Yue Wang and Unnur Valdimarsdottir
Introduction Childhood maltreatment (CM) has been indicated in adverse health outcomes across the lifespan, including severe infection-related outcomes. Yet, data are scarce on the potential role of CM in severe COVID-19-related outcomes as well as on mechanisms underlying this association.
Methods We included 151,427 individuals in the UK Biobank who responded to questions on the history of CM and were alive on January 31st, 2020. Binomial logistic regression models were performed to estimate the association between a history of CM and severe COVID-19 outcomes, as well as COVID-19 diagnosis and vaccination as secondary outcomes.
Results We found the number of CM types was associated with the risk of severe COVID-19 outcomes in a graded manner (p for trend < 0.01). Compared to individuals with no history of CM, individuals exposed to any CM were associated with a higher risk of severe COVID-19 outcomes (Odds Ratio [OR]=1.54 [95%CI 1.31-1.81]). Largely comparable risk patterns were observed across groups of high vs. low genetic risks for severe COVID-19 outcomes (p for difference > 0.05). Mediation analysis revealed that 50.9% of the association between CM and severe COVID-19 outcomes was explained by suboptimal socioeconomic status, lifestyle, and pre-pandemic diagnosis of psychiatric disorders or other chronic medical conditions. In contrast, any CM exposure was only weakly associated with COVID-19 diagnosis while significantly associated with not being vaccinated for COVID-19.
Conclusions Our data suggest that childhood maltreatment is robustly associated with severe COVID-19 outcomes partly through the identified pre-pandemic vulnerability factors.
