Institute of Applied Health Research College of Medical and Dental Sciences University of Birmingham United Kingdom.
Warwick Medical School University of Warwick Coventry United Kingdom.
J Am Heart Assoc. 2020 Feb 18;9(4):e014580. doi: 10.1161/JAHA.119.014580. Epub 2020 Feb 17.
Background Domestic abuse (DA) against women is a global public health problem. Although the possible health burden could be substantial, the associations between DA and subsequent cardiometabolic disease (cardiovascular disease, hypertension, and type 2 diabetes mellitus) and all-cause mortality are poorly understood. Methods and Results This retrospective cohort study consisted of UK-based primary care patients between January 1, 1995, to December 1, 2017. Overall, 18 547 women exposed to DA were matched to 72 231 unexposed women by age and lifestyle factors. The main outcomes, presented as adjusted incidence rate ratios (IRRs), were the risk of developing cardiovascular disease, hypertension, type 2 diabetes mellitus, and all-cause mortality. In total, 181 exposed women experienced a cardiovascular disease event compared with 644 of the unexposed control group, relating to an increased adjusted IRR of 1.31 (95% CI, 1.11-1.55; =0.001). There was also an increased risk of subsequent type 2 diabetes mellitus (adjusted IRR: 1.51; 95% CI, 1.30-1.76; <0.001) and all-cause mortality (adjusted IRR: 1.44; 95% CI, 1.24-1.67; <0.001) following exposure to DA. This observation was not seen with hypertension (adjusted IRR: 0.99; 95% CI, 0.88-1.12; =0.873). Conclusions There is an increased risk of subsequent cardiovascular disease, type 2 diabetes mellitus, and all-cause mortality in female survivors of DA. However, there is no association with the development of hypertension in this group, in keeping with previous literature. Considering the high prevalence of DA, clinicians should be made aware of the disproportionally increased risk and thus are encouraged to manage modifiable risk factors actively in this group.
针对女性的家庭暴力（DA）是一个全球性的公共卫生问题。尽管可能造成的健康负担相当大，但 DA 与随后发生的心血管疾病（心血管疾病、高血压和 2 型糖尿病）和全因死亡率之间的关联仍知之甚少。
本回顾性队列研究纳入了 1995 年 1 月 1 日至 2017 年 12 月 1 日期间英国的初级保健患者。共有 18547 名暴露于 DA 的女性按年龄和生活方式因素与 72231 名未暴露于 DA 的女性进行匹配。主要结局以调整后的发病率比（IRR）呈现，为发生心血管疾病、高血压、2 型糖尿病和全因死亡率的风险。共有 181 名暴露于 DA 的女性发生了心血管疾病事件，而未暴露于 DA 的对照组中有 644 名发生了心血管疾病事件，这表明调整后的 IRR 为 1.31（95%CI，1.11-1.55；=0.001）。暴露于 DA 后，发生 2 型糖尿病（调整后的 IRR：1.51；95%CI，1.30-1.76；<0.001）和全因死亡率（调整后的 IRR：1.44；95%CI，1.24-1.67；<0.001）的风险也增加。但这一观察结果在高血压（调整后的 IRR：0.99；95%CI，0.88-1.12；=0.873）中并未出现。
DA 女性幸存者随后发生心血管疾病、2 型糖尿病和全因死亡率的风险增加。然而，在这组人群中，与高血压的发展没有关联，这与之前的文献一致。考虑到 DA 的高患病率，临床医生应该意识到这一群体中不成比例的风险增加，因此鼓励他们积极管理这一组人群的可改变的风险因素。
