Studying the Life Course Health Consequences of Childhood Adversity

The adverse health consequences of low socioeconomic position (SEP) are well documented1, 2, including several studies that have examined when in the life course socio-economic differences in health emerge and how inequalities change with age.3-7 The findings from these life course studies can shed light on the underlying pathways to disease inequalities, and the degree to which these may differ across health outcomes. Aside from SEP, the physical health consequences of other forms of adversity are less well studied (although a considerable body of evidence exists for mental health (e.g.8, 9)). The study by Su et al in this issue of Circulation10 therefore makes a valuable contribution to the literature. The authors use data from 394 participants from the Georgia Stress and Heart Study to investigate the cardiovascular consequences of reported adverse child experiences (ACEs), specifically: childhood abuse (emotional, physical and sexual), childhood neglect (emotional and physical), and growing up with household dysfunction (substance abuse, mental illness, domestic violence, criminal household member, and parental marital discord). The study has repeated measurements of blood pressure obtained in a standardised way. The authors showed that retrospective report of the number of ACEs experienced up to 18 years were not related to mean blood pressure in childhood (younger than 10 years of age) or change in blood pressure from childhood to early adulthood, but that those who reported a greater number of ACEs had a more rapid age-related increase in systolic and diastolic blood pressure from their mid- to late-20s, such that by age 38 those who reported 4 or more ACEs compared with those reporting none had 9.3mmHg and 7.6mmHg higher systolic and diastolic blood pressure, respectively. The authors demonstrated that in their data, the association between ACEs and blood pressure were similar in males and females and across two ethnic groups (African Americans and European Americans), and remained after adjustment for childhood SEP and health behaviours. Whilst this study is an important step forwards for the understanding of how adversity might influence cardiovascular health, there are several important challenges to this type of research that need to be addressed by future studies.