COVID-19 Pandemic
Adverse Childhood Experiences (ACEs) and COVID-19 severity: a multinational study Mary M Barker* Mary Barker Yue Wang Kadri Kõiv Nora P Skjerdingstad Omid V Ebrahimi Helga Ask Kelli Lehto Thor Aspelund Fang Fang Unnur A Valdimarsdóttir
Aims: Exposure to adverse childhood experiences (ACEs) has been shown to be associated with COVID-19-related-hospitalization and -mortality. In this multinational study we aimed to investigate the associations between ACEs and both self-reported acute COVID-19 severity and long COVID, across four Nordic countries.
Method: Currently, data from the Omtanke2020 study (N=2,043) in Sweden and the Stress-And-Gene-Analysis (SAGA) cohort (N=12,345) in Iceland have been analyzed. ACE exposure was measured using modified versions of the Life Stressor Checklist-Revised and the Adverse Childhood Experiences International Questionnaire (ACE-IQ) in Sweden and Iceland, respectively. All included participants had been previously infected with COVID-19. Severe acute COVID-19 was defined as participants being bedridden due to COVID-19 for ≥7 days, while long COVID was defined as symptoms of COVID-19 lasting ≥3 months. Associations were explored using multivariable modified Poisson regression models in both cohorts, and regression-based causal mediation analysis in the SAGA cohort.
Results: Exposure to ≥1 ACE was associated with a higher prevalence of severe acute COVID-19 in both the Omtanke2020 (prevalence ratio [PR]: 1.42, 95% CI: 1.08-1.87) and SAGA cohorts. (PR: 1.73, 95% CI: 1.42-2.12). Similarly, participants exposed to ≥1 ACE had a higher prevalence of long COVID in both cohorts (Omtanke2020 – PR: 1.51, 95% CI: 1.15-1.99; SAGA – PR: 1.73, 95% CI: 1.46-2.05). Mediation analysis showed that >35% of the associations between ACEs and severe acute COVID-19/long COVID were explained by socioeconomic status, lifestyle, and/or pre-pandemic psychiatric or physical diagnoses.
Conclusions: Our results highlight the role of ACEs in both acute and long-term COVID-19-related outcomes. Next, we will conduct the analysis in three further Nordic cohorts: the Estonian Biobank, MoBa (Norway) and CIPA (Norway), and use meta-analyses to pool all cohort-specific results.