Sex-specific relationships between adverse childhood experiences and chronic obstructive pulmonary disease in five states

Abstract

PurposeAdverse childhood experiences (ACEs) before age 18 have been repeatedly associated with several chronic diseases in adulthood such as depression, heart disease, cancer, diabetes, and stroke. We examined sex-specific relationships between individual ACEs and the number of ACEs with chronic obstructive pulmonary disease (COPD) in the general population.Materials and methodsData from 26,546 women and 19,015 men aged ≥18 years in five states of the 2011 Behavioral Risk Factor Surveillance System were analyzed. We used log-linear regression to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals (CIs) for the relationship of eight ACEs with COPD after adjustment for age group, race/ethnicity, marital status, educational attainment, employment, asthma history, health insurance coverage, and smoking status.ResultsSome 63.8% of women and 62.2% of men reported ≥1 ACE. COPD was reported by 4.9% of women and 4.0% of men. In women, but not in men, there was a higher likelihood of COPD associated with verbal abuse (PR =1.30, 95% CI: 1.05, 1.61), sexual abuse (PR =1.69, 95% CI: 1.36, 2.10), living with a substance abusing household member (PR =1.49, 95% CI: 1.23, 1.81), witnessing domestic violence (PR =1.40, 95% CI: 1.14, 1.72), and parental separation/divorce (PR =1.47, 95% CI: 1.21, 1.80) during childhood compared to those with no individual ACEs. Reporting ≥5 ACEs (PR =2.08, 95% CI: 1.55, 2.80) compared to none was associated with a higher likelihood of COPD among women only.ConclusionACEs are related to COPD, especially among women. These findings underscore the need for further research that examines sex-specific differences and the possible mechanisms linking ACEs and COPD. This work adds to a growing body of research suggesting that ACEs may contribute to health problems later in life and suggesting a need for program and policy solutions.

Childhood maltreatment as a risk factor for COPD: findings from a population-based survey of Canadian adults

“…Our findings are for the most part consistent with three other studies that examined associations between CM and COPD based on samples from the American population 7,13,14. Using data from 3,000 respondents to the Wisconsin Longitudinal Study, Springer7 found a significant association between CPA and bronchitis/emphysema in adulthood; however, the association did not remain when controlling for mental health and smoking status.…”

“…Many of our findings are similar to those of Cunningham et al14 who examined associations between several childhood adversities, including CPA, CSA, and CEIPV, and COPD using a large sample (n=46,000) of the general population in five American states. Consistent with our results, in the fully adjusted models controlling for sociodemographic variables and smoking status, they found that among females there was a higher likelihood of COPD in adulthood for those who reported CSA and CEIPV, and similar to our findings the association between CPA and COPD did not attain statistical significance.…”

“…In addition, unlike previous studies,7,13,14 we considered severity and frequency for the specific types of maltreatment. The CM items are behavior specific and thus are likely to have higher validity and reliability than broad and subjectively defined questions 43–46.…”

“…The extensive array of variables collected in the 2012 CCHS-MH made it possible to control for the potentially confounding effects of sociodemographic factors and to examine the mediating effects of smoking status (including smoking intensity and years since quitting) as well as mental and substance use disorders when examining associations between CM and COPD. Previous studies have used more simplistic controls for smoking status (ie, current smoker/former smoker) 7,13,14. This would tend to underestimate the importance of the mediation role of smoking in the association between CM and COPD since heavy smoking and persistent smoking15,16,18 elevate the risk of COPD 19,20…”

“…Childhood adversities (including childhood maltreatment [CM]) are related to various physical chronic conditions in adulthood 8–12. Although associations between CM and COPD have rarely been studied, recent research provides evidence of a possible link 7,13,14…”