Adverse childhood experiences and incident coronary heart disease: a counterfactual analysis in the Whitehall II prospective cohort study

Mifuyu Akasaki; Owen Nicholas; Jessica Abell; Carlos A Valencia-Hernández; Rebecca Hardy; Andrew Steptoe

doi:10.1016/j.ajpc.2021.100220

Adverse childhood experiences and incident coronary heart disease: a counterfactual analysis in the Whitehall II prospective cohort study

Am J Prev Cardiol. 2021 Jun 24:7:100220. doi: 10.1016/j.ajpc.2021.100220. eCollection 2021 Sep.

Authors

Mifuyu Akasaki^{1

2}, Owen Nicholas³, Jessica Abell², Carlos A Valencia-Hernández⁴, Rebecca Hardy¹, Andrew Steptoe²

Affiliations

¹ Social Research Institute, Institute of Education, University College London, London, UK.
² Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
³ Department of Statistical Science, Faculty of Mathematical and Physical Sciences, University College London, London, UK.
⁴ Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK.

Abstract

Objectives: Adverse childhood experience is thought to be associated with risk of coronary heart disease, but it is not clear which experiences are cardiotoxic, and whether risk increases with the accumulation of adverse childhood experiences.

Methods: Participants were 5149 adults (72.6% men) in the Whitehall II cohort study. Parental death was recorded at phase 1 (median age in years 44.3), and 13 other adverse childhood experiences at phase 5 (55.3). We applied Cox proportional hazards regression with person-time from phase 5 to examine associations of adverse childhood experiences with incident coronary heart disease. We predicted hazard ratios according to count of the experiences, and examined dose-response effect. We finally estimated reduction of coronary heart disease in a hypothetical scenario, the absence of adverse childhood experiences.

Results: Among study participants, 62.9% had at least one adversity, with "financial problems" having the highest prevalence (26.1%). There were 509 first episodes of coronary heart disease during an average 12.9 years follow-up. Among 14 adverse childhood experiences in a multiply adjusted model, "parental unemployment" showed the highest hazard of coronary heart disease incidence (hazard ratio; 95% confidence interval: 1.53; 1.16 to 2.02). No dose-response effect was observed (constant for proportionality in hazard ratio: 1.05, 0.99 to 1.11). Based on the estimates of final model, in the absence of childhood adversities, we estimated a 6.0% reduction in coronary heart disease (0.94; 0.87 to 1.01), but the confidence interval includes one.

Conclusion: Although individual adverse childhood experiences show some association with coronary heart disease, there is no clear relationship with the number of adverse experiences. Further research is required to quantify effects of multiple and combinations of adverse childhood experiences considering timing, duration, and severity.

Keywords: Adverse childhood experiences; Counterfactual analysis; Incident coronary heart disease; Prospective longitudinal study.

Grants and funding

K013351/MRC_/Medical Research Council/United Kingdom