The co-occurrence of diabetes and adverse childhood experiences and its impact on mortality in US adults

Background: Diabetes is a leading cause of death in the US. Adverse childhood experiences (ACEs) have also been linked to increased mortality. ACEs are associated with the development of diabetes however the amplified effect on mortality has not been studied. Methods: Data from Midlife development in the United States (MIDUS), from 1995 to 1996 (Wave 1), 2004-2006 (Wave 2), and 2011-2014 (Wave 3) were used with a total of 3023 participants. Survey Cox proportional hazards regression models were used to calculate all-cause mortality. Univariate and multivariable Cox models were performed for the four combinations of diabetes and ACE categories, with estimation of hazard ratio completed for each. Results: After adjusting for covariates and comorbidity burden, 'ACE only' was not significantly different in mortality compared to 'no diabetes and no ACE'. 'Diabetes only' had a 78% higher mortality (HR 1.78, 95% CI 1.04-3.04) compared to 'no diabetes and no ACE'. 'Diabetes and ACE' had a 132% higher mortality (HR 2.32, 95% CI 1.64-3.28) compared to 'no diabetes and no ACE.' Limitations: ACE and diabetes measures are self-report, and while longitudinal a temporal relationship cannot be established. Therefore, future research should collect prospective data to investigate mechanisms for this association based on observational data. Conclusions: Results showed a strong association between 'diabetes and ACE' and mortality with a pronounced difference between both 'ACE only' and 'diabetes only' after 20-year follow-up. These results suggest an amplified effect of diabetes and ACE on mortality for adults who have experienced ACEs.