Background/Purpose: We and others have previously reported that post-traumatic stress disorder (PTSD) is associated with increased risk of developing SLE. We aimed to investigate the relationship between physical and sexual abuse as a child and future risk of developing SLE among African American women.

Methods: We examined whether there was an association between self-reported physical and sexual abuse in childhood and SLE risk in a large nationwide prospective cohort of African American women, the Black Women’s Health Study (59,000 women enrolled in 1995 and followed through 2017). Nine childhood abuse questions (from Conflict Tactics Scale, Straus MA, 1979 and Pregnancy Abuse Assessment Screen, McFarlane J, 1992) were asked on the 2005 questionnaire. Types of physical and sexual child abuse were described and response categories were, never, 1-3 times or ≥ 4 times (for questions not answered, we considered responses to be ‘never’). Covariate data, mainly concerning childhood exposures, were obtained from baseline and biennial questionnaires. Incident SLE was identified by self-report and verified by medical record review for 1997 Updated ACR Criteria. We used Cox regression models to estimate HRs and 95%CIs for SLE risk related to several types of past physical and sexual abuse, adjusting for potential confounders.

Results: Of the 36,153 women who answered the child abuse questions, mean age at study baseline was 39.2 years (10.6 SD), 14% were current smokers, and mean BMI was 27.9 (6.6 SD). During 670,841 person-years of follow-up, we identified 102 incident SLE cases with self-reported data on childhood physical and sexual abuse. Compared to women who denied any abuse, those who reported frequent severe abuse, including being choked, burned, physically attacked, having genitals exposed to them or having sexual relations, all occurring ≥ 4 times, experienced increased risk of SLE as an adult (HRs 2.3-3.7)(Table).

Conclusion: Childhood physical and sexual abuse, in particular severe and frequent abuse, were associated with increased risk of developing SLE among adult African American women. While these results are based on small numbers and there is a potential for recall bias, they are thought-provoking and need to be pursued and verified. The biologic mechanisms underlying this association are not well understood, but could involve dysregulation of the hypothalamic-pituitary axis and stress hormones in PTSD, or stimulation of inflammatory cytokines.