Racial-ethnic differences in associations between traumatic childhood experiences and both metabolic syndrome prevalence and type 2 diabetes mellitus risk among a cohort of US women
Objective: Childhood adversity has been associated with metabolic syndrome (MetS) and type 2 diabetes risk in adulthood. However, studies have yet to investigate traumatic childhood experiences (TCEs) beyond abuse and neglect (e.g., natural disaster) while considering potential racial-ethnic differences.
Research Design and Methods: To investigate race-ethnicity as a potential modifier of the TCEs-MetS-type 2 diabetes association, we used prospectively collected data from 42,173 eligible non-Hispanic White (NHW [88%]), Black/African American (BAA [7%]), and Hispanic/Latina (4%) Sister Study participants (aged 35-74 years) enrolled from 2003-2009. A modified Brief Betrayal Trauma Survey captured TCEs. At least three prevalent metabolic abnormalities defined MetS, and self-report of a new diagnosis during the study period defined type 2 diabetes. We used adjusted Cox Proportional Hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for type 2 diabetes over a mean ± SD follow-up of 11.1 ± 2.7 years, overall and by race-ethnicity. We also tested for modification and mediation by MetS.
Results: Incident cases of type 2 diabetes were reported (2,479 among NHWs, 461 among BAAs, and 281 among Latinas). Reporting any TCEs (50% among NHWs, 53% among BAAs, and 51% among Latinas) was associated with a 13% higher type 2 diabetes risk (HR=1.13 [95% CI: 1.04-1.22]). Associations were strongest among Latinas (HR=1.64 [1.21-2.22] vs. HRs=1.09 for BAAs and NHWs). MetS was not a modifier but mediated (indirect effect: HR=1.01 [1.00-1.01], p=0.02) the overall association.
Conclusions: TCE-type 2 diabetes associations varied by race-ethnicity and were partially explained by MetS.
