title: Childhood adversity, adult neighborhood context, and cumulative biological risk for chronic diseases in adulthood.
abstract: OBJECTIVE
  We examined the association between childhood adversity and cumulative biological risk for a variety of chronic diseases in adulthood, and whether this association varied by neighborhood affluence.
  
  
  METHODS
  Data were drawn from the Chicago Community Adult Health Study (2001-2003), a cross-sectional probability sample that included interviews and blood collection (n = 550 adults). A childhood adversity score was calculated from eight items. Neighborhood affluence was defined using Census data. An index to reflect cumulative biological risk was constructed as a count of eight biomarkers above clinically established thresholds, including systolic and diastolic blood pressure, resting heart rate, C-reactive protein, waist circumference, hemoglobin A1c, and total and high-density lipoprotein cholesterol. Generalized linear models with a Poisson link function were used to estimate incident rate ratios (IRRs).
  
  
  RESULTS
  A 1-standard-deviation increase in the childhood adversity score was associated with a 9% increase in cumulative biological risk, after adjustment for demographic and behavioral characteristics (IRR = 1.09, 95% confidence interval (CI) = 1.02-1.17). This association was modified by neighborhood affluence (IRR = 0.92, 95% CI = 0.86, 0.99). Stratified models indicated that childhood adversity was associated with elevated cumulative biological risk only among individuals who resided in low-affluence (bottom tertile) neighborhoods (IRR = 1.16, 95% CI = 1.05, 1.28); there was no association in high-affluence (top tertile) neighborhoods (IRR = 0.97, 95% CI = 0.83, 1.14).
  
  
  CONCLUSIONS
  Childhood adversity is associated with elevated cumulative biological risk in adulthood, and neighborhood affluence may buffer this association. Results demonstrate the importance of neighborhood characteristics for associations between childhood adversity and disease risk, even after accounting for adult socioeconomic status.
authors: From the Department of Internal Medicine (N.S., M.A.A.), Howard University College of Medicine, Washington, DC; Department of Anthropology (A.N.), Vanderbilt University, Nashville, Tennessee; Department of Social and Behavioral Sciences (D.R.W., A.L.R.), Harvard School of Public Health, Boston, Massachusetts; and Department of African and African American Studies (D.R.W.), Harvard University, Boston, Massachusetts.
authors: Natalie
authors: N
authors: Slopen
authors: Amy
authors: A
authors: Non
authors: David R
authors: DR
authors: Williams
authors: Andrea L
authors: AL
authors: Roberts
authors: Michelle A
authors: MA
authors: Albert
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D002641:Chicago / Q000453:epidemiology; D002648:Child; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006339:Heart Rate; D006801:Humans; D016012:Poisson Distribution; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D002784:Cholesterol; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human