Asthma and lower airway disease
Abuse during childhood and adolescence and risk of adult-onset asthma in African American women

https://doi.org/10.1016/j.jaci.2012.10.023Get rights and content

Background

Experiences of violence contribute to the occurrence of childhood asthma, but there is little information on the effect of early-life abuse on adult-onset asthma.

Objective

We prospectively assessed the relation between physical and sexual abuse during childhood and adolescence and the incidence of adult-onset asthma in the Black Women's Health Study.

Methods

We followed 28,456 women from 1995 through 2011 with biennial mailed questionnaires. Experiences of physical and sexual abuse that occurred during childhood and adolescence were obtained in 2005. Cox regression models were used to estimate incidence rate ratios (IRRs) and 95% CIs.

Results

During 417,931 person-years of follow-up, 1,160 participants reported physician-diagnosed asthma and concurrent use of asthma medication. Compared with women who experienced no abuse during childhood or adolescence, the multivariable IRR for any childhood abuse was 1.24 (95% CI, 1.06-1.45), and for any adolescent abuse, it was 1.10 (95% CI, 0.88-1.36). The IRR was higher for childhood physical abuse (IRR, 1.29; 95% CI, 1.07-1.49) than for childhood sexual abuse (IRR, 1.15; 95% CI, 0.88-1.49). IRRs for physical and sexual abuse during adolescence were compatible with 1.0. The association between childhood abuse and asthma incidence was stronger in older compared with younger women.

Conclusion

In this large cohort of African American women, there was a positive association between adult-onset asthma and childhood physical abuse and weaker associations for childhood sexual abuse and any abuse during adolescence. Given the high prevalence of asthma and childhood abuse, this association is of public health importance.

Section snippets

Study population

The BWHS is a prospective cohort study established in 1995, when 59,000 African American women aged 21 through 69 years were recruited mainly from subscribers to Essence magazine, a general readership magazine targeted to black women.15 The baseline questionnaire elicited information on demographic and lifestyle factors, reproductive history, and medical conditions. The cohort is followed biennially by using mailed and Web-based health questionnaires. Follow-up has averaged more than 80% of the

Results

During 16 years of follow-up comprising 417,931 person-years, 1,160 women reported incident adult-onset asthma together with asthma medication use. The mean age at diagnosis was 47 years (SD, 11 years; range, 23-82 years).

Compared with women who were not abused during childhood or adolescence, abused women were younger, more likely to be current drinkers, more likely to have been exposed to secondhand smoke, and more likely to have reported more pack years of smoking, a higher prevalence of

Discussion

In this large cohort of African American women, exposure to physical abuse during childhood was associated with an increased incidence of adult-onset asthma of greater than 20%. The risk was higher among women who also felt in danger in the home as a child. IRRs were weaker for sexual abuse during childhood, and there was little evidence that abuse during adolescence increased asthma incidence. The adverse effect of childhood physical abuse was confined to older women.

Two previous studies have

References (40)

  • S.F. Suglia et al.

    Maternal intimate partner violence and increased asthma incidence in children: buffering effects of supportive caregiving

    Arch Pediatr Adolesc Med

    (2009)
  • M.J. Sternthal et al.

    Community violence and urban childhood asthma: a multilevel analysis

    Eur Respir J

    (2010)
  • H.L. Wegman et al.

    A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood

    Psychosom Med

    (2009)
  • S. Romans et al.

    Childhood abuse and later medical disorders in women. An epidemiological study

    Psychother Psychosom

    (2002)
  • K.M. Scott et al.

    Childhood adversity, early-onset depressive/anxiety disorders, and adult-onset asthma

    Psychosom Med

    (2008)
  • B.S. McEwen

    Protective and damaging effects of stress mediators

    N Engl J Med

    (1998)
  • C. Heim et al.

    Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood

    JAMA

    (2000)
  • L. Rosenberg et al.

    The Black Women's Health Study: a follow-up study for causes and preventions of illness

    J Am Med Womens Assoc

    (1995)
  • M.A. Straus

    Measuring intrafamily conflict and violence: the Conflict Tactics (CT) scales

    J Marriage Fam

    (1979)
  • J. McFarlane et al.

    Assessing for abuse during pregnancy. Severity and frequency of injuries and associated entry into prenatal care

    JAMA

    (1992)
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    Supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (HL107314).

    Disclosure of potential conflict of interest: All authors received grants from the National Institutes of Health/National Heart, Lung, and Blood Institute.

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