The risk of immune-mediated inflammatory diseases following exposure to childhood maltreatment: A retrospective cohort study using UK primary care data
Liam Snook,
Sonica Minhas,
Vrinda Nadda,
Ben Hammond,
Krishna M. Gokhale,
Julie Taylor,
Caroline Bradbury-Jones,
Siddhartha Bandyopadhyay,
Krishnarajah Nirantharakumar,
Nicola J. Adderley,
Joht Singh Chandan
Affiliations
Liam Snook
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK
Sonica Minhas
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK
Vrinda Nadda
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E12AD, UK
Ben Hammond
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK
Krishna M. Gokhale
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK
Julie Taylor
School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK
Caroline Bradbury-Jones
School of Nursing and Midwifery, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK
Siddhartha Bandyopadhyay
Department for Economics, University of Birmingham, B152TT, UK
Krishnarajah Nirantharakumar
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK
Nicola J. Adderley
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK
Joht Singh Chandan
Department of Applied Health Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK; Birmingham Health Partners, UK; Corresponding author. Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham,B152TT, UK.
Background: As a global public health issue, childhood maltreatment is associated with significant morbidity and mortality. We aimed to investigate the association between childhood maltreatment and immune-mediated inflammatory disorders (IMIDs). Methods: We conducted a retrospective matched open cohort study using a UK primary care database between January 1, 1995 and January 31, 2021. Clinical codes were used to identify patients exposed to childhood maltreatment who were matched by general practice (GP), age, and sex to up to four unexposed patients. Cox regression analysis was used to evaluate the risk of developing IMIDs (inflammatory bowel disease, coeliac disease, rheumatoid arthritis, psoriasis, multiple sclerosis, systemic lupus erythematosus) during follow-up in the exposed versus unexposed groups. Results: 256,130 exposed patients were matched to 712,478 unexposed patients. Those exposed to childhood maltreatment were 1) at an increased risk of developing Rheumatoid arthritis (aHR 1·39; 95 % CI 1·12-1·74) and Psoriasis (aHR 1·16; 95 % CI 1·10-1·23), 2) not statistically significantly at risk of developing inflammatory bowel disease (aHR 0·87; 95 % CI 0·75-1·00), multiple sclerosis (aHR 1·07; 95 % CI 0·77-1·49) and systemic lupus erythematosus (aHR 1·28; 95 % CI 0·89-1·85) and 3) at a reduced risk of coeliac disease (aHR 0·74; 95 % CI 0·62-0·88) compared to the unexposed group. Interpretations: Childhood maltreatment is estimated to affect one in three children globally; therefore, an increased risk of developing rheumatoid arthritis and psoriasis represents a substantial contribution to the burden of IMIDs. Implementation of broad public health approaches to prevent and detect childhood maltreatment and its negative downstream consequences, such as, IMID development, is essential.
