Childhood adversities and rate of adulthood all-cause hospitalization in the general population: A retrospective cohort study

Abstract

Objective The study examined the association between specific childhood adversities and rate of all-cause hospitalization in adulthood in a large sample of the general population and assessed whether adult socioeconomic and health-related factors mediate those associations. Methods We used linked data available from Statistics Canada i.e., the Canadian Community Health Survey (CCHS-2005) linked to Discharge Abstract Database (DAD 2005–2017) and Canadian Vital Statistics Database (CVSD 2005–2017). CCHS-2005 measured self-reported exposure to childhood adversities, namely prolonged hospitalization, parental divorce, parental unemployment, prolonged trauma, parental substance use, physical abuse, and being sent away from home for wrongdoing, from a sample of household residents aged 18 years and above (n = 11,340). The number and causes of hospitalization were derived from linkage with DAD. Negative binomial regression was used to characterize the association between childhood adversities and the rate of hospitalization and to identify potential mediators between them. Results During the 12-year follow-up, 37,080 hospitalizations occurred among the respondents, and there were 2,030 deaths. Exposure to at least one childhood adversity and specific adversities (except parental divorce) were significantly associated with the hospitalization rate among people below 65 years. The associations (except for physical abuse) were attenuated when adjusted for one or more of the adulthood factors such as depression, restriction of activity, smoking, chronic conditions, poor perceived health, obesity, unmet health care needs, poor education, and unemployment, observations that are consistent with mediation effects. The associations were not significant among those aged 65 and above. Conclusion Childhood adversities significantly increased the rate of hospitalization in young and middle adulthood, and the effect was potentially mediated by adulthood socioeconomic status and health and health care access related factors. Health care overutilization may be reduced through primary prevention of childhood adversities and intervention on those potentially mediating pathways such as improving adulthood socioeconomic circumstances and lifestyle modifications.