title: Cumulative childhood stress and autoimmune diseases in adults.
abstract: OBJECTIVE
  To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult.
  
  
  METHODS
  Retrospective cohort study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 in San Diego, California, and eligible for follow-up through 2005. ACEs included childhood physical, emotional, or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. The total number of ACEs (ACE Score range = 0-8) was used as a measure of cumulative childhood stress. The outcome was hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings: T- helper 1 (Th1) (e.g., idiopathic myocarditis); T-helper 2 (Th2) (e.g., myasthenia gravis); Th2 rheumatic (e.g., rheumatoid arthritis); and mixed Th1/Th2 (e.g., autoimmune hemolytic anemia).
  
  
  RESULTS
  Sixty-four percent reported at least one ACE. The event rate (per 10,000 person-years) for a first hospitalization with any autoimmune disease was 31.4 in women and 34.4 in men. First hospitalizations for any autoimmune disease increased with increasing number of ACEs (p < .05). Compared with persons with no ACEs, persons with >or=2 ACEs were at a 70% increased risk for hospitalizations with Th1, 80% increased risk for Th2, and 100% increased risk for rheumatic diseases (p < .05).
  
  
  CONCLUSIONS
  Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood. These findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, 4770 Buford Highway, N.E., MS K-50, Atlanta, GA 30341-3717, USA. skd7@cdc.gov
authors.forename: Shanta R
authors.initials: SR
authors.lastname: Dube
authors.forename: DeLisa
authors.initials: D
authors.lastname: Fairweather
authors.forename: William S
authors.initials: WS
authors.lastname: Pearson
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Felitti
authors.forename: Robert F
authors.initials: RF
authors.lastname: Anda
authors.forename: Janet B
authors.initials: JB
authors.lastname: Croft
mesh_terms: D000328:Adult; D032721:Adult Children / Q000523:psychology; D000744:Anemia, Hemolytic, Autoimmune / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000523:psychology; D001327:Autoimmune Diseases / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000523:psychology; D002140:California / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data; D015331:Cohort Studies; D004198:Disease Susceptibility; D004243:Divorce; D017579:Domestic Violence; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000503:physiopathology / Q000523:psychology; D008222:Lymphokines / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000523:psychology; D012216:Rheumatic Diseases / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D011795:Surveys and Questionnaires; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology
chemical_list: D008222:Lymphokines