Domestic abuse elevates risk for CVD, diabetes, all-cause mortality
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Women who survived domestic abuse were found to be at greater risk for developing CVD, type 2 diabetes and all-cause mortality compared with women who did not experience abuse.
According to research published in the Go Red for Women issue of the Journal of the American Heart Association, women who have been noted by general practitioners to have been exposed to domestic abuse experienced increased risk for CVD (adjusted incidence rate ratio [aIRR] = 1.31; 95% CI, 1.11-1.55), subsequent type 2 diabetes (aIRR = 1.51; 95% CI, 1.3-1.76) and all-cause mortality (aIRR = 1.44; 95% CI, 1.24-1.67) compared with women who were not identified as having been exposed to domestic abuse.
However, domestic abuse exposure did not correlate with an increase in the development of hypertension (aIRR = 0.99; 95% CI, 0.88-1.12).
“The findings should serve as a reminder to all clinicians to consider the impact of domestic abuse on the health of their patients,” Joht Singh Chandan, MFPH, MBBS, FHEA, BSc, academic clinical fellow on the West Midlands public health registrar training scheme at the University of Birmingham, U.K., told Healio. “The findings should also serve as a reminder to ensure clinicians are asking about potential exposure to domestic abuse in women whom they have concerns about to ensure necessary safeguards can be put in place to protect and support these women.”
At baseline, the domestic abuse survivors also had a higher incidence of excessive drinking compared with the unexposed group (10.1% vs. 3.5%) and a greater proportion of baseline type 2 diabetes (2.5% vs. 2%). In addition, survivors were more likely to have at least one comorbidity at baseline (22.3% vs. 18.2%) and had higher prevalence of hypertension (6% vs. 5.7%) and greater use of lipid-lowering medications at baseline (5.2% vs. 4.7%).
“We need to take a public health approach to domestic abuse which includes improving the way we identify and detect abuse, as well as implement safeguards to prevent the associated negative consequences,” Chandan said in an interview. “It is important for clinicians at any point to understand the potential signs and symptoms associated with domestic abuse and look to enquire with their patients as to any such experiences, following which to document their findings and also refer their patients to the appropriate support services.”
For this retrospective cohort study, researchers assessed data from the Health Improvement Network database to identify women coded with previous exposure to domestic abuse (mean age, 37 years; mean follow-up, 2 years) between 1995 and 2017. This analysis matched each woman from the exposed group by age and lifestyle to four women from an unexposed group from the same database.
“Further research is required to improve our understanding of the biological pathways that link abusive experiences and the developing of cardiometabolic disease,” Chandan told Healio. “Possible hypotheses relate to the role of stress on the body following traumatic exposures, lifestyle factors such as alcohol intake, obesity and smoking mediating the relationship or mental ill health precipitating. However, more research is needed to understand the exact role these factors play on the relationship.” – by Scott Buzby
For more information:
Joht Singh Chandan, MFPH, MBBS, FHEA, BSc, can be reached at joht.chandan@nhs.net; Twitter: @JohtChandan.
Disclosures: The authors report no relevant financial disclosures.
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