P2362 - Higher Household Dysfunction in Adverse Childhood Experiences Score & Low Household Income Associate With Increased Risk of Cirrhosis in Adulthood

Kaia C. Miller, BA¹, Alice Parish, MSPH¹, Donna Niedzwiecki, PhD², Melissa A. Troester, PhD³, Joellen M. Schildkraut, PhD, MPH⁴, Andrew J. Muir, MD, MHS², Cathrine Hoyo, PhD⁵, Cynthia A. Moylan, MD, MHS, MS^1
1Duke University, Durham, NC; ²Duke University School of Medicine, Durham, NC; ³University of North Carolina Chapel Hill, Chapel Hill, NC; ⁴Emory University, Atlanta, GA; ⁵North Carolina State University, Raleigh, NC

Introduction: Adverse childhood experiences (ACEs) have been linked to development of chronic liver disease later in life. This link was driven by increased risk behaviors for viral and alcoholic liver disease (ALD). With the rise of non-alcoholic steatohepatitis (NASH) and its different underlying risks, we aimed to update characterizations of he association between ACEs and cirrhosis.

Methods: We conducted a cross-sectional analysis of participants (pts) enrolled in the Southern Liver Health Study, a multi-site study investigating associations between environmental exposures and liver cancer. We included two cohorts of pts: diagnosis of cirrhosis and healthy controls aged 40-75 years enrolled from 1/1/2022–1/31/2023. History of ACEs was collected via a validated survey with scores ranging from 0-8. Demographic data was obtained for all pts and chart review of cirrhosis pts enrolled at Duke was performed for additional medical history. We used adjusted multivariable logistic regression models to test the association between ACEs and cirrhosis.

Results: 461 pts were included in the final analyses (cirrhosis, n=187; control, n=274). More pts with cirrhosis were older (median: 61 vs. 58.5 yrs), male (46% vs. 28%), and non-Hispanic White (79% vs. 61%) (Table 1). Both cohorts reported a median of 1 ACE while more cirrhosis pts reported ≥4 ACEs than controls (20% vs. 15%). NASH was the most common etiology of cirrhosis (49%). Cirrhosis significantly associated with history of ≥1 ACE in the household dysfunction domain but not with total ACE score or history of ACEs in the childhood abuse domain. There was a significant interaction between number of ACEs and household income (HHI) on the odds of cirrhosis, such that in pts with a HHI of < $50,000/yr, pts with ≥4 ACEs had 3 times the odds of cirrhosis than pts with 0-3 ACEs.

Discussion: Reporting ≥1 ACE related to household dysfunction associated with 78% higher odds of cirrhosis in adulthood. High total ACE score and low HHI also significantly associated with cirrhosis. While we did not find an association between total ACE score and cirrhosis, we found that certain ACEs impacted risk for cirrhosis more than others. Income and other household factors also likely play a role. The high prevalence of NASH cirrhosis and different risk behaviors may explain these findings, but larger studies are needed. Future efforts should focus on how ACEs differently impact cirrhosis risk by etiology in order to develop preventative strategies.


Disclosures:


Kaia C. Miller, BA¹, Alice Parish, MSPH¹, Donna Niedzwiecki, PhD², Melissa A. Troester, PhD³, Joellen M. Schildkraut, PhD, MPH⁴, Andrew J. Muir, MD, MHS², Cathrine Hoyo, PhD⁵, Cynthia A. Moylan, MD, MHS, MS¹. P2362 - Higher Household Dysfunction in Adverse Childhood Experiences Score & Low Household Income Associate With Increased Risk of Cirrhosis in Adulthood, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.