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Abstract Number: 2807

Association of Exposure to Childhood Abuse with Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women

Candace H. Feldman1, Susan Malspeis2, Cianna Leatherwood1, Laura Kubzansky3, Karen Costenbader1 and Andrea Roberts4, 1Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, 2Brigham and Women's Hospital, Boston, MA, 3Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 4Harvard T.H. Chan School of Public Health, Boston, MA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: epidemiologic methods and trauma, Lupus

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Session Information

Date: Tuesday, October 23, 2018

Session Title: 5T086 ACR Abstract: Epidemiology & Pub Health III: SLE & SSc, Big Data & Large Cohorts (2802–2807)

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Prior studies demonstrated associations between post-traumatic stress disorder and increased risk of incident SLE and between childhood trauma and increased risk of hospitalization for autoimmune disease during adulthood. Severe stressors may alter immune function and result in increased inflammation and cytokine release, thereby increasing risk of SLE. We examined if childhood abuse is associated with increased risk of incident SLE.

Methods: Data are from the Nurses’ Health Study II, a longitudinal cohort of female U.S.-based nurses enrolled in 1989 followed with biennial questionnaires. To measure childhood physical and emotional maltreatment, we used the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire (CTQ), for sexual abuse, the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scales (CTS-SA), and for childhood physical assault, the Physical Assault Scale of the Conflict Tactics Scales (CTS-PA), all administered in 2001 with 75% response rate (68,505/91,268). Higher scores indicate more frequent abuse. We defined incident SLE through 2015 by self-report, confirmed by medical record review with >4 SLE ACR criteria. We excluded 1,071 women with missing childhood abuse exposure data or with self-reported, unconfirmed connective tissue disease. Multivariable Cox regression models evaluated the association (hazard ratio [HR] and 95% CI) between childhood abuse and incident SLE. We examined whether biennially assessed risk factors (e.g. smoking, BMI, alcohol use, oral contraceptive use) and potential confounders (e.g. age, race, median household income, parental education) accounted for increased SLE risk among those with vs. without childhood abuse exposure.

Results: Among 67,434 women, with a mean age of 34.6 (SD 4.8) in 1989, with >24 years of follow-up, there were 93 incident SLE cases. In age and race-adjusted models, exposure to the highest vs. lowest physical and emotional maltreatment was associated with >2-fold greater risk of SLE (HR 2.21 (95% CI 1.29-3.80)). Exposure to moderate and high levels of physical assault was associated with 1.70 (95% CI 1.08-2.68) times higher risk of SLE vs. no exposure. We did not find statistically significant associations between sexual abuse and SLE risk. After additionally accounting for potential lifestyle, reproductive and socioeconomic factors in separate models, HRs were only slightly attenuated (Table).

Conclusion: In this longitudinal cohort, we observed significantly increased risk of incident SLE among women who experienced childhood physical and emotional abuse compared with women who had not. Our findings suggest that exposure to extreme childhood stress and adversity may contribute to SLE development. Further studies are needed to investigate the role of timing and of the socioenvironmental context of abuse exposures and potential underlying mechanisms.


 

Table. Association of childhood trauma exposure with risk of incident SLE in multivariable-adjusted models (N=67,434)

Scale

SLE Cases/ Person-years

Age and race-adjusted models Hazard ratio (95% CI)

Lifestyle factor-adjusted models* Hazard ratio (95% CI)

Reproductive factor-adjusted models** Hazard ratio (95% CI)

Socioeconomic factor- adjusted models+ Hazard ratio (95% CI)

Childhood Physical and Emotional Maltreatment (CTQ)

None

22/577,387

Ref.

Ref.

Ref.

Ref.

Low

24/356,531

1.81 (1.01-3.24)

1.78 (1.00-3.19)

1.80 (1.01-3.22)

1.80 (1.01-3.23)

Medium

14/327,027

1.12 (0.57-2.19)

1.07 (0.55-2.10)

1.09 (0.56-2.13)

1.11 (0.57-2.18)

High

33/385,090

2.21 (1.29-3.80)

2.05 (1.18-3.53)

2.12 (1.23-3.65)

2.19 (1.27-3.77)

p for trend

 

p=0.01

p=0.03

p=0.02

p=0.02

Childhood Physical Assault (CTS-PA)

None

34/769,049

Ref.

Ref.

Ref.

Ref.

Low

17/333,044

1.14 (0.63-2.04)

1.11 (0.62-1.99)

1.11 (0.62-2.00)

1.14 (0.62-2.04)

Med/High

42/544762

1.70 (1.08-2.68)

1.60 (1.01-2.53)

1.63 (1.03-2.57)

1.69 (1.07-2.66)

p for trend

 

p=0.02

p=0.04

p=0.03

p=0.02

Childhood Sexual Abuse (CTS-SA)

None

60/1,097,828

Ref.

Ref.

Ref.

Ref.

Low

25/388,509

1.15 (0.72-1.84)

1.10 (0.69-1.76)

1.12 (0.79-1.79)

1.14 (0.71-1.82)

Med/High

8/160,518

0.89 (0.42-1.86)

0.79 (0.38-1.67)

0.82 (0.39-1.73)

0.87 (0.41-1.82)

p for trend

 

p=0.84

p=0.60

p=0.68

p=0.80

*Adjusted for age, race/ethnicity, smoking status (never, past, current), BMI (18.5-<25, 25-<30, 30+), cumulative alcohol use (0-<5g/day, >5g/day), exercise (0-9 mets/week, >10 mets/week)

**Adjusted for age, race/ethnicity, ever/never oral contraceptive use, menopausal status, age at menarche (<10, >10)

+Adjusted for age, race/ethnicity, parental education (<high school, some college, college+), median household income (<40K, >40K)

 


Disclosure: C. H. Feldman, None; S. Malspeis, None; C. Leatherwood, None; L. Kubzansky, None; K. Costenbader, None; A. Roberts, None.

To cite this abstract in AMA style:

Feldman CH, Malspeis S, Leatherwood C, Kubzansky L, Costenbader K, Roberts A. Association of Exposure to Childhood Abuse with Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/association-of-exposure-to-childhood-abuse-with-incident-systemic-lupus-erythematosus-in-a-longitudinal-cohort-of-women/. Accessed April 11, 2021.
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