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Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study.
Bhattarai, Asmita; Dimitropoulos, Gina; Bulloch, Andrew G M; Tough, Suzanne C; Patten, Scott B.
Afiliación
  • Bhattarai A; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada. asmita.bhattarai1@ucalgary.ca.
  • Dimitropoulos G; Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada. asmita.bhattarai1@ucalgary.ca.
  • Bulloch AGM; Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
  • Tough SC; Faculty of Social Work, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
  • Patten SB; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
BMC Public Health ; 23(1): 2036, 2023 10 18.
Article en En | MEDLINE | ID: mdl-37853382
ABSTRACT

BACKGROUND:

The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors.

METHODS:

The study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994-2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035).

RESULTS:

During the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM.

CONCLUSION:

The findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Mortalidad Prematura / Abuso Físico Límite: Adult / Humans País/Región como asunto: America do norte Idioma: En Revista: BMC Public Health Asunto de la revista: SAUDE PUBLICA Año: 2023 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Mortalidad Prematura / Abuso Físico Límite: Adult / Humans País/Región como asunto: America do norte Idioma: En Revista: BMC Public Health Asunto de la revista: SAUDE PUBLICA Año: 2023 Tipo del documento: Article País de afiliación: Canadá