Increased Cardiometabolic and Mortality Risk Following Childhood Maltreatment in the United Kingdom.
Increased Cardiometabolic and Mortality Risk Following Childhood Maltreatment in the United Kingdom.
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DOI：
10.1161/jaha.119.015855
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发表时间：
2020-05-18
影响因子：
5.4
通讯作者：
Nirantharakumar K
中科院分区：
文献类型：
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作者：
Chandan JS;Okoth K;Gokhale KM;Bandyopadhyay S;Taylor J;Nirantharakumar K
儿童虐待仍然是一个重大的公共卫生问题，与若干不良健康结果有关。本研究探讨了儿童虐待与随后发生的心脏代谢疾病和全因死亡率之间的关系。使用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，我们进行了一项基于人群的开放式回顾性队列研究。我们将80657名有儿童虐待或虐待相关问题历史记录的成年患者（暴露组）与16314名未暴露的患者进行匹配。关注的结局是心血管疾病、高血压、2型糖尿病的发展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），而未暴露组为254例（发病率为4.6 / 10000人-年）。对关键协变量进行调整后，调整后的发病率比为1.71 （95% CI 1.42-2.06）。此外，与未暴露组相比，暴露组在研究期间发生高血压（校正发病率比1.42,95% CI为1.26-1.59）、2型糖尿病（校正发病率比2.13,95% CI为1.86-2.45）和全因死亡率（校正发病率比1.75,95% CI为1.52-2.02）的风险增加。考虑到儿童遭受虐待的高患病率，我们已经证明了可预防的心脏代谢疾病的实质性相关负担。显然有必要确保实施公共卫生措施，以防止儿童遭受虐待后的不良后果。
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. 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. 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.