Adverse childhood experiences and chronic lung diseases in adulthood: a systematic review and meta-analysis

<b>Background</b>: Adverse childhood experiences (ACE) affect physical and mental health and may appear as risk factors for the development of different conditions in adult life. <b>Objective</b>: To perform a literature review and meta-analysis on risk indicators for the development of chronic lung diseases in adulthood associated with ACE. <b>Method</b>: We conducted a systematic literature review according to the <i>PRISMA</i> (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases <i>PubMed, PsycINFO</i>, and <i>Web of Science</i>. Quantitative studies involving male and female adults were included. Fixed- and random-effect models were used in the estimation of meta-analytical measures. The heterogeneity between studies was assessed using I² statistics and Cochran’s Q test. <b>Results</b>: A total of 19 studies were selected for the meta-analysis. The analyses showed statistically significant associations between ACE and lung diseases in general (OR = 1.41; CI 95%: 1.28–1.54), besides specific associations with asthma (OR = 1.32; CI 95%: 1.13–1.50) and COPD (OR = 1.44; CI 95%: 1.13–1.76). When the mediating effect of smoking was assessed separately we found a significant – although not quite expressive – association (OR = 1.06; CI 95%: 1.02 to 1.10), which weakens the hypothesis that a direct relationship exists between childhood trauma and the occurrence of lung diseases. <b>Conclusions</b>: ACE are an important risk factor for the development of lung diseases in adulthood, whether through direct or indirect contribution to this outcome, which highlights the relevance of increasing the awareness of health staff for the early detection and intervention in situations of vulnerability or risk in childhood as an important preventative measure.

<b>背景</b>：不良童年经历（Adverse Childhood Experiences, ACE）可损害个体身心健康，并可能成为成年后多种疾病发生的风险因素。<b>目的</b>：针对与不良童年经历相关的成年期慢性肺部疾病发生风险指标，开展系统文献回顾与荟萃分析。<b>方法</b>：本研究遵循<i>PRISMA（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，系统评价与荟萃分析首选报告条目）</i>指南，依托PubMed、PsycINFO及Web of Science三大在线数据库开展系统文献回顾。研究纳入涵盖成年男性与女性的定量研究，采用固定效应模型与随机效应模型估算荟萃分析相关指标，并通过I²统计量与Cochran Q检验评估各研究间的异质性。<b>结果</b>：本研究共筛选出19项研究用于荟萃分析。分析结果显示，不良童年经历与总体肺部疾病存在具有统计学显著性的关联（比值比（Odds Ratio, OR）=1.41；95%置信区间（Confidence Interval, CI）：1.28–1.54），同时与哮喘、慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）分别存在特异性关联，对应效应量分别为OR=1.32（95%CI：1.13–1.50）与OR=1.44（95%CI：1.13–1.76）。在单独评估吸烟的中介效应时，本研究发现虽关联强度较弱但仍具有统计学意义的关联（OR=1.06；95%CI：1.02~1.10），该结果削弱了"儿童期创伤与肺部疾病发生存在直接关联"的假说。<b>结论</b>：不良童年经历是成年期肺部疾病发生的重要风险因素，无论其通过直接或间接途径促成该疾病结局，这一发现凸显了提升医护人员对儿童期脆弱或风险情境的早期识别与干预意识的必要性，将其作为重要的预防措施。