Childhood adversities experienced by working-aged coronary heart disease patients

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Abstract

Objective

The aim of this study is to investigate associations between childhood adversities and coronary heart disease (CHD).

Methods

This was a case-control study based on a postal questionnaire addressed to randomly selected working-aged Finns, and response rate was 39% (N=15,477). The sample comprised 319 CHD patients. Four age- and gender-matched controls were selected for every patient. The participants were asked in six questions to think about their childhood adversities.

Results

Fear of some family member and someone in the family being seriously or chronically ill were more common during childhood among working-aged CHD patients than among controls. Likewise, among female CHD patients, serious conflicts in the family and someone in the family having had alcohol problems and, among male CHD patients, long-lasting financial problems were more common than among controls. Odds ratios (OR) varied between 1.27 and 2.66. Adjustment for education had no influence among women, but it had an influence among men. Upon adjustment for conventional risk factors (smoking, obesity, and hypertension), the association mostly disappeared. A family member having been seriously or chronically ill was statistically significant after full adjustment among both genders.

Conclusion

Working-aged CHD patients have experienced more dramatic events during their childhood than did the control population. This issue cannot be solved in doctors' offices. Health-promoting social policies are of vital importance.

Introduction

It has been reported that increasing numbers of various work stressors and divorce are associated with total and cardiovascular mortality among men [1]. Some stressors (abuse history, lifetime traumas, turmoil in childhood family, and recent stressful life events) have been found to be related to poor health status [2]. In addition, emotional disturbance has been found to be a significant risk factor for coronary heart disease (CHD; [3]). Genetic factors have a significant role, but behaviours bear a complex relationship to the onset, maintenance, and progression as well as elimination of cardiovascular risk factors [4]. Even a dose–response relation of adverse childhood events, such as abuse, neglect, and household dysfunction, to ischemic heart disease has been found [5].

Traumatic events are without dispute associated with CHD. We already know that economic problems during childhood are associated with current health, and the association of childhood social problems with health is, in fact, somewhat weaker and less consistent than that of economic problems [6]. However, social variation is seen in some CHD risk factors in young people [7], and furthermore, there are socioeconomic inequalities in cases of self-reported chest pain [8].

It is possible that life events during adulthood are consequences of the disease, but life events during childhood cannot be. However, we know very little regarding the way childhood adversities involving financial problems, conflicts in the family, alcohol problems, and matters of personal security are associated with CHD. We examined the issue from this point of view in a nationwide sample in Finland.

Section snippets

Material and methods

The Health and Social Support study (HeSSup) is a prospective study on the psychosocial health of the Finnish working-aged population. The HeSSup population consisted of a random sample of 52,739 individuals drawn from the Finnish Population Register in four age groups: 20–24, 30–34, 40–44, and 50–54. The survey was carried out by postal questionnaire during the year 1998. Forms were returned by 21,101 individuals (approximately 5000 in each age group), a response rate of 40.0% (42.7% in 20–24,

Results

The most common childhood adversities had been long-lasting financial difficulties in the family and someone in the family seriously or chronically ill (Table 3). Almost half of the CHD patients reported these. Among the controls, over 10 percentage points fewer reported the same.

One in three had experienced serious conflicts and someone in the family had problems with alcohol (Table 3). Among the controls, 7 to 8 percentage points fewer reported the same. One in five had often been afraid of

Discussion

The principal finding in this study was that CHD patients have experienced significantly more childhood adversities than did the general population. Life events include not only family problems but also financial problems and those concerning personal security. It is also noteworthy that some of the adversities seem to be associated specifically with CHD because they were almost independent of the traditional risk factors such as smoking, hypertension, and obesity. Nor did low education have a

References (18)

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