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Relationship Between Childhood Adversity, Adult Hardships, And Surgery Among Patients With Peripheral Arterial Disease
Natalie Hmeluk, Martina Jelley, MD, MSPH, FACP, Juell Homco, PhD, MPH, Nicholas Hollman, MPH, Peter R. Nelson, MD, MS, Julie Miller-Cribbs, MSW, PhD, Wato Nsa, MD, PhD, Arad Abadi, MD, Prashanth Iyer, MD, Kimberly Zamor, MD, MS, RPVI, Fernando Motta, MD, Kelly Kempe, MD.
University of Oklahoma, Tulsa, OK, USA.
OBJECTIVES: Childhood abuse, neglect, and household dysfunction, collectively known as adverse childhood experiences (ACEs), are strongly correlated with the progression of multiple diseases, including cardiovascular disease. ACEs often contribute to adult hardships and increase the risk of health-risk behaviors (e.g., tobacco use), chronic disease, and social problems. No study to date has examined the relationship between ACEs and adult hardships among patients with peripheral arterial disease (PAD). In this study, we explore the relationship between childhood adversity, adult hardships, and PAD-related health outcomes, such as surgical procedures, among patients with PAD.
METHODS: In this survey-based, cross-sectional study, individuals with PAD were recruited at an academic vascular surgery clinic. The survey included 5 questions related to adult hardships—self-reported financial, food, medical, and house insecurity in the past year—and 10 questions based on the original CDC-Kaiser ACEs study. Surgical procedure data were collected from patient charts. Wilcoxon Rank Sum tests were used to assess the relationship between ACE scores and material adult hardships. Pearson chi-square tests were used to evaluate the relationship between ACEs and the total number of surgeries.
RESULTS: A total of 118 participants with PAD completed the survey. The majority of the sample identified as male gender (55.9%, n=66) and White (64.4%, n=76). Among the group, 39.8% (
n=47) reported experiencing no ACEs, 21.2% (
n=25) reported one ACE, 12.7% (
n=15) reported two ACEs, 11.0% (
n=13) reported three ACEs, and 15.3% (
n=18) reported at least four ACEs. The median ACE score was significantly higher for those who reported the following hardships compared to those who did not: not getting enough to eat (Mdn=3.0 vs. 1.0,
p < 0.001), being behind on bills (Mdn=2.0 vs. 0.0,
p < 0.001), and experiencing disconnected utilities (Mdn=2.5 vs. 1.0,
p = 0.001). A significant association was noted between reporting ≥ 4 ACEs and having ≥ 1 vascular surgery compared to patients who experienced 0 - 3 ACEs (
p=0.047; 77.8% vs. 52.5%).
CONCLUSIONS: Our findings suggest that a higher number of ACEs may indirectly contribute to an individual’s risk for vascular surgery intervention in a patient population with PAD. While the results may be correlative, and not causative, these findings warrant further studies to elucidate the role of ACEs and hardships versus other risk factors on PAD-related vascular surgery interventions.
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