Background/Purpose: Early life trauma (ELT) and neighborhood deprivation (ND)—a measure of socioeconomic position (SEP)—represent two aspects of the early life social environment that can be internalized to negatively affect downstream health via dysregulation of stress response mechanisms and contributing to immune dysfunction and activation of inflammatory processes. Experienced psychosocial stress and low SEP in adulthood has been associated with increased systemic lupus erythematosus (SLE) risk, but the impact of early life trauma and neighborhood deprivation on adult SLE risk is not known.

Methods: We use data from 23,839 eligible participants in The Sister Study, a prospective cohort of US self-identified females aged 35 to 74 at enrollment (2003-2009). Eligible participants were SLE free at the first follow-up when the Stress and Coping Questionnaire was administered, had ELT data, and had US Census measures available for their residence at age 10. Incident SLE was self-reported during follow-up. Measures of ELT were derived from 20 types of reported trauma experienced before age 18; we use a cumulative ELT score and a categorical variable consisting of six patterns of co-occurring ELT (identified using latent class analysis). A continuous latent measure of early life ND (based on US census tract characteristics) was estimated using confirmatory factor analysis with increasing values representing greater deprivation. Hazard ratios (HR) and 95% confidence intervals (CI) for SLE were estimated using Cox proportional hazards models, which were adjusted for age (as the time scale) and early life household income as a measure of individual childhood SEP.

Results: Over follow-up, 94 participants reported being diagnosed with SLE between completion of the Stress questionnaire and 2021. Approximately 52% of participants reported at least one ELT. Cumulative ELT score was associated with increasing SLE hazard (HR: 1.24; 95%CI: 1.11, 1.38). Compared to the latent class for low ELT, elevated SLE hazards were observed for participants in latent classes representing high overall ELT (HR: 3.71; 95%CI: 1.56; 8.83), moderate overall ELT (HR: 2.77; 95%CI: 1.49, 5.17), and sexual trauma with household dysfunction (HR: 1.59; 95%CI: 0.79, 3.21), but not for familial health issues or high betrayal trauma (i.e., the perpetrator was someone close to the participant). In addition, participants in the highest quartile of early life ND had 1.29 times greater hazard of adult SLE (95%CI: 0.69, 2.41) compared to those in the lowest quartile. In models stratified by ND quartiles, the largest adult SLE hazard due to increasing ELT score was associated with the highest quartile of ND (HR: 1.40; 95%CI: 1.20, 1.63).

Conclusion: Hazards of adult SLE increased with higher levels of experienced ELT, specific patterns of co-occurring ELT, as well as greater ND, after adjusting for childhood SEP. Furthermore, combined exposure to ELT and greater ND was associated with even higher SLE hazard than when considering ELT alone. These results suggest that an adverse early life social environment represents a potentially important risk factor for SLE later in life.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effects-of-early-life-trauma-and-socioeconomic-position-on-systemic-lupus-erythematosus-risk-in-adulthood/