摘要：Objectives. We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood. Methods. Using a prospective cohort design, we matched children (aged 0–11 years) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children. Both groups completed a medical status examination (measured health outcomes and blood tests) and interview during 2003 through 2005 (mean age = 41.2 years). Results. After adjusting for age, gender, and race, child maltreatment predicted above normal hemoglobin, lower albumin levels, poor peak airflow, and vision problems in adulthood. Physical abuse predicted malnutrition, albumin, blood urea nitrogen, and hemoglobin A1C. Neglect predicted hemoglobin A1C, albumin, poor peak airflow, and oral health and vision problems, Sexual abuse predicted hepatitis C and oral health problems. Additional controls for childhood socioeconomic status, adult socioeconomic status, unhealthy behaviors, smoking, and mental health problems play varying roles in attenuating or intensifying these relationships. Conclusions. Child abuse and neglect affect long-term health status—increasing risk for diabetes, lung disease, malnutrition, and vision problems—and support the need for early health care prevention. A developing scientific consensus indicates that the “origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life.” 1 (p2252) In the United States, an estimated 3.3 million children were referred to child protection service agencies for suspected maltreatment in 2009 and about 700 000 were determined to be victims. 2 Child maltreatment has been related to numerous physical health conditions, including infectious diseases, pain, hypertension, diabetes, asthma, heart disease, inflammation, obesity, and poor general health. 3–11 Researchers have also found that patients who report histories of abuse have high rates of primary care visits 12,13 and high annual health care costs. 14,15 However, the existing literature relies heavily on cross-sectional designs that cannot demonstrate that childhood adversities cause particular outcomes but only that childhood adversities are associated with certain outcomes. 16 Additionally, reliance on retrospective self-reports of childhood abuse is problematic because of problems with forgetting, reconstruction of memory, and inconsistencies in reports over time, 17–24 introducing considerable ambiguity into the meaning of the associations reported in these studies. A review of studies relating childhood trauma and physical disorders among adults in the United States demonstrated that future research needs to include “objectively measured biological data using a longitudinal design.” 25 (p509) This article presents findings from the first prospective study of documented cases of childhood physical and sexual abuse and neglect and matched controls who were followed up and administered a medical status examination (physical tests and blood collection) in middle adulthood. A variety of outcomes from this project have been described in previous articles. 26–29 We sought to determine whether children with documented histories of abuse and neglect are at increased risk for negative physical health outcomes in adulthood compared with a group of nonabused and nonneglected matched controls and to compare these maltreated children and controls in adulthood to a US sample on comparable health indicators. 30 This study offers several advantages. First, unlike most cross-sectional studies of childhood maltreatment, we used a prospective matched cohort design, thereby providing an appropriate comparison group and assessment of the correct temporal sequence of events. Second, we used measured health outcomes through a physical examination and the results of blood tests, rather than self-reports of medical problems. Third, we traced development beyond adolescence and young adulthood to middle adulthood. Fourth, the large heterogeneous sample included men and women and was varied in terms of race/ethnicity. Fifth, we examined risk for negative health consequences in victims of 3 different types of childhood maltreatment: physical abuse, sexual abuse, and neglect. Sixth, we used unambiguous definitions of child abuse and neglect. Finally, we used documented cases of childhood maltreatment to minimize potential problems with reliance on retrospective self-reports.
