Risk of Cardiometabolic Disease and All-Cause Mortality in Female Survivors of Domestic Abuse

Abstract

Background Domestic abuse (DA) against women is a global public health problem. Although the possible health burden could be substantial, the associations between DA and subsequent cardiometabolic disease (cardiovascular disease, hypertension, and type 2 diabetes mellitus) and all-cause mortality are poorly understood. Methods and Results This retrospective cohort study consisted of UK-based primary care patients between January 1, 1995, to December 1, 2017. Overall, 18 547 women exposed to DA were matched to 72 231 unexposed women by age and lifestyle factors. The main outcomes, presented as adjusted incidence rate ratios (IRRs), were the risk of developing cardiovascular disease, hypertension, type 2 diabetes mellitus, and all-cause mortality. In total, 181 exposed women experienced a cardiovascular disease event compared with 644 of the unexposed control group, relating to an increased adjusted IRR of 1.31 (95% CI, 1.11-1.55; P=0.001). There was also an increased risk of subsequent type 2 diabetes mellitus (adjusted IRR: 1.51; 95% CI, 1.30-1.76; P<0.001) and all-cause mortality (adjusted IRR: 1.44; 95% CI, 1.24-1.67; P<0.001) following exposure to DA. This observation was not seen with hypertension (adjusted IRR: 0.99; 95% CI, 0.88-1.12; P=0.873). Conclusions There is an increased risk of subsequent cardiovascular disease, type 2 diabetes mellitus, and all-cause mortality in female survivors of DA. However, there is no association with the development of hypertension in this group, in keeping with previous literature. Considering the high prevalence of DA, clinicians should be made aware of the disproportionally increased risk and thus are encouraged to manage modifiable risk factors actively in this group.

Keywords: cardiovascular disease; domestic abuse; epidemiology; hypertension; type 2 diabetes mellitus.

Figure 1

Cardiometabolic disease risk. aIRR indicates adjusted incidence rate ratio.