Background

Children who are exposed to adversities might be more susceptible to disease development during childhood and in later life due to impaired physiological and mental development. To explore this hypothesis, we assessed hospitalisation patterns through childhood and into adult life among those exposed to different trajectories of adversities during childhood.

Methods

For this population-based cohort study, we used annually updated data from Danish nationwide registers covering more than half a million children (aged 0–15 years) born between 1994 and 2001. Children who were alive and resident in Denmark on their 16th birthday were included in the analysis. Cluster analysis was used to divide children into five distinct trajectories according to their experience of childhood adversities, including poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics. To describe comprehensively the disease patterns experienced by these groups of children, we assessed the associations of each adversity trajectory with hospital admission patterns according to the entire spectrum of disease diagnoses in the International Classification of Diseases 10th edition, from birth to 24 years of age, using survival models.

Findings

508 168 children born between Jan 1, 1994, and Dec 31, 2001, were followed up until Dec 31, 2018, capturing more than 3·8 million hospital admissions from birth to early adulthood. Hospitalisation rates were consistently higher in all four adversity groups compared with the low adversity group. The high adversity group (14 577 children, 3%), who were exposed to adversities of deprivation, family loss, and negative family dynamics, had a markedly higher rate of hospitalisations across all ages. For example, we observed 243 additional hospital admissions per 1000 person-years (95% CI 238–248) in the high versus low adversity group for those aged 16–24 years. These associations were particularly strong for diagnoses related to injuries, unspecified symptoms, and factors influencing health service contacts (eg, health screening and observation). They also covered a considerable burden of respiratory and infectious diseases, congenital malformations, diseases of the nervous system (especially in early life), mental and behavioural diagnoses, and diagnoses related to pregnancy and childbirth in early adult life.

Interpretation

The close linkage between childhood adversities and poor lifelong health outcomes highlights a need for public health and policy attention on improving the socioeconomic circumstances children are born into to prevent the early emergence of health inequalities.

Funding

None.

中文翻译：

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暴露于童年逆境的儿童的住院模式：一项针对 50 万儿童的基于人群的队列研究

背景

由于生理和心理发育受损，暴露于逆境的儿童在童年和晚年可能更容易患上疾病。为了探索这一假设，我们评估了那些在童年时期暴露于不同逆境轨迹的人从童年到成年的住院模式。

方法

对于这项基于人群的队列研究，我们使用了丹麦全国登记册中每年更新的数据，涵盖 1994 年至 2001 年间出生的超过 50 万儿童（0-15 岁）。在 16 岁生日时还活着并居住在丹麦的儿童是纳入分析。聚类分析用于根据儿童童年逆境的经历将儿童分为五个不同的轨迹，包括贫困和物质剥夺、家庭内的损失或损失威胁以及家庭动态的各个方面。为了全面描述这些儿童群体经历的疾病模式，我们根据国际疾病分类第 10 版中的整个疾病诊断谱评估了每个逆境轨迹与住院模式的关联，

发现

对 1994 年 1 月 1 日至 2001 年 12 月 31 日期间出生的 508 168 名儿童进行了随访，直至 2018 年 12 月 31 日，从出生到成年早期的住院人数超过 3·800 万。与低逆境组相比，所有四个逆境组的住院率始终较高。高逆境组（14 577 名儿童，3%）暴露于贫困、家庭损失和消极家庭动态的逆境中，所有年龄段的住院率均显着较高。例如，在 16-24 岁的高逆境组和低逆境组中，我们观察到每 1000 人年增加 243 次住院（95% CI 238-248）。这些关联对于与伤害、未指明的症状和影响卫生服务接触的因素（例如，健康检查和观察）相关的诊断特别强烈。

解释

童年逆境与终生健康状况不佳之间的密切联系凸显了公共卫生和政策关注改善儿童出生所处的社会经济环境以防止健康不平等过早出现的必要性。

资金

没有。