Sex-specific relationships between adverse childhood experiences and chronic obstructive pulmonary disease in five states

• Published in: International journal of chronic obstructive pulmonary disease 2014-01, Vol.9 (default), p.1033-1043
• Main Authors: Cunningham, Timothy J, Ford, Earl S, Croft, Janet B, Merrick, Melissa T, Rolle, Italia V, Giles, Wayne H
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adults; Age groups; Aged; Asthma; Bronchitis; Child Abuse, Sexual; Child health; Chronic illnesses; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Cooperation; Disease sex factors; Divorce; Domestic Violence; Educational attainment; Emotional abuse; Ethnicity; Female; Health insurance; Health maintenance organizations; Hispanic people; HMOs; Households; Humans; Imprisonment; Life Change Events; Linear Models; Male; Medical research; Mental disorders; Mental Disorders - epidemiology; Middle Aged; Original Research; Population; Prevalence; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - psychology; Regression analysis; Residence Characteristics; Risk Factors; Sex crimes; Sex Factors; Smoking; Substance-Related Disorders - epidemiology; Surveillance; United States - epidemiology; Variables; Womens health; Young Adult
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S68226

Adverse childhood experiences (ACEs) before age 18 have been repeatedly associated with several chronic diseases in adulthood such as depression, heart disease, cancer, diabetes, and stroke. We examined sex-specific relationships between individual ACEs and the number of ACEs with chronic obstructive pulmonary disease (COPD) in the general population. Data from 26,546 women and 19,015 men aged ≥18 years in five states of the 2011 Behavioral Risk Factor Surveillance System were analyzed. We used log-linear regression to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals (CIs) for the relationship of eight ACEs with COPD after adjustment for age group, race/ethnicity, marital status, educational attainment, employment, asthma history, health insurance coverage, and smoking status. Some 63.8% of women and 62.2% of men reported ≥1 ACE. COPD was reported by 4.9% of women and 4.0% of men. In women, but not in men, there was a higher likelihood of COPD associated with verbal abuse (PR =1.30, 95% CI: 1.05, 1.61), sexual abuse (PR =1.69, 95% CI: 1.36, 2.10), living with a substance abusing household member (PR =1.49, 95% CI: 1.23, 1.81), witnessing domestic violence (PR =1.40, 95% CI: 1.14, 1.72), and parental separation/divorce (PR =1.47, 95% CI: 1.21, 1.80) during childhood compared to those with no individual ACEs. Reporting ≥5 ACEs (PR =2.08, 95% CI: 1.55, 2.80) compared to none was associated with a higher likelihood of COPD among women only. ACEs are related to COPD, especially among women. These findings underscore the need for further research that examines sex-specific differences and the possible mechanisms linking ACEs and COPD. This work adds to a growing body of research suggesting that ACEs may contribute to health problems later in life and suggesting a need for program and policy solutions.