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      The association between exposure to childhood maltreatment and the subsequent development of functional somatic and visceral pain syndromes

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          Abstract

          Background: Childhood maltreatment is a global public health issue linked to a vast mortality and morbidity burden. This study builds on current literature to explore the risk of developing central sensitivity syndromes (CSS) (consisting of somatic and visceral pain syndromes) subsequent to childhood maltreatment exposure.

          Methods: A retrospective population based open cohort study using the UK primary care database, ‘The Health Improvement Network,’ between 1st January 1995-31st December 2018. 80,657 adult patients who had experienced childhood maltreatment or maltreatment related concerns (exposed patients) were matched to 161,314 unexposed patients by age and sex. Outcomes of interest were the development of CSS: either somatic (Fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder, chronic lower back pain, chronic headache, myofascial pain syndrome and restless leg syndrome) or visceral (Interstitial cystitis, vulvodynia, chronic prostatitis and irritable bowel syndrome) in nature. Effect sizes are presented as adjusted incidence rate ratios (aIRR) with confidence intervals (CI). Models were adjusted for the following covariates at cohort entry: age, sex, deprivation, anxiety, depression and serious mental ill health.

          Results: The average age at cohort entry was 23.4 years and the median follow was 2.2 years. There was an increased risk of developing fibromyalgia (aIRR 2.06; 95% CI 1.71–2.48), chronic fatigue syndrome (1.47; 1.08–2.00), chronic lower back pain (1.99; 1.68–2.35), restless leg syndrome (1.82; 1.41–2.35) and irritable bowel syndrome (1.15; 1.08–1.22) when compared to the unexposed group, whereas no statistical association was seen with the development of temporomandibular joint disorder (1.00; 0.88–1.13), chronic headache (1.04; 0.59–1.86), interstitial cystitis (1.19; 0.51–2.74), vulvodynia (0.65; 0.34–1.26), chronic prostatitis (0.34; 0.07–1.77) and myofascial pain syndrome (0.88; 0.36–2.14). Outcome numbers were low, most likely, due to the rarity of visceral conditions (aside from irritable bowel syndrome). The association between a history of childhood maltreatment and CSS were mainly observed in somatic CSS.

          Interpretation: The debilitating effects of CSS carry a substantial physical, psychological and economic burden to both the individuals who are diagnosed with them and the health services who serve them. Primary prevention approaches targeting childhood maltreatment as well as secondary preventative approaches should be considered to minimise the associated burden of CSS.

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          Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis

          Summary Background An increasing number of studies are identifying associations between adverse childhood experiences (ACEs) and ill health throughout the life course. We aimed to calculate the proportions of major risk factors for and causes of ill health that are attributable to one or multiple types of ACE and the associated financial costs. Methods In this systematic review and meta-analysis, we searched for studies in which risk data in individuals with ACEs were compared with these data in those without ACEs. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and the Education Resources Information Center) for quantitative studies published between Jan 1, 1990, and July 11, 2018, that reported risks of health-related behaviours and causes of ill health in adults that were associated with cumulative measures of ACEs (ie, number of ACEs). We included studies in adults in populations that did not have a high risk of ACEs, that had sample sizes of at least 1000 people, and that provided ACE prevalence data. We calculated the pooled RR for risk factors (harmful alcohol use, illicit drug use, smoking, and obesity) and causes of ill health (cancer, diabetes, cardiovascular disease, respiratory disease, anxiety, and depression) associated with ACEs. RRs were used to estimate the population-attributable fractions (PAFs) of risk attributable to ACEs and the disability-adjusted life-years (DALYs) and financial costs associated with ACEs. This study was prospectively registered in PROSPERO (CRD42018090356). Findings Of 4387 unique articles found following our initial search, after review of the titles (and abstracts, when the title was relevant), we assessed 880 (20%) full-text articles. We considered 221 (25%) full-text articles for inclusion, of which 23 (10%) articles met all selection criteria for our meta-analysis. We found a pooled prevalence of 23·5% of individuals (95% CI 18·7–28·5) with one ACE and 18·7% (14·7–23·2) with two or more ACEs in Europe (from ten studies) and of 23·4% of individuals (22·0–24·8) with one ACE and 35·0% (31·6–38·4) with two or more ACEs in north America (from nine studies). Illicit drug use had the highest PAFs associated with ACEs of all the risk factors assessed in both regions (34·1% in Europe; 41·1% in north America). In both regions, PAFs of causes of ill health were highest for mental illness outcomes: ACEs were attributed to about 30% of cases of anxiety and 40% of cases of depression in north America and more than a quarter of both conditions in Europe. Costs of cardiovascular disease attributable to ACEs were substantially higher than for most other causes of ill health because of higher DALYs for this condition. Total annual costs attributable to ACEs were estimated to be US$581 billion in Europe and $748 billion in north America. More than 75% of these costs arose in individuals with two or more ACEs. Interpretation Millions of adults across Europe and north America live with a legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of 3 million DALYs or $105 billion. Programmes to prevent ACEs and moderate their effects are available. Rebalancing expenditure towards ensuring safe and nurturing childhoods would be economically beneficial and relieve pressures on health-care systems. Funding World Health Organization Regional Office for Europe.
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            Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates.

            The degree of generalisability of patient databases to the general population is important for interpreting database research. This report describes the representativeness of The Health Improvement Network (THIN), a UK primary care database, of the UK population. Demographics, deprivation (Townsend), Quality and Outcomes Framework (QOF) condition prevalence and deaths from THIN were compared with national statistical and QOF 2006/2007 data. Demographics were similar although THIN contained fewer people aged under 25 years. Condition prevalence was comparable, e.g. 3.5% diabetes prevalence in THIN, 3.7% nationally. More THIN patients lived in the most affluent areas (23.5% in THIN, 20% nationally). Between 1990 and 2009, standardised mortality ratio ranged from 0.81 (95% CI: 0.39-1.49; 1990) to 0.93 (95% CI: 0.48-1.64; 1995). Adjusting for demographics/deprivation, the 2006 THIN death rate was 9.08/1000 population close to the national death rate of 9.4/1000 population. THIN is generalisable to the UK for demographics, major condition prevalence and death rates adjusted for demographics and deprivation.
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              Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes.

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                Author and article information

                Contributors
                Journal
                EClinicalMedicine
                EClinicalMedicine
                EClinicalMedicine
                Elsevier
                2589-5370
                06 June 2020
                June 2020
                06 June 2020
                : 23
                : 100392
                Affiliations
                [a ]Warwick Medical School, University of Warwick, Coventry CV47HL, United Kingdom
                [b ]Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
                [c ]Arthritis Research, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
                [d ]Centre of Crime, Justice and Policing, The Department of Economics, University of Birmingham, B152TT, United Kingdom
                [e ]Child Protection, School of Nursing, College of Medical and Dental Sciences, University of Birmingham, B152TT, United Kingdom
                [f ]Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, United Kingdom
                [g ]Midlands Health Data Research UK, University of Birmingham B152TT, United Kingdom
                Author notes
                [* ]Corresponding author at: Institute of Applied Health Research, College of Medical and Dental sciences, University of Birmingham, B152TT k.nirantharan@ 123456bham.ac.uk
                [1]

                Equal Contribution.

                Article
                S2589-5370(20)30136-X 100392
                10.1016/j.eclinm.2020.100392
                7329705
                32637892
                3297ffe5-a60b-4ca5-ab77-0509445f0130
                © 2020 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 9 February 2020
                : 5 May 2020
                : 6 May 2020
                Categories
                Research paper

                childhood maltreatment,central sensitivity syndromes,epidemiology,primary care

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