Abstract：
OBJECTIVE: The impact of adverse childhood experiences (ACEs) on health-related quality of life (HRQOL) is increasingly recognized, however, this has not been studied in cancer survivors in the United States. This study investigates if ACEs are associated with HRQOL in cancer survivors.
METHODS: We conducted a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System from states that administered ACEs and Cancer Survivorship modules. Eligibility criteria included being a cancer survivor and not currently receiving cancer treatment. Primary exposure was number of ACEs (categorized as 0, 1-2, 3, or ≥ 4). Primary outcomes were self-reported measures of HRQOL including worse overall health and ≥ 14 unhealthy days (mentally or physically) per month. Mantel-Haenszel stratified analyses were performed and prevalence ratios were adjusted for age.
RESULTS: Of 5,780 participants, 62.0% were female and 67.8% were ≥ 65 years. Prevalence of worse overall health was 22.5% for individuals with no ACEs compared to 30.2% for 2-3 ACEs (aPR = 1.4, 95% CI 1.2, 1.5) and 38.5% for ≥ 4 ACEs (aPR = 1.7, 95% CI 1.5, 2.0). Prevalence of ≥ 14 unhealthy days was 18.1% with no ACEs compared to 21.0% for 1 ACE (aPR = 1.3, 95% CI 1, 1.3), 29.0% for 2-3 ACEs (aPR = 1.6, 95% CI 1.4, 1.8), and 44.8% for ≥ 4 ACEs (aPR = 2.2, 95% CI 2.0, 2.5).
CONCLUSIONS: Our study provides novel evidence of the association of multiple ACEs with higher prevalence of poor HRQOL in cancer survivors.
CONCLUSIONS: Screening for ACEs is warranted in all patients to guide targeted interventions to improve HRQOL and mitigate the impact of ACEs on HRQoL in cancer survivors.
METHODS: We conducted a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System from states that administered ACEs and Cancer Survivorship modules. Eligibility criteria included being a cancer survivor and not currently receiving cancer treatment. Primary exposure was number of ACEs (categorized as 0, 1-2, 3, or ≥ 4). Primary outcomes were self-reported measures of HRQOL including worse overall health and ≥ 14 unhealthy days (mentally or physically) per month. Mantel-Haenszel stratified analyses were performed and prevalence ratios were adjusted for age.
RESULTS: Of 5,780 participants, 62.0% were female and 67.8% were ≥ 65 years. Prevalence of worse overall health was 22.5% for individuals with no ACEs compared to 30.2% for 2-3 ACEs (aPR = 1.4, 95% CI 1.2, 1.5) and 38.5% for ≥ 4 ACEs (aPR = 1.7, 95% CI 1.5, 2.0). Prevalence of ≥ 14 unhealthy days was 18.1% with no ACEs compared to 21.0% for 1 ACE (aPR = 1.3, 95% CI 1, 1.3), 29.0% for 2-3 ACEs (aPR = 1.6, 95% CI 1.4, 1.8), and 44.8% for ≥ 4 ACEs (aPR = 2.2, 95% CI 2.0, 2.5).
CONCLUSIONS: Our study provides novel evidence of the association of multiple ACEs with higher prevalence of poor HRQOL in cancer survivors.
CONCLUSIONS: Screening for ACEs is warranted in all patients to guide targeted interventions to improve HRQOL and mitigate the impact of ACEs on HRQoL in cancer survivors.
摘要：
目标：儿童不良经历（ACEs）对健康相关生活质量（HRQOL）的影响日益得到认可，然而,这还没有在美国的癌症幸存者中进行研究。这项研究调查了癌症幸存者中ACE是否与HRQOL相关。
方法：我们从管理ACE和癌症生存模块的州对2020年行为危险因素监测系统进行了横断面分析。资格标准包括是癌症幸存者并且目前未接受癌症治疗。主要暴露是ACEs的数量（分类为0、1-2、3或≥4）。主要结果是自我报告的HRQOL指标，包括总体健康状况较差和每月≥14天（精神或身体）不健康。进行Mantel-Haenszel分层分析，并根据年龄调整患病率。
结果：在5,780名参与者中，62.0%为女性，67.8%为≥65岁。没有ACE的个体总体健康状况较差的患病率为22.5％，而2-3个ACE的患病率为30.2％（aPR=1.4，95％CI1.2，1.5），≥4个ACE的患病率为38.5％（aPR=1.7，95％CI1.5，2.0）。≥14天不健康的患病率为18.1％，没有ACE，而1ACE为21.0％（aPR=1.3，95％CI1，1.3），2-3种ACEs为29.0%（APR=1.6，95%CI1.4，1.8），≥4种ACEs的比例为44.8%（aPR=2.2，95%CI2.0，2.5）。
结论：我们的研究提供了癌症幸存者中多种ACE与较高的低HRQOL患病率相关的新证据。
结论：所有患者都有必要进行ACE筛查，以指导针对性干预措施改善HRQOL并减轻ACE对癌症幸存者HRQoL的影响。
方法：我们从管理ACE和癌症生存模块的州对2020年行为危险因素监测系统进行了横断面分析。资格标准包括是癌症幸存者并且目前未接受癌症治疗。主要暴露是ACEs的数量（分类为0、1-2、3或≥4）。主要结果是自我报告的HRQOL指标，包括总体健康状况较差和每月≥14天（精神或身体）不健康。进行Mantel-Haenszel分层分析，并根据年龄调整患病率。
结果：在5,780名参与者中，62.0%为女性，67.8%为≥65岁。没有ACE的个体总体健康状况较差的患病率为22.5％，而2-3个ACE的患病率为30.2％（aPR=1.4，95％CI1.2，1.5），≥4个ACE的患病率为38.5％（aPR=1.7，95％CI1.5，2.0）。≥14天不健康的患病率为18.1％，没有ACE，而1ACE为21.0％（aPR=1.3，95％CI1，1.3），2-3种ACEs为29.0%（APR=1.6，95%CI1.4，1.8），≥4种ACEs的比例为44.8%（aPR=2.2，95%CI2.0，2.5）。
结论：我们的研究提供了癌症幸存者中多种ACE与较高的低HRQOL患病率相关的新证据。
结论：所有患者都有必要进行ACE筛查，以指导针对性干预措施改善HRQOL并减轻ACE对癌症幸存者HRQoL的影响。
