Supplementary information files for The relationship of childhood adversity with diurnal cortisol patterns and C-reactive protein at 60-64 years of age in the 1946 National Survey of Health and Development

Supplementary files for article The relationship of childhood adversity with diurnal cortisol patterns and C-reactive protein at 60-64 years of age in the 1946 National Survey of Health and Development.BackgroundEarly life adversity is increasingly prevalent and associated with greater morbidity and mortality. It is hypothesised that the link between psychosocial early life adversity and poor health in adulthood is due to abnormal hypothalamic-pituitary-adrenal (HPA) axis functioning (often measured as cortisol patterning) and inflammation (often measured via c-reactive protein (CRP)). This study aimed to investigate the relationship between early life psychosocial adversity and cortisol patterning and CRP at 60-64 years of age.MethodsThe MRC National Survey of Health and Development (NSHD) was used. The analytic “cortisol sample” included 843 individuals and the “CRP sample” included 1,150 individuals. Data on adversity experienced between ages 0-15 years were utilised to compose a cumulative childhood psychosocial early life adversity (ELA) score (0, 1, 2, 3+). CRP and salivary cortisol (waking, 30 min after waking, and evening) were collected at 60-64 years. Associations between the psychosocial ELA score and cortisol outcomes (cortisol awakening response (CAR), diurnal slope (DS), and evening and morning cortisol) were assessed using general linear regression. Tobit regression was used to assess the association between psychosocial ELA score and CRP. Adjustments were made for age at follow-up, sex, childhood maternal education, childhood paternal social class, childhood housing tenure, and birth weight. After testing for sex by ELA score interactions, analyses were repeated stratified by sex for the CRP sample.ResultsIn fully adjusted models, individuals who experienced the highest level of childhood psychosocial adversity (3+) had a 24.63 (-41.49, -7.76) % lower waking cortisol and a 7.30 (1.49, 13.12) % lower decline in cortisol across the day compared to those with a psychosocial ELA score of zero. In females, the highest level of childhood psychosocial adversity, compared to the lowest, was associated with 32.61 (2.98, 62.25) % higher CRP at 60-64 years, which attenuated to 20.38 % (-9.38, 50.14) upon adjustment for measures of early life socioeconomic position. Conversely, the association between childhood psychosocial adversity and CRP in males was null.ConclusionsOur results suggest that high-levels of psychosocial adversity in childhood might result in a lower morning cortisol and flatter DS in mid-to-late-adulthood. The finding that adversity was related to higher CRP in females but not males requires replication and further investigation.

本数据集为《1946年全国健康与发展调查》中《儿童期逆境与60~64岁人群日间皮质醇模式及C反应蛋白水平的关联》一文的补充资料。
背景：早期生活逆境（early life adversity, ELA）的患病率日益升高，且与更高的发病及死亡风险相关。现有假说认为，心理社会性早期生活逆境与成年期健康不良之间的关联，源于下丘脑-垂体-肾上腺（hypothalamic-pituitary-adrenal, HPA）轴功能异常（通常以皮质醇模式作为评估指标）及炎症反应异常（通常通过C反应蛋白（C-reactive protein, CRP）进行检测）。本研究旨在探讨早期心理社会性逆境与60~64岁人群皮质醇模式及CRP水平之间的关联。
方法：本研究采用英国医学研究理事会（Medical Research Council, MRC）1946年全国健康与发展调查（National Survey of Health and Development, NSHD）的数据。分析所用的“皮质醇样本”纳入843名个体，“CRP样本”纳入1150名个体。研究利用研究对象0~15岁期间经历的逆境数据，构建了累积性儿童期心理社会性早期生活逆境（ELA）评分（分值划分为0、1、2及≥3四个等级）。在研究对象60~64岁时，采集其唾液皮质醇样本（觉醒时、觉醒后30分钟及晚间）与CRP水平。采用一般线性回归分析，评估心理社会性ELA评分与皮质醇结局指标（皮质醇觉醒反应（cortisol awakening response, CAR）、日间斜率（diurnal slope, DS）以及晚间与晨间皮质醇水平）之间的关联。采用Tobit回归分析，评估心理社会性ELA评分与CRP水平之间的关联。协变量调整包括随访时年龄、性别、童年期母亲受教育程度、童年期父亲社会阶层、童年期住房保有状况以及出生体重。在检验性别与ELA评分的交互作用后，针对CRP样本按性别分层重复开展分析。
结果：在完全校正模型中，与ELA评分为0的研究对象相比，儿童期经历最高水平心理社会性逆境（≥3分）的人群，其晨间觉醒皮质醇水平降低24.63%（95%置信区间：-41.49, -7.76），日间皮质醇下降幅度减少7.30%（95%置信区间：1.49, 13.12）。在女性群体中，与ELA评分最低的人群相比，儿童期经历最高水平心理社会性逆境的人群，其60~64岁时的CRP水平升高32.61%（95%置信区间：2.98, 62.25）；在校正早期社会经济地位相关指标后，该关联减弱至20.38%（95%置信区间：-9.38, 50.14）。与之相反，男性群体中未发现儿童期心理社会性逆境与CRP水平存在显著关联。
结论：本研究结果表明，儿童期高水平的心理社会性逆境可能导致中老年时期晨间皮质醇水平降低以及日间皮质醇斜率变平缓。女性群体中儿童期逆境与CRP水平升高相关，而男性群体中未发现该关联，这一发现有待进一步重复验证与深入研究。