Adverse childhood experiences and adult cardiometabolic risk factors and disease outcomes: Cross-sectional, populationbased study of adults in rural Uganda

Abstract

Background Cardiovascular diseases (CVD) pose a major threat to public health in sub-Saharan African communities, where the burden of these classes of ill¬nesses is expected to double by 2030. Growing research suggests that past developmental experiences and early life conditions may also elevate CVD risk throughout the life course. Greater childhood stress and adversity are consistently associated with a range of adult CVDs and associated risk factors, yet little research exists on the long-term effects of early life stress on adult physi¬cal health outcomes, especially CVD risk, in sub-Saha¬ran African contexts. This study aims to evaluate the as¬sociations between adverse childhood experiences and adult cardiometabolic risk factors and health outcomes in a population-based study of adults living in Mbarara, a rural region of southwestern Uganda. Methods Data come from an ongoing, whole-popula¬tion social network cohort study of adults living in the eight villages of Nyakabare Parish, Mbarara. A modified version of the Adverse Childhood Experiences-Interna¬tional Questionnaire (ACEs) assessed past exposure to physical, emotional, and sexual adversity. Participants also took part in a health fair where medical histories on cardiometabolic risk factors and cardiovascular dis¬eases were gathered. Multiple logistic regression mod¬els estimated the associations between ACEs and car¬diometabolic risk factors and health outcomes. Results Data were available on 545 adults. The aver¬age number of ACEs was 4.9 out of a possible 16. The cumulative number of ACEs were associated with hav-ing a history of heart attack and/or heart failure (adjust¬ed odds ratio (AOR) = 1.11, 95% confidence interval (CI) = 0.999-1.234, P = 0.051), but the estimated asso¬ciation was not statistically significant. ACEs did not have statistically significant associations with any oth¬ers measures of adult cardiometabolic risk and CVD. Conclusions Adverse childhood experiences are not associated with a range of adult cardiometabolic risk factors and health outcomes in this sample of rural Ugandan adults. Further research in this sample is necessary to identify the pathways that may motivate these null relationship and possibly protect against adverse cardiometabolic and cardiovascular health outcomes.