Adverse Childhood Experiences and Chronic Obstructive Pulmonary Disease in Adults

CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, Atlanta, GA 30341-3717, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 06/2008; 34(5):396-403. DOI: 10.1016/j.amepre.2008.02.002
Source: PubMed


Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality in the U.S. However, little is known about the influence of childhood stressors on its occurrence.
Data were from 15,472 adult HMO members enrolled in the Adverse Childhood Experiences (ACE) Study from 1995 to 1997 and eligible for the prospective phase. Eight ACEs were assessed: abuse (emotional, physical, sexual); witnessing domestic violence; growing up with substance-abusing, mentally ill, or criminal household members; and parental separation or divorce. The number of ACEs (ACE Score) was used to examine the relationship of childhood stressors to the risk of COPD. Three methods of case ascertainment were used to define COPD: baseline reports of prevalent COPD, incident hospitalizations with COPD as a discharge diagnosis, and rates of prescription medications to treat COPD during follow-up. Follow-up data were available through 2004.
The ACE Score had a graded relationship to each of three measures of the occurrence of COPD. Compared to people with an ACE Score of 0, those with an ACE Score of > or =5 had 2.6 times the risk of prevalent COPD, 2.0 times the risk of incident hospitalizations, and 1.6 times the rates of prescriptions (p<0.01 for all comparisons). These associations were only modestly reduced by adjustment for smoking. The mean age at hospitalization decreased as the ACE Score increased (p<0.01).
Decades after they occur, adverse childhood experiences increase the risk of COPD. Because this increased risk is only partially mediated by cigarette smoking, other mechanisms by which ACEs may contribute to the occurrence of COPD merit consideration.

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Available from: David W Brown, Feb 25, 2015
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    • "Notes as per Table 2 A. Islam et al. reduced lung capacity in adult life (Vrijlandt et al. 2006) and that children exposed to traumatic stress, such as physical and sexual abuse, have a higher incidence of respiratory problems decades later (Anda et al. 2008). The results are also consistent with findings that living in violent environments promotes respiratory diseases (Wright and Steinbach 2001). "
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    • "So, for example, in a study on lung cancer, mortality and morbidity were not just related to increased smoking behaviours, but strongly correlated also with the ACE listed previously (Brown et al., 2010). Further, two or more ACE show a 70 per cent risk of hospitalisation for autoimmune disease (Dube et al., 2009) and there are many other linkages, such as prescription drug use (Anda et al., 2008a), chronic obstructive pulmonary disease (Anda et al., 2008b) and poorer health-related quality of life (Corso et al., 2008). Work on poly-victimisation in the USA shows the same kind of trends. "
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    • "Some of the most prevalent types of ELS include abuse, neglect, and household dysfunction (e.g., witnessing domestic violence). A number of studies have linked ELS with widespread negative health outcomes, including severe obesity (Anda et al., 2006), heart disease (Dong et al., 2004), chronic obstructive pulmonary disease (Anda et al., 2008), liver disease (Dong et al., 2003), sexually transmitted disease (Hillis et al., 2000), depressive disorders (Chapman et al., 2004), and attempted suicide (Dube et al., 2001). The relationship between the breadth of childhood exposure to adversity and health in adulthood is strongly graded, with the likelihood of negative health outcomes increasing as the number of categories of exposure increases (Felitti et al., 1998). "
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