Date of Award

1-1-2023

Language

English

Document Type

Master's Thesis

Degree Name

Master of Science (MS)

College/School/Department

Department of Epidemiology and Biostatistics

Content Description

1 online resource (v, 29 pages)

Dissertation/Thesis Chair

Allison Appleton

Committee Members

Akiko Hosler

Keywords

Adverse childhood experiences, Asthma, Cardiometabolic health, Depression, Hepatitis C, Multiple morbidity, Metabolism, Heart

Subject Categories

Epidemiology

Abstract

ACEs stands for Adverse Childhood Experiences, which are traumatic or stressful events that occur in childhood before the age of 18 (Wisner, 2022). These experiences can include physical, emotional, or sexual abuse; neglect; household dysfunction, such as parental separation, domestic violence, substance abuse, or incarceration; or exposure to community violence, racism, or discrimination. Research has shown that individuals who experience ACEs are at a higher risk for developing chronic diseases such as heart disease, diabetes, cancer, and mental health disorders later in life (Felitti, 2002). This is because ACEs can cause toxic stress, which is chronic activation of the stress response system in the absence of protective buffering from supportive relationships (Shonkoff et al. 2012). This can lead to changes in brain development, immune function, and hormonal systems, which in turn can increase the risk of chronic diseases. Several studies have demonstrated that ACEs are associated with cardiometabolic outcomes in adulthood (Danese & Tan, 2020). However, the potential moderating role of co-morbid conditions in the association between ACEs and cardiometabolic outcomes have not yet been considered. The present study hypothesized that childhood adversity would be associated with an increased risk of cardiometabolic outcomes, and that association would be stronger among those with other health prevalent conditions, including asthma, hepatitis C, infection, and depression. The hypotheses were tested using a subset of the data 2020 Behavioral Risk Factor Surveillance System (BRFSS) (n=5846), which was collected over telephone surveys from adults in the United States aged 18 and above. Multivariate logistic regression results showed that childhood adversity was significantly associated with cardiometabolic outcomes controlled for gender, age, race and education. In particular having 1-3 ACEs compared to no events increases the odds of cardiometabolic diseases by 1.05(95 % CI 0.916,1.205). Also, we see that presence of 4 or more ACEs compared to no events increases the odds of CVD by 1.597(95 %CI 1.317,1.937) times. Stratified logistic models also showed increased odds of having cardiometabolic disease according to ACEs among those with asthma, hepatitis C or multiple morbidity compared to those with no such diseases. The odds ratio for the 4 or more ACE category is 1.378 (95% CI = 0.936 to 2.028) in the depression group, while it is only 1.196 (95% CI = 0.933 to 1.532) in the no depression group. Similarly, the odds ratio for the 4 or more ACE category is 2.626 (95% CI = 1.631 to 4.226) in the asthma group, while it is only 1.292 (95% CI = 1.036 to 1.610) in the no asthma group. Also, the odds ratio for the 4 or more ACE category is 5.407 (95% CI = 1.044 to 28.004) in the hepatitis C group, while it is only 1.512 (95% CI = 1.243 to 1.841) in the no hepatitis C group. The multiple morbidity group showed no significant association between the two groups. Overall, the findings of this study provide further evidence for the long-term impact of childhood adversity on cardiometabolic outcomes in adulthood and suggest that individuals with co-morbid health conditions may be particularly vulnerable to these effects. These results underscore the importance of early identification and intervention to address the negative health consequences of ACEs and highlight the need for integrated care approaches that address both physical and mental health needs.

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