Background Adverse childhood experiences (ACE) such as abuse, neglect and household challenges are associated with poorer adult health status and onset of rheumatic diseases. There has been no research associating ACE with outcomes among adults with systemic lupus erythematosus (SLE).
Objectives To characterize relationships of ACE and health outcomes of disease activity, damage, quality of life and depression in SLE patients.
Methods Data were derived from the California Lupus Epidemiology Study (CLUES), a population based, multi-ethnic cohort of patients with SLE. Participants completed self-report measures of SLE activity (Systemic Lupus Activity Questionnaire; SLAQ), damage (Brief Index of Lupus Damage; BILD), quality of life (SF-36), depression (Patient Health Questionnaire; PHQ8) and sociodemographics. They completed the Adverse Childhood Experiences (ACE) survey, a validated 10-item scale covering 3 domains (abuse, neglect and household challenges prior to age 18). We compared demographics and SLE outcomes by ACE score and domains using ANOVA.
Results The 166 CLUES participants were mostly women (89%) and were racially/ethnically diverse (31% non-Hispanic White, 22% Hispanic, 15% African American, 31% Asian American). Mean age was 44±14; mean age at diagnosis 28±12. The median ACE score was 1; 30 (18%) had a score of 4 or higher. ACE scores ≥4 were more common in Hispanic (27%) and African American (32%) participants (p=0.01) compared to other races/ethnic groups, and in participants with poverty level incomes (61% vs 13%, p<0.001); but did not differ by education or age at study entry or diagnosis. Higher overall ACE scores were associated with greater SLE activity and damage, poorer quality of life, and higher levels of depressive symptoms. For each ACE domain, increasing scores were generally associated with worse outcomes, but did not always reach statistical significance (Table).
Conclusions Adverse childhood experiences are reported frequently in individuals with SLE; accumulation of adverse experiences is associated with poor SLE outcomes. Higher scores in each domain, especially childhood neglect or abuse, were associated with poorer health measures in adulthood. Further research regarding ACE patterns and SLE outcomes is warranted.
Disclosure of Interest None declared