Adverse childhood experiences and multimorbidity of internalising and cardiometabolic conditions in mid to older age

Background Multimorbidity of internalising and cardiometabolic conditions (ICM-MM) is the most common combination of mental and physical health conditions in older age. Few studies have examined the likelihood that individuals with adverse childhood experiences (ACEs) such as abuse or neglect will develop ICM-MM in mid to late adulthood, or gender disparities.

UK Biobank participants (n = 157,184, mean age 55.94, SD= 7.74; 68186 males and 88998 females) reported on ACEs as well as sociodemographic and lifestyle factors. Diagnoses of internalising conditions (depression and anxiety) and cardiometabolic conditions (hypertension, obesity, type 2 diabetes, dyslipidaemia and chronic kidney disease) were obtained through linked electronic healthcare records. Logistic regression models tested associations between ACEs and internalising conditions, cardiometabolic conditions and ICM-MM, accounting for gender differences and sociodemographic and lifestyle factors.

ACEs were associated with all individual and multimorbid presentations. Stronger associations were found with internalising conditions (OR 1.84) and ICM-MM (OR range 1.73-2.15) than cardiometabolic conditions (OR range 1.08-1.44). Females were more likely to report most ACEs, but health risks following ACEs were similar for both genders. The associations remained when accounting for sociodemographic and lifestyle factors, including gender, age, socioeconomic status, ethnicity, diet, alcohol intake, smoking status and physical activity levels.

This is the first study to report associations between ACEs and the most common type of physical and mental health multimorbidity in mid to late adulthood. The results highlight the importance of early ACE intervention and trauma-informed healthcare. Competing Interest Statement Michael J. Owen reports grants from Akrivia Health and Takeda Pharmaceuticals outside the submitted work. Funding Statement This work was funded by a PhD studentship to LKB from Health and Care Research Wales (MvdB; PH, MJO, FR, MMW; HS 22 04) and the Tackling Multimorbidity at Scale Strategic Priorities Fund programme (MvdB, PH, MJO, MMW, RP; MR/W014416/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced are available online at https://www.ukbiobank.ac.uk/use-our-data/