Experiências adversas na infância e capacidade física no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

Abstract

The aim of this study was to investigate associations of an exposure score and also of specific aspects of adverse childhood experiences (ACEs) with physical capability in adulthood, in a Brazilian context. Data from the third visit of the Longitudinal Study of Adult Health (ELSA-Brasil), carried out between 2017 and 2019, were used. A total of 10,896 Brazilian civil servants, active and retired, aged between 41 and 84 years, and who had available data on physical capability and exposure to ACEs, were included. Physical capability was measured using the Short Physical Performance Battery (SPPB), whose final score ranges from 0 to 12. This score was transformed into a nominal variable with two categories: low physical capability (≤7 points) and high physical capability (≥8 points). The investigation of exposure to ACEs was carried out using five questions from the International Questionnaire of Adverse Childhood Experiences and two questions developed by ELSA-Brasil researchers which, together, assessed exposure to family dysfunction (separation or divorce of parents; death of parents or guardians; having lived with a family member who abused alcohol and/or drugs and/or medication, who had depression or another mental illness, and who had been arrested or condemned) and to child labor in the first fourteen years of life. Exposures were analyzed using a four-level score, relative to the number of reported exposures: no exposure (score=0), exposure to one type of ACE (score=1), exposure to two types (score=2) and exposure to three or more types (score≥3); and separately. Descriptive analyzes and binary logistic regressions were performed, adjusted for possible confounding factors: age, sex, race/skin color, maternal and paternal education. The mean age of participants was 59.2 years (SD=8.71) and 55.1% were female. Exposure to at least one type of ACE was reported by 42.2% of the population and low physical capability was observed in 28% of participants. Individuals exposed to one type of ACE (OR=1.18; 95%CI=1.07;1.32), two types (OR=1.19; 95%CI=1.02;1.39) and three or more types (OR=1.36; 95%CI=1.05;1.75) had more chances of low physical capability when compared to unexposed individuals. Specifically, having lived with family members who had been arrested or condemned (OR=1.43; 95%CI=1.02;1.99), death of parents or guardians (OR=1.22; 95%CI=1.05;1.41) and separation or divorce of parents (OR=1.17; 95%CI=1.01;1.36) were associated with low physical capability regardless of confounding factors. The evidence from this investigation points to a possible negative effect of ACEs on the physical capability of adulthood, highlighting the need for actions to prevent these exposures and their damage.