Table 2.
Risk of cause specific premature mortality (before age 70 years) with at least 40 deaths attributed according to the severity of physical abuse during childhood or adolescence among 67 726 female nurses (Nurses’ Health Study II, 2001-19)
| Cause specific mortality | Severity of physical abuse | P for trend‡ | |||
|---|---|---|---|---|---|
| None | Mild | Moderate | Severe | ||
| Cancer | |||||
| Events/crude incidence per 1000 person years | 393/0.71 | 175/0.79 | 221/0.71 | 85/0.83 | — |
| Multivariable models adjusted for childhood characteristics* | 1.00 (reference) | 1.12 (0.93 to 1.34) | 0.98 (0.83 to 1.15) | 1.04 (0.82 to 1.31) | 0.97 |
| Full models additionally adjusted for adult characteristics† | 1.00 (reference) | 1.14 (0.95 to 1.37) | 1.00 (0.85 to 1.18) | 1.04 (0.82 to 1.31) | 0.86 |
| Cardiovascular disease | |||||
| Events/crude incidence per 1000 person years | 68/0.12 | 19/0.09 | 51/0.16 | 16/0.16 | — |
| Multivariable models adjusted for childhood characteristics* | 1.00 (reference) | 0.70 (0.42 to 1.17) | 1.29 (0.89 to 1.85) | 1.08 (0.62 to 1.87) | 0.30 |
| Full models additionally adjusted for adult characteristics† | 1.00 (reference) | 0.70 (0.42 to 1.17) | 1.29 (0.89 to 1.87) | 0.92 (0.53 to 1.62) | 0.51 |
| External causes of injury and poisoning | |||||
| Events/crude incidence per 1000 person years | 36/0.06 | 14/0.06 | 24/0.08 | 20/0.19 | — |
| Multivariable models adjusted for childhood characteristics* | 1.00 (reference) | 0.95 (0.51 to 1.77) | 1.10 (0.66 to 1.86) | 2.81 (1.62 to 4.89) | 0.007 |
| Full models additionally adjusted for adult characteristics† | 1.00 (reference) | 0.93 (0.50 to 1.73) | 1.06 (0.63 to 1.79) | 2.45 (1.40 to 4.29) | 0.02 |
| Senility and ill-defined diseases | |||||
| Events/crude incidence per 1000 person years | 39/0.07 | 10/0.05 | 28/0.09 | 12/0.12 | — |
| Multivariable models adjusted for childhood characteristics* | 1.00 (reference) | 0.69 (0.34 to 1.39) | 1.31 (0.80 to 2.13) | 1.46 (0.75 to 2.84) | 0.17 |
| Full models additionally adjusted for adult characteristics† | 1.00 (reference) | 0.73 (0.36 to 1.48) | 1.30 (0.79 to 2.14) | 1.27 (0.64 to 2.51) | 0.28 |
| Suicide | |||||
| Events/crude incidence per 1000 person years | 17/0.03 | 7/0.03 | 14/0.04 | 11/0.11 | — |
| Multivariable models adjusted for childhood characteristics* | 1.00 (reference) | 1.00 (0.41 to 2.41) | 1.45 (0.71 to 2.96) | 3.05 (1.41 to 6.60) | 0.01 |
| Full models additionally adjusted for adult characteristics† | 1.00 (reference) | 1.02 (0.42 to 2.52) | 1.52 (0.74 to 3.13) | 2.80 (1.26 to 6.22) | 0.02 |
| Respiratory disease | |||||
| Events/crude incidence per 1000 person years | 18/0.03 | 11/0.05 | 12/0.04 | 8/0.08 | — |
| Multivariable models adjusted for childhood characteristics* | 1.00 (reference) | 1.55 (0.73 to 3.29) | 1.15 (0.55 to 2.39) | 2.08 (0.89 to 4.83) | 0.19 |
| Full models additionally adjusted for adult characteristics† | 1.00 (reference) | 1.41 (0.65 to 3.04) | 1.02 (0.49 to 2.15) | 1.73 (0.73 to 4.08) | 0.40 |
| Diseases of the digestive system | |||||
| Events/crude incidence per 1000 person years | 16/0.03 | 7/0.03 | 11/0.04 | 8/0.08 | — |
| Multivariable models adjusted for childhood characteristics* | 1.00 (reference) | 1.15 (0.47 to 2.80) | 1.16 (0.53 to 2.50) | 2.40 (1.01 to 5.68) | 0.12 |
| Full models additionally adjusted for adult characteristics† | 1.00 (reference) | 0.97 (0.38 to 2.44) | 0.95 (0.43 to 2.10) | 1.83 (0.75 to 4.48) | 0.39 |
Data are hazard ratios (95% confidence intervals).
Model adjusted for age (continuous), white race or ethnicity (no or yes), body shape at age 5 (somatogram figure 1, 2, 3, 4, or ≥5), age at menarche (continuous), parental highest education (less than high school, completed high school, or more than high school), parents owned a home during infancy (no or yes), parents worked as a professional, manager, or executive during infancy (no or yes), the tier of birth (north, middle, south, or outside of United States or uncertain).
Based on multivariable models with further adjustment for time varying body mass index (<24.9, 25-29.9, 30-34.9, or ≥35), smoking status (never, former, current 1-34 cigarettes/day, or current ≥35 cigarettes/day), parity (≤1, 2, or ≥3), Alternative Healthy Eating Index 2010 dietary score (five categories), alcohol intake (0, 1-14, or ≥15 g/day), oral contraceptive use (never, past, or current), menopausal status (premenopausal, postmenopausal, or uncertain), and postmenopausal hormone use (never, past, or current).
P for trend was conducted by modeling the categories of increasing severity of physical abuse as an ordinal level variable using integer values.