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Adverse Childhood Experiences and Decreased Renal Function: Impact on All-Cause Mortality in U.S. Adults

  • Mukoso N. Ozieh
    Correspondence
    Address correspondence to: Mukoso N. Ozieh, MD, MSCR, Division of Nephrology, Department of Medicine, The Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee WI 53226.
    Affiliations
    Division of Nephrology, Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin

    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin

    Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
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  • Emma Garacci
    Affiliations
    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin

    Division of General Internal Medicine, Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin
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  • Jennifer A. Campbell
    Affiliations
    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin

    Division of General Internal Medicine, Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin
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  • Rebekah J. Walker
    Affiliations
    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin

    Division of General Internal Medicine, Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin
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  • Leonard E. Egede
    Affiliations
    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin

    Division of General Internal Medicine, Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin
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      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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