Introduction
Evidence suggests that individuals with a history of adverse childhood experiences
have higher odds of developing kidney disease than individuals with no adverse childhood
experiences. However, no study has examined the influence of coexisting adverse childhood
experiences and kidney disease on mortality risk. This study uses a longitudinal survey
of adults to examine the influence of coexisting adverse childhood experiences and
decreased renal function on all-cause mortality in a sample of U.S. adults.
Methods
A total of 1,205 adults participating in the Midlife Development in the United States
series between 1995 and 2014 were used for this analysis performed in 2019. A total
of 6 types of adverse childhood experiences were available in the data set, which
were combined to create a dichotomous variable with any adverse experience counted
as yes. Decreased renal function was defined as an estimated glomerular filtration rate
<60 milliliter/minute/1.73 m2. The main outcome was all-cause mortality. Cox proportional hazards models were performed
to examine 4 combinations of adverse childhood experiences and decreased renal function
associated with overall survival (neither, adverse childhood experiences only, decreased
renal function only, or both) controlling for covariables.
Results
In fully adjusted models, adverse childhood experiences and decreased renal function
were associated with increased all-cause mortality relative to neither (hazard ratio=2.85,
95% CI=1.30, 6.25). Decreased renal function only and adverse childhood experiences
only were not significantly associated with all-cause mortality (hazard ratio=1.14,
95% CI=0.64, 2.04 and hazard ratio=1.55, 95% CI=0.44, 5.41, respectively). When using
decreased renal function as the reference group, coexisting adverse childhood experiences
and decreased renal function was associated with a 64% increased risk of all-cause
mortality, though this relationship was not statistically significant.
Conclusions
Coexistence of adverse childhood experiences and decreased renal function is associated
with higher all-cause mortality than seen in individuals with neither adverse childhood
experiences nor decreased renal function and may be associated with higher all-cause
mortality than seen in individuals with decreased renal function alone. Future research
is needed to better understand this potential association.
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