Background Adverse childhood experiences (ACEs) have been linked to poorer adult health outcomes. ACEs may be a risk factor for heightened disease activity among Black American women living with systemic lupus erythematosus (SLE), who experience worse outcomes compared to their White counterparts. However, there is a paucity of research on the role of ACEs in the pathogenesis of SLE, and in particular, mechanisms through which childhood adversity may impact disease activity. This study sought to examine if ACEs (e.g., physical/sexual abuse, household incarceration, etc.) and other traumas experienced in the lifecourse are associated with disease activity among Black American women living with SLE.

Methods Participants were from the Black Women’s Experiences Living with Lupus (BeWELL) Study, which recruited Black women (n=418) with a validated diagnosis of SLE living in metropolitan Atlanta, GA, USA, largely from a population-based registry. Multivariable cross-sectional regression models were specified examining patient-reported disease activity, measured using the Systemic Lupus Activity Questionnaire (SLAQ), in relation to the ACE Questionnaire and the Trauma History Screen.

Results Controlling for sociodemographic and health-related covariates, ACE score was significantly associated with disease activity (β=1.52, SE=0.35, p<.001). Trauma was found to mediate this relationship (Sobel test z=4.77, p<.001). In the final model, the association between ACE and SLAQ was attenuated and not significant (β=0.72, SE=0.38, p=.06). Additional analyses restricting items to trauma specifically in adulthood resulted in substantively similar conclusions.

Conclusions Consistent with the stress proliferation theory, results suggest that childhood adversity increases the risk of traumas experienced in later developmental periods, including in adulthood. Adversities experienced at various developmental periods across the lifecourse increase SLE severity among Black American women, and may contribute to racial inequities in SLE outcomes. Importantly, findings suggest that the impact of childhood adversity on adult disease activity may be reversible through interventions aimed at preventing subsequent traumas.