METHODS: Respondents were from the eleven U.S. states that included the optional ACE module questionnaire in the 2021 Behavioral Risk Factor Surveillance Systems (BRFSS). Relative importance (RI) was estimated for ten ACEs to respondents\' self-rated general health (SRGH), physically unhealthy days (PUD), mentally unhealthy days (MUD), and activity limitation days (ALD). A variable\'s importance was measured as the average gains in R-squared after adding the variable to all sub-models. Statistical analysis was performed in 2023.
RESULTS: After controlling for demographics, household mental illness was the most important ACE for SRGH, MUD, and ALD, with RIs of 16.4, 28.4 and 23.4, respectively. This ACE was ranked second for PUD (RI=17.8). Sexual abuse was ranked first for PUD (18.7), second for MUD (16.6) and ALD (20.9), and fifth for SRGH (10.4). Parental separation (RI ≤2.4) and incarcerated household member (2.8-5.4) were the least important ACEs for all 4 outcomes. Sexual abuse, parental separation, emotional abuse, and basic needs were not met were considerably more important among females while household mental illness and household substance abuse were more important among males.
CONCLUSIONS: This study highlight that certain ACEs play a greater role than others for HRQOL with certain ACEs having a greater relative importance according to sex. Additionally, a significant proportion of the long-term impacts of ACE to HRQOL was indirectly through the mediation effect of other explanatory variables.
方法:受访者来自美国11个州,其中包括2021年行为风险因素监测系统(BRFSS)中的可选ACE模块问卷。估计十个ACE对受访者自我评估的一般健康状况(SRGH)的相对重要性(RI),身体不健康的日子(PUD),精神不健康的日子(MUD),和活动限制日(ALD)。变量的重要性被测量为在将变量添加到所有子模型之后的R平方的平均增益。2023年进行统计分析。
结果:在控制人口统计学之后,家庭精神疾病是SRGH最重要的ACE,MUD,和ALD,RI分别为16.4、28.4和23.4。该ACE在PUD中排名第二(RI=17.8)。性虐待在PUD中排名第一(18.7),MUD(16.6)和ALD(20.9)排名第二,第五名为SRGH(10.4)。父母分离(RI≤2.4)和被监禁的家庭成员(2.8-5.4)是所有四个结局中最不重要的ACE。性虐待,父母分离,情感虐待,女性的基本需求没有得到满足,而男性的家庭精神疾病和家庭药物滥用更为重要。
结论:这项研究强调,某些ACE在HRQOL中的作用比其他ACE更大,而某些ACE根据性别具有更大的相对重要性。此外,ACE对HRQOL的长期影响中,很大一部分是通过其他解释变量的中介效应间接产生的.