Importance Childhood adversity (CA) is a powerful determinant of long-term physical and mental health that is associated with elevated risk for chronic disease and psychopathology. However, the degree to which CA contributes to mortality as a preventable driver of ill-health and death is unknown. Objective To estimate the contribution of CA to health behaviors, including smoking and sedentary behavior, as well as the annual mortality attributable to CA in the US through influences on leading causes of death (eg, cardiovascular disease). Evidence Review For this systematic review, the PsycINFO and MEDLINE databases were searched on November 15, 2019. The databases were searched for publications from inception (1806 for PsycINFO, 1946 for MEDLINE) to November 15, 2019. Meta-analyses of the associations between CA and morbidity outcomes were included. The population attributable fraction (PAF) was calculated from these associations along with the estimated US prevalence of CA. The PAF was then applied to the number of annual deaths associated with each cause of death to estimate the number of deaths that are attributable to CA. Additionally, the PAF was applied to the incidence of health behaviors to derive the number of cases attributable to CA. Exposure to 1 or more experiences of adversity before the age of 18 years was analyzed, including abuse, neglect, family violence, and economic adversity. Findings A total of 19 meta-analyses with 20 654 832 participants were reviewed. Childhood adversity accounted for approximately 439 072 deaths annually in the US, or 15% of the total US mortality in 2019 (2 854 838 deaths), through associations with leading causes of death (including heart disease, cancer, and suicide). In addition, CA was associated with millions of cases of unhealthy behaviors and disease markers, including more than 22 million cases of sexually transmitted infections, 21 million cases of illicit drug use, 19 million cases of elevated inflammation, and more than 10 million cases each of smoking and physical inactivity. The greatest proportion of outcomes attributable to CA were for suicide attempts and sexually transmitted infections, for which adversity accounted for up to 38% and 33%, respectively. Conclusions and Relevance The results of this systematic review suggest that CA is a leading contributor to morbidity and mortality in the US and may be considered a preventable determinant of mortality. The prevention of CA and the intervention on pathways that link these experiences to elevated disease risk should be considered a critical public health priority.

中文翻译：

---

美国成人儿童逆境与发病率和死亡率的关联：系统评价。

重要性 童年逆境 (CA) 是长期身心健康的重要决定因素，与慢性病和精神病理学风险升高有关。然而，作为健康不良和死亡的可预防驱动因素，CA 在多大程度上导致死亡率尚不清楚。目的 通过对主要死因（如心血管疾病）的影响，估计 CA 对健康行为（包括吸烟和久坐行为）的贡献，以及美国 CA 导致的年死亡率。证据审查 对于本次系统审查，于 2019 年 11 月 15 日检索了 PsycINFO 和 MEDLINE 数据库。检索了数据库从开始（PsycINFO 为 1806，MEDLINE 为 1946）到 2019 年 11 月 15 日的出版物。包括对 CA 与发病率结果之间关联的荟萃分析。人口归因分数 (PAF) 是根据这些关联以及估计的美国 CA 患病率计算得出的。然后将 PAF 应用于与每种死因相关的年度死亡人数，以估计可归因于 CA 的死亡人数。此外，将 PAF 应用于健康行为的发生率，以得出可归因于 CA 的病例数。分析了 18 岁之前经历过 1 次或多次逆境的经历，包括虐待、忽视、家庭暴力和经济逆境。结果 共审查了 20 654 832 名参与者的 19 项荟萃分析。在美国，儿童逆境每年造成约 439 072 人死亡，或 2019 年美国总死亡率（2 854 838 人死亡）的 15%，这与主要死因（包括心脏病、癌症和自杀）有关。此外，CA 与数百万例不健康行为和疾病标志物相关，包括超过 2200 万例性传播感染病例、2100 万例非法药物使用病例、1900 万例炎症升高病例以及超过 1000 万例病例吸烟和缺乏运动。归因于 CA 的最大比例的结果是自杀未遂和性传播感染，其中逆境分别占 38% 和 33%。结论和相关性 本系统评价的结果表明，CA 是美国发病率和死亡率的主要因素，并且可能被认为是可预防的死亡率决定因素。预防 CA 和干预将这些经历与疾病风险升高联系起来的途径应被视为一项重要的公共卫生优先事项。