Adverse childhood experiences may elevate all-cause mortality risk among adults with chronic conditions, with patients who have diabetes and documented childhood trauma facing a higher risk compared with those without exposure to childhood trauma, according to a research letter published in JAMA Pediatrics.

In the longitudinal retrospective cohort study, investigators analyzed de-identified electronic health records from more than 120 health care organizations across the United States through the TriNetX Analytics Network. They examined three distinct adult populations aged 30 to 85 years: those with diabetes (n = 5.9 million), hypertension (n = 13.4 million), and recent emergency department visits for mild to moderate medical issues (n = 3 million).

Adverse childhood experience (ACE) exposure was determined through documentation of child sexual abuse or exploitation, forced labor, maltreatment, or psychological or physical abuse. Patients with diagnoses of common psychiatric disorders, including depressive disorders, anxiety disorders, psychotic disorders, and neurodevelopmental disorders were excluded to reduce confounding effects.

The emergency department cohort had a higher risk of mortality, followed by the hypertension cohort, wrote lead study author Yesh Dhruva, BS, of the Department of Psychiatry and Behavioral Neuroscience at the Saint Louis University School of Medicine, and colleagues.

Cox proportional hazards models accounted for covariates such as sex, age, and race. For the diabetes cohorts, body mass index percentile and hemoglobin A1c levels were additionally incorporated into the models. Mean hemoglobin A1c levels were 7.22 among patients with diabetes and ACE exposure vs 7.38 in the diabetes control cohort.

The investigators identified several limitations. ACE exposure was identified via International Classification of Diseases codes, which may have underestimated true exposure because of underdiagnosis. Mortality data drawn from electronic health records and institutional records may not have captured deaths outside the participating systems. The investigators didn't differentiate ACE subtypes or severity. Survivor bias may have influenced results, as patients with severe early adversity who died prior to receiving diagnoses would be excluded.

Approximately 17% of US adults have reported multiple ACEs, which have been consistently associated with adult mental health conditions, premature mortality, and chronic diseases.

The work was supported by resources from the AHEAD Institute of Saint Louis University School of Medicine. The investigators reported no conflicts of interest.

Source: JAMA Pediatrics