ImportanceExposure to adverse childhood experiences (ACEs) before the age of 18 years is a major contributor to the global burden of disease and disability.ObjectiveTo meta-analyze data from samples with children 18 years or younger to estimate the average prevalence of ACEs, identify characteristics and contexts associated with higher or lower ACE exposure, and explore methodological factors that might influence these prevalence estimates.Design, Setting, and ParticipantsStudies that were published between January 1, 1998 and February 19, 2024, were sourced from MEDLINE, PsycINFO, CINHAL, and Embase. Inclusion criteria required studies to report the prevalence of 0, 1, 2, 3, or 4 or more ACEs using an 8- or 10-item ACEs questionnaire (plus or minus 2 items), include population samples of children 18 years or younger, and be published in English. Data from 65 studies, representing 490 423 children from 18 countries, were extracted and synthesized using a multicategory prevalence meta-analysis. These data were analyzed from February 20, 2024, through May 17, 2024.Main Outcomes and MeasuresACEs.ResultsThe mean age of children across studies was 11.9 (SD, 4.3) years, the age range across samples was 0 to 18 years, and 50.5% were female. The estimated mean prevalences were 42.3% for 0 ACEs (95% CI, 25.3%-52.7%), 22.0% for 1 ACE (95% CI, 9.9%-32.7%), 12.7% for 2 ACEs (95% CI, 3.8%-22.3%), 8.1% for 3 ACEs (95% CI, 1.4%-16.8%), and 14.8% for 4 or more ACEs (95% CI, 5.1%-24.8%). The prevalence of 4 or more ACEs was higher among adolescents vs children (prevalence ratio, 1.16; 95% CI, 1.04-1.30), children in residential care (1.26; 95% CI, 1.10-1.43), with a history of juvenile offending (95% CI, 1.29; 1.24-1.34), and in Indigenous peoples (1.63; 95% CI, 1.28-2.08), as well as in studies where file review was the primary assessment method (1.29; 95% CI, 1.23-1.34). The prevalence of 0 ACEs was lower in questionnaire-based studies where children vs parents were informants (0.85; 95% CI, 0.80-0.90).ConclusionsIn this study, ACEs were prevalent among children with notable disparities across participant demographic characteristics and contexts. As principal antecedent threats to child and adolescent well-being that can affect later life prospects, ACEs represent a pressing global social issue. Effective early identification and prevention strategies, including targeted codesigned community interventions, can reduce the prevalence of ACEs and mitigate their severe effects, thereby minimizing the harmful health consequences of childhood adversity in future generations.

中文翻译：

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儿童人口样本中童年不良经历的发生率


重要性18 岁之前暴露于不良童年经历 （ACE） 是造成全球疾病和残疾负担的主要因素。目的对 18 岁或以下儿童样本的数据进行荟萃分析，以估计 ACE 的平均患病率，确定与较高或较低的 ACE 暴露相关的特征和背景，并探索可能影响这些患病率估计的方法因素。设计、设置和参与者1998 年 1 月 1 日至 2024 年 2 月 19 日期间发表的研究来源于 MEDLINE、PsycINFO、CINHAL 和 Embase。纳入标准要求研究使用 8 项或 10 项 ACE 问卷（加或减 2 项）报告 0、1、2、3 或 4 个或更多 ACE 的患病率，包括 18 岁或以下儿童的人群样本，并以英文发布。使用多类别患病率荟萃分析提取和综合来自 65 项研究的数据，代表来自 490 423 个国家的 18 名儿童。这些数据是在 2024 年 2 月 20 日至 2024 年 5 月 17 日期间进行的分析的。主要结果和措施ACEs.结果研究中儿童的平均年龄为 11.9 （SD， 4.3） 岁，样本的年龄范围为 0 至 18 岁，其中 50.5% 为女性。0 例 ACE 的估计平均患病率为 42.3% （95% CI，25.3%-52.7%），1 例 ACE 为 22.0% （95% CI，9.9%-32.7%），2 例 ACE 为 12.7% （95% CI，3.8%-22.3%），3 例 ACE 为 8.1% （95% CI，1.4%-16.8%），4 例或更多 ACE 为 14.8% （95% CI，5.1%-24.8%）。4 个或更多 ACE 的患病率在青少年中高于儿童 （患病率，1.16;95% CI，1.04-1.30）、寄宿照料儿童 （1.26;95% CI，1.10-1.43）、有青少年犯罪史 （95% CI，1.29;1.24-1.34） 和土著人民 （1.63;95% CI，1.28-2.08），以及以文件审查为主要评估方法的研究 （1.29;95% CI，1.23-1.34）。在儿童与父母作为知情人的问卷调查研究中，0 ACE 的患病率较低 （0.85;95% CI，0.80-0.90）。结论在这项研究中，ACEs 在儿童中普遍存在，参与者的人口统计学特征和背景之间存在显着差异。作为对儿童和青少年福祉的主要前因威胁，ACE 可以影响以后的生活前景，它代表了一个紧迫的全球社会问题。有效的早期识别和预防策略，包括有针对性的共同设计的社区干预措施，可以降低 ACE 的患病率并减轻其严重影响，从而最大限度地减少童年逆境对后代的有害健康后果。