OBJECTIVES:
Childhood adversity affects the cardiovascular health of adults (Gilbert et al., 2010). Our aim is to examine the effect of childhood adversity on cardiovascular health, how they get affected by sex and race/ethnicity.
HYPOTHESIS:
1. Childhood adversity is associated with increased risk of cardiometabolic diseases
2. Childhood adversity and CVD mortality is higher in women compared to men
3. Exposure to childhood adversity and cardiometabolic diseases is greater in Non-Hispanic Black/African American compared to other races.
STUDY POPULATION:
Data will be from Behavioral Risk Factor Surveillance System (BRFSS), a joint project between all states of the United States(US), participating US territories, and the Centers for Disease Control and Prevention (CDC)
. The Behavioral Risk Factor Surveillance System (BRFSS) is controlled by the CDC’s Population Health Surveillance Branch, controlled under the Division of Population Health at the CDC’s National Center for Chronic Disease (Binkin et al., 2010). The participants in these projects are 18 years or above and are residing in the United States. These data are collected over telephone surveys that are responsible to gather the data on health-related risk behavior, chronic health conditions, and usage of preventive solutions from the noninstitutionalized adult those who are of age 18 or above.
In the year 2019, American Community Survey (ACS) claimed that 99% of all occupied homes in the United States(US) had gone through telephone service available and noncoverage telephone surveys ranged from less than 1% in several states to 1.6% in South Dakota. In contrast, approximately 3.5% homes in Puerto Rico did not go through any telephone service (Ryan & Lewis, 2017).
OUTCOMES:
A standard set of Behavioral Risk Factor Surveillance System Questionnaires are used to assess the risk of cardiovascular disease. The core component of the question includes queries about Health-related behaviors, perceptions, and conditions, such :(the use of tobacco, consumption of alcohol, food consumption, and status of health). It also includes the annual core questions and rotating core questions, that are asked each even and odd-numbered year.
The set of optional BRFFS modules is used to evaluate if any participants are diagnosed or have any symptoms of cardiovascular disease (CVD). During the interview, the Participants were asked if they encountered any of the symptoms mentioned in the above questions. For Example - “Have you ever felt pain in your chest, ever
been diagnosed with a Heart Attack?” or “Smoking Habits''. The person will have cardiovascular disease if the person has more than 4 health problems and more than 4 symptoms in the cardiovascular assessment, coded as 1. If the person has less than 4 health problems and less than 4 symptoms in the cardiovascular assessment, it will be coded as 0.
EXCLUSIONS:
Those participants will be excluded if, on any covariates, their data are missing.
EXPOSURES:
The Adverse childhood experiences, may include any form of abuse, unstable living conditions and adverse childhood experiences while growing up(upbringing).The adverse childhood experiences include-Did you live with anyone who was depressed, mentally ill, or suicidal?, Did you live with anyone who was a problem drinker or alcoholic?, Live With Anyone Who Used Illegal Drugs or Abused Prescriptions?, Live With Anyone Who Served TIme in Prison or Jail?, Live With Anyone Who Served Time in Prison or Jail?, Were Your Parents Divorced/Separated? How Often Did Your Parents Beat Each Other Up?, How Often Did A Parent Physically Hurt You In Any Way?, How often did a parent or adult in your home ever swear at you, insult you, or put you down?, How often did anyone at least 5 years older than you or an adult, ever touch you sexually?, How often did anyone at least 5 years older than you or an adult, force you to have sex?. Every yes, a person responds to, they gain a point, 11 being the highest and 0 being the lowest. Adverse childhood adversity will be considered associated with cardiovascular health if the score is more than 5, coded as 1. It will be coded as 0, is the count is less than 5, meaning not associated with childhood adversity.
ANALYSIS PLAN:
The distributions of all important variables will be examined, and variables will be categorized as needed. Bivariate analyses will be carried out using basic logistic regression. Following that, multiple logistic regression models will be constructed, including adjustments for important confounders. To account for changes in participant selection probability and to ensure comparability between the study sample and the public, all analyses will be weighted.
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