Table 4.
Risk of all cause premature mortality (before age 70 years) according to early life physical and sexual abuse among 67 726 female nurses stratified by psychological and lifestyle factors (Nurses’ Health Study II, 2001-19)*
| Stratified factors | Physical abuse | Forced sexual activity | ||||
|---|---|---|---|---|---|---|
| None or mild | Moderate or severe | Never | Ever | |||
| Diet quality | ||||||
| Top 40% (n=814 deaths) | 1.00 (reference) | 1.58 (1.30 to 1.93) | 1.00 (reference) | 1.42 (1.17 to 1.71) | ||
| Bottom 60% (n=1596 deaths) | 1.00 (reference) | 1.42 (1.22 to 1.64) | 1.00 (reference) | 1.33 (1.16 to 1.52) | ||
| P for multiplicative interaction | 0.21 | — | 0.28 | — | ||
| P for additive interaction | 0.92 | — | 0.94 | — | ||
| RERI (95% CI) | 0.02 (−0.43 to 0.47) | — | 0.02 (−0.37 to 0.40) | — | ||
| Proportion mediated by low diet quality | <0.1% | — | <0.1% | — | ||
| Smoking status | ||||||
| Never (n=1239 deaths) | 1.00 (reference) | 1.36 (1.13 to 1.63) | 1.00 (reference) | 1.08 (0.90 to 1.29) | ||
| Current or past (n=1171 deaths) | 1.00 (reference) | 1.42 (1.22 to 1.66) | 1.00 (reference) | 1.46 (1.26 to 1.68) | ||
| P for multiplicative interaction | 0.62 | — | 0.009 | — | ||
| P for additive interaction | 0.11 | — | <0.001 | — | ||
| RERI (95% CI) | 0.33 (−0.08 to 0.74) | — | 0.63 (0.28 to 0.98) | — | ||
| Proportion mediated by smoking | 12.9% (9.1% to 18.0%) | — | 16.2% (10.8% to 23.5%) | — | ||
| Body mass index | ||||||
| <25 (n=944 deaths) | 1.00 (reference) | 1.68 (1.38 to 2.04) | 1.00 (reference) | 1.39 (1.15 to 1.68) | ||
| ≥25 (n=1466 deaths) | 1.00 (reference) | 1.39 (1.19 to 1.61) | 1.00 (reference) | 1.34 (1.17 to 1.54) | ||
| P for multiplicative interaction | 0.09 | — | 0.70 | — | ||
| P for additive interaction | 0.09 | — | 0.65 | — | ||
| RERI (95% CI) | −0.32 (−0.69 to 0.05) | — | −0.07 (−0.38 to 0.24) | — | ||
| Proportion mediated by overweight or obesity | <0.1% | — | <0.1% | — | ||
| Physical activity | ||||||
| ≥30 min/day (n=750 deaths) | 1.00 (reference) | 1.43 (1.14 to 1.79) | 1.00 (reference) | 1.40 (1.14 to 1.72) | ||
| <30 min/day (n=1660 deaths) | 1.00 (reference) | 1.47 (1.28 to 1.69) | 1.00 (reference) | 1.29 (1.13 to 1.47) | ||
| P for multiplicative interaction | 0.82 | — | 0.40 | — | ||
| P for additive interaction | 0.10 | — | 0.71 | — | ||
| RERI (95% CI) | 0.38 (−0.07 to 0.83) | — | 0.08 (−0.33 to 0.48) | — | ||
| Proportion mediated by physically inactive | 3.9% (2.7% to 5.7%) | — | 7.3% (4.9% to 10.9%) | — | ||
| Phobic anxiety symptom scores | ||||||
| <3 (n=1677 deaths) | 1.00 (reference) | 1.44 (1.24 to 1.68) | 1.00 (reference) | 1.18 (1.02 to 1.37) | ||
| ≥3 (n=733 deaths) | 1.00 (reference) | 1.45 (1.19 to 1.76) | 1.00 (reference) | 1.55 (1.30 to 1.85) | ||
| P for multiplicative interaction | 0.91 | — | 0.008 | — | ||
| P for additive interaction | 0.51 | — | 0.002 | — | ||
| RERI (95% CI) | 0.13 (−0.26 to 0.53) | — | 0.54 (0.19 to 0.89) | — | ||
| Proportion mediated by anxiety | 4.7% (2.8% to 7.7%) | — | 5.9% (3.5% to 9.9%) | — | ||
| Depression | ||||||
| No (n=1557 deaths) | 1.00 (reference) | 1.32 (1.11 to 1.56) | 1.00 (reference) | 1.27 (1.09 to 1.47) | ||
| Yes (n=853 deaths) | 1.00 (reference) | 1.43 (1.20 to 1.69) | 1.00 (reference) | 1.31 (1.11 to 1.54) | ||
| P for multiplicative interaction | 0.74 | — | 0.91 | — | ||
| P for additive interaction | 0.20 | — | 0.35 | — | ||
| RERI (95% CI) | 0.27 (−0.14 to 0.67) | — | 0.18 (−0.19 to 0.54) | — | ||
| Proportion mediated by depression | 20.7% (14.4% to 28.9%) | — | 22.4% (14.7% to 32.7%) | — | ||
Data are adjusted hazard ratios (95% confidence intervals).
RERI=relative excess risk due to interaction.
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), and the tier of birth (north, middle, south, or outside of United States or uncertain).