Adverse Childhood Communication Experiences Associated With an Increased Risk of Chronic Diseases in Adults Who Are Deaf.

The present study explores adverse childhood communication experiences and its relative risks for acquiring specific chronic diseases and mental health disorders in deaf and hard of hearing adults. A cross-sectional design with snowball sampling was used to recruit deaf and hard of hearing adults who were born or became deaf in both ears prior to age 13 years. Patient-reported outcomes surveys in American Sign Language and English were disseminated to collect data about early life communication experiences with caregivers. Modified Poisson regression with robust SEs was used to calculate relative risk estimates and 95% CIs for all medical conditions with early life communication experiences as main predictors. Data collection occurred from May 2016 to July 2016, October 2016 to April 2018, and October 2018 to May 2019. The U.S. sample consisted of 1,524 adults who were born or became deaf early. After adjusting for parental hearing status and known correlates of medical conditions, poorer direct child–caregiver communication was significantly was associated with an increased risk of being diagnosed with diabetes (RRR=1.12, 95% CI=1.01, 1.24), hypertension (RRR=1.10, 95% CI=1.03, 1.17), and heart disease (RRR=1.61, 95% CI=1.39, 1.87). Poor indirect family communication/inclusion increased risks for lung diseases (RRR=1.19, 95% CI=1.07, 1.33) and depression and anxiety disorders (RRR=1.34, 95% CI=1.24, 1.44). The absolute risk increase and number needed to harm are also reported. Deaf and hard of hearing patient-reported outcomes data demonstrated that poorer direct child–caregiver communication and ongoing exclusion from incidental family communication were associated with increased risks for multiple chronic health outcomes. Practices should consider developing and utilizing an adverse childhood communication screening measure to prevent or remediate language deprivation and communication neglect in deaf and hard of hearing pediatric patients.

本研究探讨了儿童时期不良沟通经历及其在聋人和重听成年人中患特定慢性疾病和心理健康障碍的相对风险。 采用滚雪球抽样的横断面设计来招募在13岁之前双耳失聪或出生时即耳聋的聋人和重听成年人。发放了美国手语和英语的患者报告结果调查问卷，以收集有关与照顾者早期生活沟通经历的数据。采用具有稳健标准误的修正泊松回归来计算以早期生活沟通经历为主要预测因素的所有疾病状况的相对风险估计值和95%置信区间。 数据收集时间为2016年5月至2016年7月、2016年10月至2018年4月以及2018年10月至2019年5月。美国样本包括1524名早期失聪或出生时即耳聋的成年人。在对父母听力状况和已知的疾病相关因素进行调整后，儿童与照顾者之间较差的直接沟通与被诊断患有糖尿病（相对风险比=1.12，95%置信区间=1.01，1.24）、高血压（相对风险比=1.10，95%置信区间=1.03，1.17）和心脏病（相对风险比=1.61，95%置信区间=1.39，1.87）的风险增加显著相关。不良的间接家庭沟通/融入增加了患肺部疾病（相对风险比=1.19，95%置信区间=1.07，1.33）以及抑郁和焦虑障碍（相对风险比=1.34，95%置信区间=1.24，1.44）的风险。还报告了绝对风险增加和需治疗人数。 聋人和重听患者报告的结果数据表明，儿童与照顾者之间较差的直接沟通以及持续被排除在家庭偶然沟通之外，与多种慢性健康问题的风险增加有关。医疗机构应考虑开发和使用一种儿童时期不良沟通筛查措施，以预防或纠正聋人和重听儿科患者的语言剥夺和沟通忽视问题。