Adverse childhood experiences, adult hardships, and disease severity in peripheral artery disease.

Abstract

Childhood abuse, neglect, and household dysfunction, collectively known as adverse childhood experiences (ACEs), are strongly associated with the development of severe outcomes from chronic diseases, including ischemic heart attacks and stroke. ACEs also contribute to a higher risk of adult hardships, which increases the risk of health risk behaviors, chronic disease, and social problems. In this study, we describe the period prevalence of ACEs in a patient population with peripheral artery disease (PAD) and explore the relationship between childhood adversity, adult hardships, and PAD severity, such as the need for surgical procedures, among patients with PAD. In this survey-based, cross-sectional study, individuals with PAD were recruited at an academic outpatient vascular surgery clinic (2022-2025). The survey included five questions about adult hardships-self-reported financial, food, medical, and housing insecurity in the past year-and 10 questions based on the original Centers for Disease Control and Prevention-Kaiser Permanente ACE study. We collected cardiovascular disease-related and amputation surgical procedure data from patient charts. PAD severity was determined by minor (eg, peripheral stent) or major (eg, amputation) surgical procedures and ankle-brachial index and toe-brachial index scores. The Wilcoxon rank-sum test and Fisher exact and χ² tests were used to assess differences in ACE or adult hardship scores as either continuous or categorical variables, respectively, in relation to cardiovascular disease-related surgical procedures. A total of 138 participants with PAD were included in the final analysis. Most respondents identified as male (55.8%, n = 77) and White (65.9%, n = 91). For childhood adversity, 37.0% (n = 51) reported experiencing no ACEs, 24.6% (n = 34) reported one ACE, 10.9% (n = 15) reported two ACEs, 10.1% (n = 14) reported three ACEs, and 17.4% (n = 24) reported at least four ACEs. The patient characteristics associated with a high number of ACEs included women, single individuals, Black individuals, and those living in poverty. The median ACE score was significantly higher for those who reported the following adult hardships compared with those who did not: not getting enough to eat (median, 3.0 vs 1.0; P < .001), being behind on bills (median, 2.0 vs 0.0; P < .001), and experiencing disconnected utilities (median, 3.0 vs 1.0; P = .001). No statistically significant association was noted between reporting ACEs and PAD severity or adult hardships and PAD severity. Our findings suggest that a greater number of ACEs may indirectly contribute to an individual's risk for adult hardships in the PAD population, potentially placing these patients at higher risk of poor health outcomes. We did not find evidence to support a significant relationship between ACEs and PAD severity. Additional modifiable risk factors deserve ongoing analysis for improved management of patients with PAD.