PDF(Pubmed)
Abstract：
BACKGROUND: Childhood maltreatment (CM) has been indicated in adverse health outcomes across the lifespan, including severe infection-related outcomes. Yet, data are scarce on the potential role of CM in severe COVID-19-related outcomes as well as on mechanisms underlying this association.
METHODS: We included 151,427 individuals in the UK Biobank who responded to questions on the history of CM in 2016 and 2017 and were alive on January 31, 2020. Binomial logistic regression models were performed to estimate the association between a history of CM and severe COVID-19 outcomes (i.e. hospitalization or death due to COVID-19), as well as COVID-19 diagnosis and vaccination as secondary outcomes. We then explored the potential mediating roles of socio-economic status, lifestyle and pre-pandemic comorbidities, and the effect modification by polygenic risk score for severe COVID-19 outcomes.
RESULTS: The mean age of the study population at the start of the pandemic was 67.7 (SD = 7.72) years, and 56.5% were female. We found the number of CM types was associated with the risk of severe COVID-19 outcomes in a graded manner (pfor trend < 0.01). Compared to individuals with no history of CM, individuals exposed to any CM were more likely to be hospitalized or die due to COVID-19 (odds ratio [OR] = 1.54 [95%CI 1.31-1.81]), particularly after physical neglect (2.04 [1.57-2.62]). Largely comparable risk patterns were observed across groups of high vs. low genetic risks for severe COVID-19 outcomes (pfor difference > 0.05). Mediation analysis revealed that 50.9% of the association between CM and severe COVID-19 outcomes was explained by suboptimal socio-economic status, lifestyle, and pre-pandemic diagnosis of psychiatric disorders or other chronic medical conditions. In contrast, any CM exposure was only weakly associated with COVID-19 diagnosis (1.06 [1.01-1.12]) while significantly associated with not being vaccinated for COVID-19 (1.21 [1.13-1.29]).
CONCLUSIONS: Our results add to the growing knowledge base indicating the role of childhood maltreatment in negative health outcomes across the lifespan, including severe COVID-19-related outcomes. The identified factors underlying this association represent potential intervention targets for mitigating the harmful effects of childhood maltreatment in COVID-19 and similar future pandemics.
METHODS: We included 151,427 individuals in the UK Biobank who responded to questions on the history of CM in 2016 and 2017 and were alive on January 31, 2020. Binomial logistic regression models were performed to estimate the association between a history of CM and severe COVID-19 outcomes (i.e. hospitalization or death due to COVID-19), as well as COVID-19 diagnosis and vaccination as secondary outcomes. We then explored the potential mediating roles of socio-economic status, lifestyle and pre-pandemic comorbidities, and the effect modification by polygenic risk score for severe COVID-19 outcomes.
RESULTS: The mean age of the study population at the start of the pandemic was 67.7 (SD = 7.72) years, and 56.5% were female. We found the number of CM types was associated with the risk of severe COVID-19 outcomes in a graded manner (pfor trend < 0.01). Compared to individuals with no history of CM, individuals exposed to any CM were more likely to be hospitalized or die due to COVID-19 (odds ratio [OR] = 1.54 [95%CI 1.31-1.81]), particularly after physical neglect (2.04 [1.57-2.62]). Largely comparable risk patterns were observed across groups of high vs. low genetic risks for severe COVID-19 outcomes (pfor difference > 0.05). Mediation analysis revealed that 50.9% of the association between CM and severe COVID-19 outcomes was explained by suboptimal socio-economic status, lifestyle, and pre-pandemic diagnosis of psychiatric disorders or other chronic medical conditions. In contrast, any CM exposure was only weakly associated with COVID-19 diagnosis (1.06 [1.01-1.12]) while significantly associated with not being vaccinated for COVID-19 (1.21 [1.13-1.29]).
CONCLUSIONS: Our results add to the growing knowledge base indicating the role of childhood maltreatment in negative health outcomes across the lifespan, including severe COVID-19-related outcomes. The identified factors underlying this association represent potential intervention targets for mitigating the harmful effects of childhood maltreatment in COVID-19 and similar future pandemics.
摘要：
背景：儿童虐待（CM）在整个生命周期的不良健康结果中都被指出，包括严重感染相关结果。然而，关于CM在严重COVID-19相关结局中的潜在作用以及这种关联的潜在机制的数据很少。
方法：我们纳入了英国生物银行的151,427人，他们在2016年和2017年回答了关于CM病史的问题，并于2020年1月31日还活着。使用二项逻辑回归模型来估计CM病史与严重COVID-19结局（即住院或因COVID-19导致的死亡）之间的关系，以及COVID-19诊断和疫苗接种作为次要结局。然后，我们探讨了社会经济地位的潜在中介作用，生活方式和大流行前的合并症，以及通过多基因风险评分对严重COVID-19结局的效果修饰。
结果：大流行开始时研究人群的平均年龄为67.7（SD=7.72）岁，56.5%为女性。我们发现CM类型的数量与严重COVID-19结局的风险呈分级关系（pfor趋势<0.01）。与没有CM病史的人相比，暴露于任何CM的个体更有可能因COVID-19住院或死亡(比值比[OR]=1.54[95CI1.31-1.81])，特别是在身体忽视之后(2.04[1.57-2.62])。在高组与高组之间观察到了相当大的风险模式。严重COVID-19结局的低遗传风险（差异>0.05）。中介分析显示，CM和严重COVID-19结局之间的50.9%的关联是由社会经济地位欠佳解释的，生活方式,以及大流行前对精神疾病或其他慢性疾病的诊断。相比之下,任何CM暴露仅与COVID-19诊断弱相关(1.06[1.01-1.12])，而与未接种COVID-19疫苗显著相关(1.21[1.13-1.29])。
结论：我们的结果增加了不断增长的知识库，表明儿童虐待在整个生命周期的负面健康结果中的作用。包括严重的COVID-19相关结果。确定的这种关联的潜在因素代表了减轻COVID-19和类似未来大流行中儿童虐待的有害影响的潜在干预目标。
方法：我们纳入了英国生物银行的151,427人，他们在2016年和2017年回答了关于CM病史的问题，并于2020年1月31日还活着。使用二项逻辑回归模型来估计CM病史与严重COVID-19结局（即住院或因COVID-19导致的死亡）之间的关系，以及COVID-19诊断和疫苗接种作为次要结局。然后，我们探讨了社会经济地位的潜在中介作用，生活方式和大流行前的合并症，以及通过多基因风险评分对严重COVID-19结局的效果修饰。
结果：大流行开始时研究人群的平均年龄为67.7（SD=7.72）岁，56.5%为女性。我们发现CM类型的数量与严重COVID-19结局的风险呈分级关系（pfor趋势<0.01）。与没有CM病史的人相比，暴露于任何CM的个体更有可能因COVID-19住院或死亡(比值比[OR]=1.54[95CI1.31-1.81])，特别是在身体忽视之后(2.04[1.57-2.62])。在高组与高组之间观察到了相当大的风险模式。严重COVID-19结局的低遗传风险（差异>0.05）。中介分析显示，CM和严重COVID-19结局之间的50.9%的关联是由社会经济地位欠佳解释的，生活方式,以及大流行前对精神疾病或其他慢性疾病的诊断。相比之下,任何CM暴露仅与COVID-19诊断弱相关(1.06[1.01-1.12])，而与未接种COVID-19疫苗显著相关(1.21[1.13-1.29])。
结论：我们的结果增加了不断增长的知识库，表明儿童虐待在整个生命周期的负面健康结果中的作用。包括严重的COVID-19相关结果。确定的这种关联的潜在因素代表了减轻COVID-19和类似未来大流行中儿童虐待的有害影响的潜在干预目标。
