Table 2.
Incidence of cardiovascular disease (CVD) and hazard ratios for associations of adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) with incident CVD
| Case, No | Incidence rate, per 1000 person-years | HR (95% CI) | ||||
|---|---|---|---|---|---|---|
| Model 1 | Model 2 | Model 3 | Model 4 | |||
| Cardiovascular disease | ||||||
| ACEs indicatorsa (1-unit per increasing) | NA | NA | 1.12 (1.09–1.14) | 1.14 (1.11–1.17) | 1.12 (1.05–1.20) | 1.11 (1.08–1.14) |
| No. of ACEs indicators | ||||||
| 0 | 109 | 24.41 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| 1 | 272 | 33.14 | 1.24 (1.13–1.35) | 1.27 (1.16–1.39) | 1.29 (1.17–1.42) | 1.29 (1.17–1.42) |
| 2 | 204 | 37.78 | 1.37 (1.25–1.51) | 1.45 (1.32–1.60) | 1.39 (1.25–1.54) | 1.39 (1.25–1.54) |
| 3 | 137 | 42.91 | 1.54 (1.39–1.71) | 1.64 (1.48–1.82) | 1.56 (1.39–1.74) | 1.56 (1.40–1.75) |
| ≥ 4 | 67 | 43.93 | 1.55 (1.37–1.76) | 1.70 (1.50–1.93) | 1.57 (1.37–1.80) | 1.58 (1.38–1.81) |
| AAEs indicatorsa (1-unit per increasing) | NA | NA | 1.21 (1.18–1.24) | 1.22 (1.19–1.25) | 1.18 (1.15–1.22) | 1.19 (1.16–1.22) |
| No. of AAEs indicators | ||||||
| 0 | 427 | 29.31 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| 1 | 163 | 36.57 | 1.11 (1.03–1.19) | 1.16 (1.07–1.25) | 1.10 (1.01–1.19) | 1.10 (1.01–1.19) |
| 2 | 96 | 48.07 | 1.48 (1.35–1.62) | 1.52 (1.38–1.66) | 1.42 (1.29–1.56) | 1.42 (1.29–1.56) |
| 3 | 74 | 57.19 | 1.90 (1.71–2.10) | 1.94 (1.75–2.15) | 1.66 (1.49–1.85) | 1.67 (1.50–1.86) |
| ≥ 4 | 29 | 60.80 | 2.00 (1.71–2.33) | 2.07 (1.77–2.42) | 1.99 (1.70–2.34) | 2.00 (1.70–2.35) |
| Heart disease | ||||||
| ACEs indicatorsa (1-unit per increasing) | NA | NA | 1.08 (1.04–1.11) | 1.10 (1.06–1.14) | 1.06 (1.02–1.10) | 1.06 (1.02–1.10) |
| No. of ACEs indicators | ||||||
| 0 | 62 | 13.88 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| 1 | 156 | 19.01 | 1.25 (1.10–1.43) | 1.30 (1.14–1.48) | 1.33 (1.15–1.54) | 1.33 (1.15–1.54) |
| 2 | 129 | 23.89 | 1.24 (1.08–1.43) | 1.31 (1.14–1.51) | 1.25 (1.07–1.46) | 1.25 (1.07–1.46) |
| 3 | 85 | 26.62 | 1.39 (1.20–1.62) | 1.49 (1.28–1.74) | 1.42 (1.20–1.68) | 1.42 (1.20–1.67) |
| ≥ 4 | 43 | 28.20 | 1.41 (1.17–1.70) | 1.55 (1.29–1.87) | 1.37 (1.12–1.68) | 1.37 (1.12–1.68) |
| AAEs indicatorsa (1-unit per increasing) | NA | NA | 1.23 (1.19–1.28) | 1.24 (1.20–1.29) | 1.19 (1.15–1.24) | 1.19 (1.15–1.24) |
| No. of AAEs indicators | ||||||
| 0 | 265 | 18.19 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| 1 | 96 | 21.54 | 1.20 (1.08–1.34) | 1.25 (1.12–1.40) | 1.17 (1.04–1.32) | 1.17 (1.04–1.32) |
| 2 | 53 | 26.54 | 1.60 (1.40–1.82) | 1.63 (1.43–1.86) | 1.57 (1.36–1.80) | 1.57 (1.36–1.80) |
| 3 | 42 | 32.46 | 1.91 (1.65–2.22) | 1.96 (1.69–2.28) | 1.55 (1.32–1.83) | 1.55 (1.31–1.83) |
| ≥ 4 | 19 | 39.83 | 2.13 (1.71–2.66) | 2.19 (1.75–2.74) | 2.04 (1.61–2.59) | 2.04 (1.61–2.58) |
| Stroke | ||||||
| ACEs indicatorsa (1-unit per increasing) | NA | NA | 1.16 (1.13–1.19) | 1.18 (1.15–1.22) | 1.16 (1.13–1.20) | 1.17 (1.13–1.20) |
| No. of ACEs indicators | ||||||
| 0 | 52 | 11.86 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| 1 | 135 | 16.83 | 1.27 (1.13–1.44) | 1.31 (1.16–1.48) | 1.32 (1.16–1.50) | 1.32 (1.16–1.50) |
| 2 | 91 | 17.26 | 1.56 (1.38–1.77) | 1.66 (1.46–1.89) | 1.60 (1.40–1.83) | 1.60 (1.40–1.83) |
| 3 | 61 | 19.70 | 1.72 (1.50–1.97) | 1.84 (1.60–2.11) | 1.76 (1.52–2.04) | 1.76 (1.53–2.04) |
| ≥ 4 | 30 | 20.30 | 1.79 (1.53–2.10) | 1.98 (1.68–2.33) | 1.86 (1.57–2.21) | 1.87 (1.58–2.22) |
| AAEs indicatorsa (1-unit per increasing) | NA | NA | 1.19 (1.15–1.23) | 1.20 (1.16–1.24) | 1.17 (1.13–1.21) | 1.17 (1.13–1.21) |
| No. of AAEs indicators | ||||||
| 0 | 192 | 13.45 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| 1 | 81 | 18.59 | 1.06 (0.97–1.17) | 1.12 (1.01–1.23) | 1.06 (0.95–1.17) | 1.06 (0.95–1.17) |
| 2 | 48 | 24.64 | 1.34 (1.18–1.51) | 1.37 (1.21–1.55) | 1.25 (1.10–1.42) | 1.25 (1.10–1.42) |
| 3 | 34 | 27.35 | 1.74 (1.53–1.99) | 1.79 (1.57–2.05) | 1.62 (1.41–1.87) | 1.63 (1.42–1.88) |
| ≥ 4 | 14 | 30.70 | 2.11 (1.74–2.55) | 2.22 (1.83–2.69) | 2.17 (1.78–2.64) | 2.17 (1.78–2.65) |
Model 1 was adjusted for age and sex
Model 2 was adjusted for age, sex, residence, educational level, marital status, physical activity, smoking status, and alcohol consumption
Model 3 was adjusted as Model 2 plus body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; use of diabetes medications, hypertension medications, and lipid-lowering therapy; and depressive symptoms score
Model 4 was adjusted as Model 3 plus young adulthood social support
Abbreviations: ACEs Adverse childhood experiences, AAEs Adverse adulthood experiences, No. Number, HR Hazard ratio, 95% CI, 95% confidence interval, NA Not available or not applicable
aContinuous variable