With the burden of disease great from atopic disease—asthma, allergic rhinoconjunctivitis, and atopic eczema—the investigators of a new study stress the importance of including domestic violence and abuse (DVA) as risk factors in public health strategy, based on previous research and their new findings.
“Previous studies demonstrated that exposure to domestic violence and abuse is associated with a heightened risk for atopy, which could be explained by an increased allostatic load,” they wrote in The Journal of Allergy and Clinical Immunology: In Practice. “These studies are limited by a cross-sectional design, small sample size, and recall bias.”1
Their population-based retrospective analysis investigated outcomes among 2 cohorts of women matched by age and deprivation quintile: 13,852 exposed to DVA (mean [SD] age, 37.20 [12.56] years) and 49,036 not exposed to DVA (mean age, 36.78 [12.32] years). The data on these women—with no history of atopic disease between January 1, 1995, and September 30, 2019—came from the United Kingdom’s anonymized IQVIA Medical Research Data dataset.
The incidence rate of atopic disease development was 33.6% higher among the women exposed to DVA compared with those not exposed: 20.10 per 1000 person-years (n = 967 women) vs 13.24 per 1000 person-years (n = 2607 women). Overall, this represented a 52% (HR, 1.52; 95% CI, 1.41-1.64) increased risk of atopic disease development for the women exposed to DVA.
This risk remained high when each of the 3 atopic diseases previously mentioned was considered for its individual potential to develop in women exposed to DVA (P < .001 for all):
- Asthma had the highest risk of development at 69% (HR, 1.69; 95% CI, 1.44-1.99)
- Allergic rhinoconjunctivitis had a 63% (HR, 1.63; 95% CI, 1.45-1.84) greater risk of developing
- Eczema had a 40% (HR, 1.40; 95% CI, 1.26-1.56) greater risk of developing
According to the study authors, 25% of women in the United Kingdom could be affected by DVA at some point in their lifetime,2 and for those 16 years and older, exposure to DVA is twice as likely in women vs men.3 For the present analysis, the women who participated could enter (the index date) and leave (the exit date) at different time points. Study entrance was date of the first read clinical code (this identified their exposure to DVA) or their eligibility date for the study if not exposed to DVA, and study exit was the earliest of death, patient left their practice, last data collection from the patient’s practice, study end date, or an atopic disease was diagnosed in the patient.
Most patients in each cohort were not smokers, at 53.93% in the exposed cohort and 72.93% in the unexposed cohort, and according to the Townsend deprivation quintile (1, least deprived; 5, most deprived), most lived in an area designated a 3 (16.85% of the exposed cohort and 17.04% of the unexposed cohort), a 4 (21.66% and 21.74%, respectively), or a 5 (22.66% and 22.08%, respectively).
Restricting their analysis to women exposed to DVA just during the study period, the authors continued to see higher risks among these women. Their overall risk for all atopic disease was 18% higher (HR, 1.18; 95% CI, 1.00-1.40; P = .052), and breaking it down by disease saw a 57% greater risk of asthma (HR, 1.57; 95% CI, 1.12-2.19; P = .009), a 5% greater risk of atopic eczema (HR, 1.05; 95% CI, 0.82-1.35; P = .693), and a 23% greater risk of allergic rhinoconjunctivitis (HR, 1.23; 95% CI, 0.93-1.62; P = .142).
Underscoring the strength of their findings, the study authors said that their analysis is the first to attempt to explore the relationship between DVA and several atopic diseases using a longitudinal study design, and that their findings support both existing evidence (for developing asthma) and new evidence (for developing atopic eczema and allergic rhinoconjunctivitis).
Principal limitations are the possibility of unrecorded or unsuspected cases of DVA and patients classified as victims of DVA actually being the perpetrators of DVA.
“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 in wider society by public health professionals and its devastating downstream consequences are urgently needed,” they concluded.
1. Nash K, Minhas S, Metheny N, et al. Exposure to domestic abuse and the subsequent development of atopic disease in women. J Allergy Clin Immunol Pract. 2023;11(6):1752-1756.e3. doi:10.1016/j.jaip.2023.03.016
2. Crime in England and Wales: Year ending September 2019. Office for National Statistics. January 23, 2020. Accessed July 26, 2023. https://tinyurl.com/ykeuyjhz
3. Intimate personal violence and partner abuse. Office for National Statistics. February 11, 2016. Accessed July 26, 2023. https://tinyurl.com/5n87dxk9