Joht Singh Chandan, PhD

Credit: University of Birmingham

Domestic violence and abuse (DVA) has a significant risk associated with development of atopic disease in women, according to recent findings, aligning with prior observational data.¹

These findings resulted from research into trauma responses and their connection with atopic disease. Prior studies have indicated that those experiencing trauma exhibit TH1 to TH2 cell shifts that raise IgE levels, and the investigators into this new study note that this could affect atopic disease.²

The research was authored by Joht Singh Chandan, PhD, from the College of Medical and Dental Sciences’ Institute of Applied Health Research at the University of Birmingham in the United Kingdom.

“Further understanding of this association and awareness of the health impacts of DVA in women will enable evidence-based implementation of public health policies to prevent the subsequent development of atopic diseases in those who have been exposed to DVA,” Chandan and colleagues wrote.

Background and Findings

The investigators conducted a population-based, retrospective cohort study and used the IMRD database, a large UK primary care database known to represent the country's demographic structure and commonly seen comorbidities.

The research team sought to investigate the association between domestic violence and the risk of developing atopic diseases. The team’s study period spanned from January 1, 1995, to September 30, 2019, with data gathered from 808 participating general practices.

Read codes were used by the investigators to identify patients and record their clinical information, and standardized mortality ratios were employed by the team to assess acceptable mortality recording dates. They noted that participants with pre-existing atopic diseases were excluded from the research, and both exposed and unexposed cohorts were matched based on age and Townsend deprivation quintile.

Cox regression analysis was conducted to calculate hazard ratios, adjusted for relevant covariates, with the research team defining atopy by a diagnosis of asthma, atopic eczema, or allergic rhinoconjunctivitis. Sensitivity analyses were also performed, including incident cases exclusively and incorporating ethnicity as a covariate.

During the investigators’ study period, the cohort found to have been exposed to domestic violence and abuse was shown to have a higher incidence of atopic disease among the women, with an adjusted hazard ratio of 1.52 (95% CI, 1.41 - 1.64) after accounting for potential confounding variables.

The team’s reported link was particularly notable for asthma (aHR = 1.69; 95% CI, 1.44 - 1.99) and allergic rhinoconjunctivitis (aHR = 1.63; 95% CI, 1.45 - 1.84) versus the link with atopic eczema (aHR = 1.40; 95% CI, 1.26 - 1.56).

The investigators added that their restricting of the analysis to incident-only women led to similar findings, with exposed women having a higher risk of atopic disease (aHR = 1.18; 95% CI, 1.00 - 1.40) and showing a stronger association with asthma (aHR = 1.57; 95% CI, 1.12 - 2.19).

Additionally, the investigators noted that when ethnicity was included as one of their covariates, the results remained consistent with the primary analysis, a fact which reinforces the robustness of their study’s findings.

Overall, the research team concluded that the women in their study who had recorded exposure to domestic violence and abuse ended up with a 52% higher risk for developing atopic disease compared to those who were unexposed.

“Therefore, implementation of systematic public health measures, adopting the consideration of DVA in clinical interactions with patients who present with ill health, and encouragement of measures to prevent DVA…are urgently needed,” they wrote.

References

1. ^{Nash K, Minhas S, Metheny N, Nirantharakumar K, Adderley NJ, Chandan JS. Exposure to Domestic Abuse and the Subsequent Development of Atopic Disease in Women. J Allergy Clin Immunol Pract. Published May 5, 2023. doi: https://doi.org/10.1016/j.jaip.2023.03.016.}
2. ^{Wright RJ, Cohen RT, Cohen S. The impact of stress on the development and expression of atopy. Curr Opin Allergy Clin Immunol. 2005; 5: 23-29.}