A nested case-control study evaluating the relationship between adverse childhood experiences and immune-mediated inflammatory disease in the Canadian Longitudinal Study on Aging

Abstract

Objective 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.Design Nested retrospective case-control study.Setting We used data from the Canadian Longitudinal Study on Aging (CLSA), which recruited participants aged 45–85 years between 2010 and 2015.Participants 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.Primary and secondary outcome measures 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.Results 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.Conclusion 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.