O'Mahony Julia, Bernstein Charles N, Marrie Ruth Ann
Mellen Center, Cleveland Clinic, Cleveland, Ohio, USA
Department of Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada.
BMJ Open. 2025 Jan 20;15(1):e087133. doi: 10.1136/bmjopen-2024-087133.
Adverse childhood experiences (ACE) have inconsistently been implicated as risk factors for immune-mediated inflammatory diseases (IMID). We evaluated whether the association of ACE with disease differs between IMID and other chronic diseases.
Nested retrospective case-control study.
We used data from the Canadian Longitudinal Study on Aging (CLSA), which recruited participants aged 45-85 years between 2010 and 2015.
We included 12 627 CLSA participants: 2 102 who reported diagnoses of IMID (258 multiple sclerosis (MS), 1 692 rheumatoid arthritis (RA) and 160 inflammatory bowel disease (IBD)), 5 519 with diabetes, 170 with epilepsy, 3 889 with asthma and 1 125 with no chronic diseases. ACE, including childhood maltreatment (physical, emotional and sexual abuse, neglect) and household dysfunction, were queried using questions from the Childhood Experiences of Violence Questionnaire-Short Form and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire.
We first evaluated whether the association of maltreatment differed across diagnoses (IMID, diabetes, asthma, epilepsy, no chronic diseases). Second, we evaluated whether the association between maltreatment differed across IMID. We repeated our analyses for different types of ACE.
Maltreatment or household dysfunction was experienced by 64% of participants and 30% experienced both. On multivariable analysis, history of any maltreatment, sexual abuse, any household dysfunction and having ≥3 types of ACE were all associated with increased risk of IMID compared with no chronic disease. The association between ACE and IMID did not differ across MS, RA and IBD.
ACE are common among Canadians with and without chronic diseases. History of any maltreatment or household dysfunction is associated with increased risk of chronic disease.
童年不良经历（ACE）一直被认为是免疫介导的炎症性疾病（IMID）的风险因素，但相关研究结果并不一致。我们评估了ACE与疾病的关联在IMID和其他慢性疾病之间是否存在差异。
嵌套式回顾性病例对照研究。
我们使用了加拿大老龄化纵向研究（CLSA）的数据，该研究在2010年至2015年期间招募了45 - 85岁的参与者。
我们纳入了12627名CLSA参与者：2102名报告患有IMID的参与者（258名多发性硬化症（MS）、1692名类风湿性关节炎（RA）和160名炎症性肠病（IBD））、5519名患有糖尿病的参与者、170名患有癫痫的参与者、3889名患有哮喘的参与者以及1125名无慢性疾病的参与者。使用暴力童年经历问卷简表和青少年到成人健康纵向研究第三波问卷中的问题来询问ACE，包括童年虐待（身体、情感和性虐待、忽视）和家庭功能障碍。
我们首先评估了虐待与不同诊断（IMID、糖尿病、哮喘、癫痫、无慢性疾病）之间的关联是否存在差异。其次，我们评估了虐待与不同IMID之间的关联是否存在差异。我们针对不同类型的ACE重复了分析。
64%的参与者经历过虐待或家庭功能障碍，30%的参与者两者都经历过。在多变量分析中，与无慢性疾病相比，任何虐待史、性虐待、任何家庭功能障碍以及有≥3种类型的ACE均与IMID风险增加相关。ACE与IMID之间的关联在MS、RA和IBD之间没有差异。
ACE在患有和未患有慢性疾病的加拿大人中都很常见。任何虐待史或家庭功能障碍都与慢性疾病风险增加相关。
