Abstract：
Adverse childhood experiences (ACE) are important for chronic diseases yet their association with multimorbidity remains understudied. Few studies consider the complexity of multimorbidity or observe multimorbidity development over time.
We investigated whether ACE were associated with multimorbidity at baseline and over a 12-year follow-up period.
5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA).
An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12-year period (2008-2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time.
Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with ≥3 ACE had three times the risk of having ≥3 chronic diseases (RRR 3.06, 95 % CI 1.85-5.05) and falling into ≥3 chronic disease categories (RRR 2·93 95 % CI 1·74-4·95). Graded associations persisted during 12-year follow-up, though differences in multimorbidity between those with ≥3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0·01-0·03, and B -0·01, 95 % CI -0·02-0·00, number of chronic conditions and chronic condition categories respectively).
ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association.
We investigated whether ACE were associated with multimorbidity at baseline and over a 12-year follow-up period.
5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA).
An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12-year period (2008-2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time.
Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with ≥3 ACE had three times the risk of having ≥3 chronic diseases (RRR 3.06, 95 % CI 1.85-5.05) and falling into ≥3 chronic disease categories (RRR 2·93 95 % CI 1·74-4·95). Graded associations persisted during 12-year follow-up, though differences in multimorbidity between those with ≥3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0·01-0·03, and B -0·01, 95 % CI -0·02-0·00, number of chronic conditions and chronic condition categories respectively).
ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association.
摘要：
背景：不良儿童经历（ACE）对慢性疾病很重要，但其与多重性疾病的关系仍未得到充分研究。很少有研究考虑多浊度的复杂性或观察多浊度随时间的发展。
目的：我们调查了在基线和12年随访期间ACE是否与多发病率相关。
方法：5326名50岁以上的参与者来自英国纵向老龄化研究（ELSA）。
方法：使用八个ACE项目测量滥用，得出ACE汇总评分，社会关怀,和家庭功能障碍。从12年（2008-2019年）对29种慢性病的重复测量中，我们得出了两种多发病率指标：慢性病的数量和慢性病类别的数量。我们使用多项逻辑回归来评估ACE和两种措施之间的关联。估计了混合效应模型，以检查ACE随时间变化的多发病率轨迹。
结果：观察到ACE和多症之间的分级关联。与那些没有ACE的人相比，ACE≥3项的参与者患≥3项慢性疾病的风险是其3倍(RRR3.06,95%CI1.85-5.05),并且属于≥3项慢性疾病类别(RRR2·9395%CI1·74-4·95).在12年的随访中，分级协会持续存在，尽管患有≥3ACE的患者与未患有ACE的患者之间的多重性差异保持不变（分别为B0.02，95％CI0·01-0·03和B-0·01，95％CI-0·02-0·00，慢性疾病的数量和慢性疾病类别）。
结论：ACE与多症风险和复杂性相关，在50岁之前出现的协会。ACE患者的早期干预可以减弱这种关联。
目的：我们调查了在基线和12年随访期间ACE是否与多发病率相关。
方法：5326名50岁以上的参与者来自英国纵向老龄化研究（ELSA）。
方法：使用八个ACE项目测量滥用，得出ACE汇总评分，社会关怀,和家庭功能障碍。从12年（2008-2019年）对29种慢性病的重复测量中，我们得出了两种多发病率指标：慢性病的数量和慢性病类别的数量。我们使用多项逻辑回归来评估ACE和两种措施之间的关联。估计了混合效应模型，以检查ACE随时间变化的多发病率轨迹。
结果：观察到ACE和多症之间的分级关联。与那些没有ACE的人相比，ACE≥3项的参与者患≥3项慢性疾病的风险是其3倍(RRR3.06,95%CI1.85-5.05),并且属于≥3项慢性疾病类别(RRR2·9395%CI1·74-4·95).在12年的随访中，分级协会持续存在，尽管患有≥3ACE的患者与未患有ACE的患者之间的多重性差异保持不变（分别为B0.02，95％CI0·01-0·03和B-0·01，95％CI-0·02-0·00，慢性疾病的数量和慢性疾病类别）。
结论：ACE与多症风险和复杂性相关，在50岁之前出现的协会。ACE患者的早期干预可以减弱这种关联。
