一生中创伤暴露与老年人关节炎。
Lifetime Trauma Exposure and Arthritis in Older Adults.
机构信息
From the San Francisco Veterans Affairs Health Care System (Nishimi, Schmajuk, Neylan, O'Donovan); Department of Psychiatry and Behavioral Sciences, University of California San Francisco (Nishimi, Neylan, O'Donovan), San Francisco, California; Department of Epidemiology, Boston University School of Public Health (Chen), Boston, Massachusetts; and Departments of Medicine (Schmajuk) and Neurology (Neylan), University of California San Francisco, San Francisco, California.
出版信息
Psychosom Med. 2024 Oct 1;86(8):670-680. doi: 10.1097/PSY.0000000000001331. Epub 2024 Jul 2.
OBJECTIVE
Experiencing potentially traumatic events across one's lifecourse increases risk for poor physical health outcomes. Existing models emphasize the effects of any lifetime trauma exposure, risk accumulation (multiple traumas over time), and sensitive periods of exposure (specific exposure timepoints leading to lasting consequences). We examined how different indices of trauma exposure across the lifecourse were associated with later life arthritis, a common and debilitating health condition.
METHODS
Data include 5717 Health and Retirement Study participants (age mean [standard deviation] = 65.4 [12.9] years) who reported on lifetime adversity and trauma in 2006-2008. Lifetime trauma exposure was modeled as any trauma, accumulation of traumas, and lifecourse profiles (no exposure, childhood only, adulthood only, childhood and adulthood exposure). Outcomes included prevalent arthritis at baseline and incident arthritis across 12 years of follow-up. Covariate-adjusted generalized linear models for prevalence ratios and Cox proportional hazards models for hazard ratios were conducted.
RESULTS
Any lifetime trauma was associated with both prevalent arthritis at baseline (prevalence ratio = 1.13, 95% confidence interval = 1.05-1.22) and incident arthritis over 12 years (hazard ratio = 1.25, 95% confidence interval = 1.17-1.47). Greater trauma accumulation was significantly associated with both prevalent and incident arthritis. Childhood exposure was particularly strongly associated with prevalent and incident cases, with adulthood exposure being unassociated with incident arthritis. Across models, trauma exposure was associated with prevalent cases of both immune-related and osteoarthritis types.
CONCLUSIONS
Higher lifetime trauma burden, especially during childhood, may predispose individuals to arthritis later in life. Early intervention or prevention efforts should identify trauma as an important risk factor for musculoskeletal health across the lifecourse.
目的
一生中经历潜在创伤性事件会增加身体健康状况不佳的风险。现有模型强调了任何终生创伤暴露、风险积累（随着时间的推移多次创伤）和敏感暴露期（特定的暴露时间点导致持久的后果）的影响。我们研究了一生中不同的创伤暴露指数与晚年关节炎（一种常见的、使人衰弱的健康状况）之间的关系。
方法
数据包括 5717 名健康与退休研究参与者（年龄平均[标准差]=65.4[12.9]岁），他们在 2006-2008 年报告了一生中的逆境和创伤。终生创伤暴露被建模为任何创伤、创伤积累和生命历程特征（无暴露、仅儿童期、仅成年期、儿童期和成年期暴露）。结果包括基线时的现患关节炎和 12 年随访期间的新发关节炎。进行了调整协变量的广义线性模型以获得患病率比，以及 Cox 比例风险模型以获得风险比。
结果
任何一生中的创伤都与基线时的现患关节炎（患病率比=1.13，95%置信区间=1.05-1.22）和 12 年内的新发关节炎（风险比=1.25，95%置信区间=1.17-1.47）有关。更多的创伤积累与现患和新发关节炎都有显著的相关性。儿童期暴露与现患和新发病例特别密切相关，而成年期暴露与新发关节炎无关。在所有模型中，创伤暴露与免疫相关和骨关节炎类型的现患病例都有关。
结论
更高的终生创伤负担，尤其是在儿童时期，可能使个体在以后的生活中易患关节炎。早期干预或预防措施应将创伤视为一生中影响肌肉骨骼健康的一个重要危险因素。
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