1.55–2.12）。参与儿童福利服务与过早全因死亡率之间的联系对于调整家庭功能障碍和不利的家庭社会经济条件是强有力的。独立于儿童福利服务的参与，家庭功能障碍或社会经济状况均与死亡率无关。这项研究表明，参与儿童福利服务可以有效地避免儿童患上逆境，并避免自我报告或追溯措施带来的弊端。

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