Adverse Childhood Experiences Related to Poor Adult Health among Lesbian, Gay, & Bisexual Individuals

OBJECTIVES:

We explored the association of sexual orientation with poor adult health outcomes before and after adjustment for exposure to adverse childhood experiences (ACEs).

METHODS:

Data were from the 2012 North Carolina, 2011 Washington, and 2011 and 2012 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding health risks, perceived poor health, and chronic conditions by sexual orientation and 8 categories of ACEs. There were 711 lesbian, gay, and bisexual (LGB) respondents and 29 690 heterosexual respondents.

RESULTS:

LGB individuals had a higher prevalence of all ACEs than heterosexuals, with odds ratios ranging from 1.4 to 3.1. After adjustment for cumulative exposure to ACEs, sexual orientation was no longer associated with poor physical health, current smoking, and binge drinking. Associations with poor mental health, activity limitation, HIV risk behaviors, current asthma, depression, and disability remained, but were attenuated.

CONCLUSIONS:

The higher prevalence of ACEs among LGB individuals may account for some of their excess risk for poor adult health outcomes. 

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By:   Austin A1, Herrick H1, Proescholdbell S1.

• 1At the time of the study, Anna Austin and Scott Proescholdbell were with the Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. Harry Herrick was with the Behavioral Risk Factor Surveillance System, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh. 

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Pulmonary Impairment in Tuberculosis Survivors: The Korean National Health and Nutrition Examination Survey 2008-2012

Pulmonary tuberculosis (TB) can affect lung function, but studies regarding long-term follow-up in patients with no sequelae on chest X-ray (CXR) have not been performed. We evaluated lung functional impairment and persistent respiratory symptoms in those with prior pulmonary TB and those with prior pulmonary TB with no residual sequelae on CXR, and determined risk factors for airflow obstruction.

We used data from adults aged ≥ 40 years from the annual Korean National Health and Nutrition Examination Surveys conducted between 2008 and 2012. P values for comparisons were adjusted for age, sex, and smoking status.

In total of 14,967 adults, 822 subjects (5.5%) had diagnosed and treated pulmonary TB (mean 29.0 years ago). The FVC% (84.9 vs. 92.6), FEV₁% (83.4 vs. 92.4), and FEV₁/FVC% (73.4 vs. 77.9) were significantly decreased in subjects with prior pulmonary TB compared to those without (p < 0.001, each). In 12,885 subjects with no sequalae on CXR, those with prior pulmonary TB (296, 2.3%) had significantly lower FEV₁% (90.9 vs. 93.4, p = 0.001) and FEV₁/FVC% (76.6 vs. 78.4, p < 0.001) than those without. Subjects with prior pulmonary TB as well as subjects with no sequalae on CXR were more likely to experience cough and physical activity limitations due to pulmonary symptoms than those without prior pulmonary TB (p < 0.001, each). In total subjects, prior pulmonary TB (OR, 2.314; 95% CI, 1.922–2.785), along with age, male, asthma, and smoking mount was risk factor for airflow obstruction. In subjects with prior pulmonary tuberculosis, inactive TB lesion on chest x-ray (OR, 2.300; 95% CI, 1.606–3.294) were risk factors of airflow obstruction.

In addition to subjects with inactive TB lesion on CXR, subjects with no sequelae on CXR can show impaired pulmonary function and respiratory symptoms. Prior TB is a risk factor for airflow obstruction and that the risk is more important when they have inactive lesions on chest X-ray. Hence, the patients with treated TB should need to have regular follow-up of lung function and stop smoking for early detection and prevention of the chronic airway disease.

Below: Lung functions according to the presence of prior pulmonary tuberculosis.

(A) In all study subjects; (B) In subjects with normal chest X-rays. FVC: forced vital capacity; FEV1: forced expiratory volume in 1 second.

Below:  Respiratory symptoms according to the presence of prior pulmonary tuberculosis.

(A) In all study subjects; (B) In subjects with normal chest X-rays. pvalues were adjusted for age, sex, and smoking status.

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By: Jae-Woo Jung, Jae-Chol Choi, Jong-Wook Shin, Jae-Yeol Kim, Byoung-Whui Choi, In-Won Park, Department of Internal medicine, Chung-Ang University College of Medicine, Seoul, Korea

  

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