Adverse childhood experiences and incident coronary heart disease: a counterfactual analysis in the Whitehall II prospective cohort study
| Autor: | Andrew Steptoe, Carlos A. Valencia-Hernández, Mifuyu Akasaki, Owen Nicholas, Jessica Abell, Rebecca Hardy |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Counterfactual thinking
Pediatrics medicine.medical_specialty business.industry Incidence (epidemiology) Hazard ratio General Medicine Parental Death Confidence interval Original Research Contribution RC666-701 Counterfactual analysis medicine Diseases of the circulatory (Cardiovascular) system Prospective longitudinal study Adverse childhood experiences Public aspects of medicine RA1-1270 business Prospective cohort study Adverse Childhood Experiences Incident coronary heart disease Cohort study |
| Zdroj: | American Journal of Preventive Cardiology American Journal of Preventive Cardiology, Vol 7, Iss, Pp 100220-(2021) |
| ISSN: | 2666-6677 |
| Popis: | Objectives Adverse childhood experience is thought to be associated with risk of coronary heart disease, but it is not clear which experiences are cardiotoxic, and whether risk increases with the accumulation of adverse childhood experiences. Methods Participants were 5149 adults (72.6% men) in the Whitehall II cohort study. Parental death was recorded at phase 1 (median age in years 44.3), and 13 other adverse childhood experiences at phase 5 (55.3). We applied Cox proportional hazards regression with person-time from phase 5 to examine associations of adverse childhood experiences with incident coronary heart disease. We predicted hazard ratios according to count of the experiences, and examined dose-response effect. We finally estimated reduction of coronary heart disease in a hypothetical scenario, the absence of adverse childhood experiences. Results Among study participants, 62.9% had at least one adversity, with “financial problems” having the highest prevalence (26.1%). There were 509 first episodes of coronary heart disease during an average 12.9 years follow-up. Among 14 adverse childhood experiences in a multiply adjusted model, “parental unemployment” showed the highest hazard of coronary heart disease incidence (hazard ratio; 95% confidence interval: 1.53; 1.16 to 2.02). No dose-response effect was observed (constant for proportionality in hazard ratio: 1.05, 0.99 to 1.11). Based on the estimates of final model, in the absence of childhood adversities, we estimated a 6.0% reduction in coronary heart disease (0.94; 0.87 to 1.01), but the confidence interval includes one. Conclusion Although individual adverse childhood experiences show some association with coronary heart disease, there is no clear relationship with the number of adverse experiences. Further research is required to quantify effects of multiple and combinations of adverse childhood experiences considering timing, duration, and severity. |
| Databáze: | OpenAIRE |
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