title: Measuring Childhood Adversity in Life Course Cardiovascular Research: A Systematic Review.
abstract: OBJECTIVE
  Identifying the life course health effects of childhood adversity is a burgeoning area of research, particularly in relation to cardiovascular disease (CVD). However, adversity measurement varies widely across studies, which may hamper our ability to make comparisons across studies and identify mechanisms linking adversity to CVD. The purposes of this review are to summarize adversity measurement approaches in the context of CVD, identify gaps, and make recommendations for future research.
  
  
  METHODS
  PubMed and PsycINFO searches were conducted through June 2016. Studies were selected if CVD end point or predisease risk markers were investigated in association with a measure of childhood adversity. Forty-three studies were reviewed. A meta-analysis was not conducted because of the variation in exposures and outcomes assessed.
  
  
  RESULTS
  Adversity measurement was heterogeneous across studies. Metrics included different sets of adverse events, relational factors, and socioeconomic indicators. Thirty-seven percent measured childhood adversity prospectively, 23% examined a CVD end point, and 77% treated adversity as an unweighted summary score. Despite the heterogeneity in measurement, most studies found a positive association between childhood adversity and CVD risk, and the association seems to be dose-response.
  
  
  CONCLUSIONS
  The literature on childhood adversity and CVD would benefit from improving consistency of measurement, using weighted adversity composites, modeling adversity trajectories over time, and considering socioeconomic status as an antecedent factor instead of a component part of an adversity score. We suggest conceptual and analytic strategies to enhance, refine, and replicate the observed association between childhood adversity and CVD risk.
authors.affiliation: From the Department of Epidemiology and Biostatistics (Appleton, Ryan, Tracy), University at Albany School of Public Health, Rensselaer; and Department of Anthropology (Holdsworth), University at Albany, College of Arts and Sciences, Albany, New York.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Appleton
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holdsworth
authors.forename: Margaret
authors.initials: M
authors.lastname: Ryan
authors.forename: Melissa
authors.initials: M
authors.lastname: Tracy
mesh_terms: D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology*; D035843:Biomedical Research / Q000379:methods*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000523:psychology; D006801:Humans; D012307:Risk Factors