The Association Between Domestic Abuse and Atopic Diseases in the United Kingdom: A Population Based Retrospective Cohort Study
Domestic abuse is estimated to affect approximately one third of women and is associated with significant harmful psychological and physical consequences. Women experiencing domestic abuse often present to in primary care, meaning general practitioners are poised to both detect and prevent the negative consequences of domestic abuse. Although cross-sectional studies have previously demonstrated an association between domestic abuse and atopy, no cohort studies have been conducted worldwide to our knowledge. We aimed to explore the association between domestic abuse and atopy using the IQVIA medical research database, a large UK primary care database. The database has been shown to be generalisable to the UK population in terms of demographics and morbidity prevalence.
A population based retrospective open cohort study was undertaken between January 1995 to September 2019. 21,093 female patients with a GP recorded exposure to DA were matched to 74,899 unexposed females; age and Townsend deprivation quintile were used as matching parameters, whilst age, Townsend deprivation quintile and smoking status were used as model covariates. Read codes used in primary care were utilised to identify unexposed and unexposed patients and extract information on patient parameters and outcomes. Outcomes of interest were defined by diagnosis of atopic disease (asthma, atopic dermatitis and allergic rhinoconjunctivitis). To compare the risk of atopy between the exposed and unexposed group, unadjusted and adjusted odds ratios (OR) for diagnosis of atopic disease at baseline and incidence rate ratios (IRR) of development of atopic disease during the study period were calculated.
At study entry, those who were exposed to DA had a higher likelihood of having atopic diagnosis (adjusted OR 1.17, 95%CI 1.13 – 1.21). During the study period, 878 women in the exposed group (incidence rate (IR) 21.3 per 1,000 person years) developed atopy compared to 2,566 in the unexposed group (IR 14.7 per 1,000 person-years) translating to an increased risk following adjustment for covariates (adjusted IRR 1.48, 95% confidence intervals 1.37 – 1.60). The highest risks was seen in the development of asthma (aIRR 1.62, 95% CI 1.40 – 1.87) and allergic rhinoconjunctivitis (aIRR 1.62, 95% CI 1.51, 1.36 - 1.67), and weakest in atopic dermatitis (aIRR 1.40, 95% CI 1.27 – 1.53). Although GP coding of atopy is anticipated to be of high quality, previous studies have demonstrated limitations in the recording of domestic abuse. Therefore, our findings may reflect an over or under-estimate of the true effect size.
Patients exposed to domestic abuse have a higher risk of developing atopic diseases, with the greatest risk seen in asthma. In order to reduce the burden of morbidity and mortality associated with domestic abuse, it is paramount to implement targeted public health policies to prevent domestic abuse and its negative downstream consequences.