Childhood Maltreatment Associated With Atopic Disease

Childhood maltreatment may increase the risk of developing atopic disease, particularly asthma. Findings were published in eClinicalMedicine.

Affecting 1 in 3 children worldwide, childhood maltreatment, defined as any form of physical, sexual, or emotional abuse and neglect, is associated with a substantial global mortality and morbidity burden. A shift toward a proinflammatory state and alterations in white blood cell counts appear to be caused by the chronic stress of childhood maltreatment, researchers explain, which may increase risk of atopic diseases.

Recent literature has begun to demonstrate an association between childhood adversity and common atopic diseases, including asthma, atopic dermatitis (AD), and allergic rhinoconjunctivitis, but currently published cohort studies have had a small sample size and not been generalizable to the United Kingdom population.

“Knowledge of the relationship between childhood maltreatment and atopy will: enable targeted public health policies; further fuel the need for health interventions to mitigate the effects of childhood maltreatment; and prompt screening among at risk populations,” the study authors said.

They conducted a population-based retrospective matched open cohort study to explore the association between childhood maltreatment and atopy using data from participating general practices in the IQVIA Medical Research Database UK database from January 1, 1995, to September 30, 2019.

Read codes were utilized to identify patients exposed to childhood maltreatment (either suspected or confirmed) who were matched to up to 4 unexposed patients by age, sex, general practice, and Townsend deprivation quintile.

“The Townsend deprivation index is a socioeconomic measure of deprivation derived from census data, capturing variables related to employment, home ownership, and household crowding,” explained researchers.

The primary outcome was the development of atopy (asthma, AD, or allergic rhinoconjunctivitis) during follow-up in those without atopy at study entry. Subgroup analyses were conducted with the main cohort disaggregated by sex to assess whether findings differed between males and females.

A total of 183,897 exposed patients were included in the analysis and matched to 621,699 unexposed patients. Patients in the exposed cohort were followed up for 2.23 years (IQR, 0.88-5.09) in comparison to 3.49 years (IQR, 1.51-6.84) in the unexposed cohort.

Exposure to childhood maltreatment in the exposed group was indicated to occur at a mean (SD) age of 6.05 (5.24) years. Average body mass index appeared similar between the 2 groups, although patients in the exposed group were more likely to be a current smoker (20,696 [11.25%] vs 38,276 [6.16%]).

During the study period, 18,555 patients (incidence rate [IR], 28.18 per 1000 person-years) in the exposed group developed atopic disease compared with 68,368 (IR, 23.58 per 1000 person-years) in the unexposed group.

After adjusting for potential covariates, exposed patients were more likely to develop atopic disease overall (adjusted HR [aHR], 1.14; 95% CI, 1.121.15), with risk increased for the development of asthma (aHR, 1.42; 95% CI, 1.37-1.46) and lower for AD (aHR, 1.09; 95% CI, 1.07-1.12) and allergic rhinoconjunctivitis (aHR, 1.07; 95% CI, 1.04-1.11).

Associations were shown to be more pronounced in analyses restricted to females and confirmed cases of childhood maltreatment only. Lower risks comparative to atopic disease overall for AD and allergic rhinoconjunctivitis among exposed patients were noted by researchers to have been potentially caused by misdiagnosis.

Considering the substantial health burden associated with childhood maltreatment, researchers concluded that it is important to implement public health policies aimed at enhancing 3 key areas: detection and primary prevention of childhood maltreatment; secondary and tertiary prevention interventions to reduce the burden of ill health associated with exposure to maltreatment; and clinical awareness of such associations and subsequent knowledge of management.

Reference

Nash K, Minhas S, Metheny N, et al. Association between childhood maltreatment and atopy in the UK: a population based retrospective cohort study. EClinicalMedicine. 2022;53:101730. doi:10.1016/j.eclinm.2022.101730