Table. Association Between ACEs and Health Problems in the E-Risk and Dunedin Cohortsa.
| Cohort: ACE measure | No. | Relative risk (95% CI) | ||||
|---|---|---|---|---|---|---|
| Model 1 (unadjusted) | Model 2 (adjusted for sex) | Model 3 (adjusted for SES at ACE assessment) | Model 4 (adjusted for health at ACE assessment) | Model 5 (adjusted for all risk factors) | ||
| E-Risk cohort (18 y)—prospective ACE measure | ||||||
| Any mental health problem | 2009 | 1.14 (1.10-1.18) | 1.14 (1.10-1.18) | 1.12 (1.08-1.17) | 1.11 (1.07-1.15) | 1.10 (1.06-1.15) |
| Any physical health problem | 2009 | 1.09 (1.07-1.12) | 1.10 (1.07-1.12) | 1.07 (1.04-1.09) | 1.08 (1.06-1.11) | 1.06 (1.04-1.09) |
| Dunedin cohort (45 y)—prospective ACE measure | ||||||
| Any mental health problem | 918 | 1.17 (1.08-1.27) | 1.17 (1.08-1.27) | 1.17 (1.07-1.27) | 1.15 (1.06-1.25) | 1.15 (1.06-1.25) |
| Any physical health problem | 872 | 1.04 (1.01-1.07) | 1.04 (1.01-1.07) | 1.03 (1.00-1.06) | 1.04 (1.01-1.07) | 1.03 (1.00-1.06) |
| Dunedin cohort (45 y)—retrospective ACE measure | ||||||
| Any mental health problem | 855 | 1.23 (1.14-1.31) | 1.23 (1.14-1.32) | 1.20 (1.12-1.29) | 1.21 (1.12-1.30) | 1.19 (1.10-1.28) |
| Any physical health problem | 859 | 1.05 (1.02-1.07) | 1.05 (1.02-1.07) | 1.04 (1.01-1.06) | 1.03 (1.01-1.06) | 1.02 (1.00-1.05) |
Abbreviations: ACE, adverse childhood experience; Dunedin, Dunedin Multidisciplinary Health and Development Study; E-Risk, Environmental Risk Longitudinal Twin Study; SES, socioeconomic status.
Results are presented as relative risks and 95% CIs for health problems per additional ACE experienced. We controlled for covariates measured at the time of ACE assessment to reflect information clinicians would have access to at the time of ACE screening; analyses using prospective ACE measures adjusted for risk factors measured in childhood (eg, family SES disadvantage and child mental health problems), whereas analyses using the retrospective ACE measure adjusted for risk factors in adulthood (eg, SES disadvantage at 38 years and self-reported health problems at 38 years). We adjusted for sex in analyses based on both prospective and retrospective ACE measures. The sample size for each outcome includes individuals with complete data for ACEs, the health outcome, and all covariates (eg, sex, SES, and prior health measures). Estimates were obtained from quasi-Poisson regression models, which are recommended vs binomial regression models to avoid convergence problems.36 However, findings were consistent with those obtained from logistic regression models (presented in eTable 6 in the Supplement).