Wang Yue, Ge Fenfen, Aspelund Thor, Ask Helga, Hauksdóttir Arna, Hu Kejia, Jakobsdóttir Jóhanna, Zoega Helga, Shen Qing, Whalley Heather C, Pedersen Ole Birger Vesterager, Lehto Kelli, Andreassen Ole A, Fang Fang, Song Huan, Valdimarsdóttir Unnur A
Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
BMC Med. 2024 Aug 7;22(1):319. doi: 10.1186/s12916-024-03399-8.
Childhood maltreatment (CM) has been indicated in adverse health outcomes across the lifespan, including severe infection-related outcomes. Yet, data are scarce on the potential role of CM in severe COVID-19-related outcomes as well as on mechanisms underlying this association.
We included 151,427 individuals in the UK Biobank who responded to questions on the history of CM in 2016 and 2017 and were alive on January 31, 2020. Binomial logistic regression models were performed to estimate the association between a history of CM and severe COVID-19 outcomes (i.e. hospitalization or death due to COVID-19), as well as COVID-19 diagnosis and vaccination as secondary outcomes. We then explored the potential mediating roles of socio-economic status, lifestyle and pre-pandemic comorbidities, and the effect modification by polygenic risk score for severe COVID-19 outcomes.
The mean age of the study population at the start of the pandemic was 67.7 (SD = 7.72) years, and 56.5% were female. We found the number of CM types was associated with the risk of severe COVID-19 outcomes in a graded manner (p < 0.01). Compared to individuals with no history of CM, individuals exposed to any CM were more likely to be hospitalized or die due to COVID-19 (odds ratio [OR] = 1.54 [95%CI 1.31-1.81]), particularly after physical neglect (2.04 [1.57-2.62]). Largely comparable risk patterns were observed across groups of high vs. low genetic risks for severe COVID-19 outcomes (p > 0.05). Mediation analysis revealed that 50.9% of the association between CM and severe COVID-19 outcomes was explained by suboptimal socio-economic status, lifestyle, and pre-pandemic diagnosis of psychiatric disorders or other chronic medical conditions. In contrast, any CM exposure was only weakly associated with COVID-19 diagnosis (1.06 [1.01-1.12]) while significantly associated with not being vaccinated for COVID-19 (1.21 [1.13-1.29]).
Our results add to the growing knowledge base indicating the role of childhood maltreatment in negative health outcomes across the lifespan, including severe COVID-19-related outcomes. The identified factors underlying this association represent potential intervention targets for mitigating the harmful effects of childhood maltreatment in COVID-19 and similar future pandemics.
儿童期虐待（CM）已被证明会对一生的健康产生不良影响，包括与严重感染相关的后果。然而，关于CM在严重的2019冠状病毒病（COVID-19）相关后果中的潜在作用以及这种关联背后的机制的数据却很少。
我们纳入了英国生物银行中的151427名个体，他们在2016年和2017年回答了有关CM病史的问题，并在2020年1月31日仍然存活。采用二项逻辑回归模型来估计CM病史与严重COVID-19后果（即因COVID-19住院或死亡）之间的关联，以及将COVID-19诊断和疫苗接种作为次要结果。然后，我们探讨了社会经济地位、生活方式和大流行前的合并症的潜在中介作用，以及多基因风险评分对严重COVID-19后果的效应修正。
大流行开始时研究人群的平均年龄为67.7（标准差=7.72）岁，56.5%为女性。我们发现CM类型的数量与严重COVID-19后果的风险呈分级关联（p<0.01）。与没有CM病史的个体相比，经历过任何CM的个体因COVID-19住院或死亡的可能性更高（优势比[OR]=1.54[95%置信区间1.31-1.81]），尤其是在身体忽视之后（2.04[1.57-2.62]）。在严重COVID-19后果的高遗传风险组和低遗传风险组中观察到了大致相似的风险模式（p>0.05）。中介分析表明，CM与严重COVID-19后果之间50.9%的关联可由次优的社会经济地位、生活方式以及大流行前的精神疾病或其他慢性疾病诊断来解释。相比之下，任何CM暴露与COVID-19诊断仅有微弱关联（1.06[1.01-1.12]），而与未接种COVID-19疫苗显著相关（1.21[1.13-1.2]）。
我们的结果进一步丰富了知识体系，表明儿童期虐待在一生的负面健康后果中发挥作用，包括与严重COVID-19相关的后果。这种关联中确定的因素代表了潜在的干预靶点，以减轻儿童期虐待在COVID-19及未来类似大流行中的有害影响。
