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 May 18;9(10):e015855. doi: 10.1161/JAHA.119.015855. Epub 2020 May 15.
Background Childhood maltreatment remains a significant public health issue associated with a number of poor health outcomes. This study explores the association between childhood maltreatment and the subsequent development of cardiometabolic disease and all-cause mortality. Methods and Results Using a UK primary care database between January 1, 1995 and December 31, 2018, we conducted a population-based open retrospective cohort study. We matched 80 657 adult patients with a historic recording of childhood maltreatment or maltreatment-related concerns (exposed group) to 161 314 unexposed patients. Outcomes of interest were the development of cardiovascular disease, hypertension, type 2 diabetes mellitus, and risk of all-cause mortality. During the study period there were 243 new diagnoses of cardiovascular disease (incidence rate 8.3 per 10 000 person-years) in the exposed group compared with 254 in the unexposed group (incidence rate 4.6 per 10 000 person-years). Following adjustment for key covariates, this translated to an adjusted incidence rate ratio of 1.71 (95% CI 1.42-2.06). Additionally, the exposed group had an increased risk of hypertension (adjusted incidence rate ratio 1.42; 95% CI, 1.26-1.59), type 2 diabetes mellitus (adjusted incidence rate ratio 2.13; 95% CI, 1.86-2.45) and all-cause mortality (adjusted incidence rate ratio 1.75; 95% CI, 1.52-2.02) during the study period compared with the unexposed group. Conclusions Considering the high prevalence of exposure to childhood maltreatment, we have demonstrated the substantial associated burden of preventable cardiometabolic disease. There is a clear need to ensure that public health approaches are implemented to prevent the adverse consequences following exposure to childhood maltreatment.
儿童期虐待仍然是一个严重的公共卫生问题，与许多不良健康结果有关。本研究探讨了儿童期虐待与随后发生的心血管代谢疾病和全因死亡率之间的关系。
我们使用了 1995 年 1 月 1 日至 2018 年 12 月 31 日期间的英国初级保健数据库，进行了一项基于人群的回顾性开放性队列研究。我们将 80657 名有儿童期虐待或与虐待相关问题的成年患者（暴露组）与 161314 名未暴露患者进行了匹配。感兴趣的结局是心血管疾病、高血压、2 型糖尿病的发生和全因死亡率的风险。在研究期间，暴露组有 243 例新诊断的心血管疾病（发病率为 8.3/10000 人年），而未暴露组有 254 例（发病率为 4.6/10000 人年）。在校正了关键协变量后，这转化为调整后的发病率比 1.71（95%CI 1.42-2.06）。此外，与未暴露组相比，暴露组发生高血压（调整后的发病率比 1.42；95%CI，1.26-1.59）、2 型糖尿病（调整后的发病率比 2.13；95%CI，1.86-2.45）和全因死亡率（调整后的发病率比 1.75；95%CI，1.52-2.02）的风险增加。
鉴于儿童期虐待的高暴露率，我们已经证明了可预防的心血管代谢疾病的负担很大。显然需要确保实施公共卫生措施，以防止儿童期虐待暴露后的不良后果。
